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^ D. Optional Maternity Benefits <br />Prudential will pay 100% of eligible charges up to specified limits for females covered for maternity <br />benefits. The maximum for pregnancy terminated by normal delivery is 5 <br />^ E. Limited Medical Expense Benefit <br />Different benefits are provided when a covered person becomes eligible because of age for Medicare <br />Part A benefits. The benefits are designed to avoid duplication and to help pay certain charges <br />Medicare does not cover. <br />^ F. Dental Expense Insurance <br />After a covered person has satisfied aone-time 575 Basic Services deductible, Prudential will pay at <br />least 70% of eligible charges for Basic dental services; the percentage may be gradually increased to <br />100% by the fourth year of coverage if certain requirements for preventive dental care are met each <br />year. Prudential will also pay 50% of eligible charges for Major dental services after a covered person <br />satisfies a 575 Major Services deductible per benefit year. <br />There is a combined "Basic plus Major" benefit year limit of S 1,200 per individual. <br />^ 2. EMPLOYEE TERM LIFE INSURANCE <br />S is payable to your beneficiary in the event of your death from any cause. <br />^ 3. EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT <br />INSURANCE <br />S AD & D insurance is payable for your accidental loss of life or for other losses as <br />described in benefit details on inside pages. <br />^ Coverage is 24-hour, for on-job and off-job accidents. ^ Off-job only. <br />^ 4. DEPENDENT TERM LIFE INSURANCE <br />5 life insurance for your covered dependent spouse is payable to you in the event of your <br />spouse's death from any cause. <br />51,000 life insurance for your covered dependent child 5 years or older is payable to you in the event of <br />your child's death from any cause. (Amount may be lower for younger children.) <br />^ 5. WEEKLY DISABILITY INCOME BENEFIT <br />S weekly benefit will be paid for a maximum period of weeks. Benefits will start on <br />the day that you are unable to work due to accident, or the 8th day that you are unable to work <br />due to sickness. <br />Total employee contributions For employee only 5 <br />for full benefits described For employee and dependents 5 <br />Note: For details of benefits, see following pages. <br />Some benefits in this booklet may vary in some states. If there are variations <br />in your state, they will be described on the outside back cover. <br />3 <br />