San Francisco Bay Area Rapid Transit District

1 YOUR BENEFITS A Plan Designed to Provide Security for Employees of San Francisco Bay area Rapid Transit District Class 1, 2, 3, or 4 Members Short Term Disability Coverage GH 100 GB H72252 Your benefit plan has been designed to provide financial help for you when a covered loss occurs. The plan is established through a Plan Document for the Planholder, San Francisco Bay area Rapid Transit District . The plan has been established on a noninsured basis; all liability for payment of benefits is assumed by the Planholder.

2 While Principal Life Insurance Company administers payment of claims, Principal Life Insurance Company has no liability for the funding of the benefit plan. While one of the functions of Principal Life Insurance Company is to process claims according to the plan provisions, all claims under the plan are paid by the Planholder and the Planholder owns the claim files. Therefore, the final decision on any disputed claim may involve review of these files by San Francisco Bay area Rapid Transit District . The Planholder has complete discretion to construe or interpret all provisions, to determine eligibility for benefits, and to determine the type and extent of benefits, if any, to be provided.

3 The Planholder's decisions in such matters shall be controlling, binding, and final. In any action to review any such decision by the Planholder, the Planholder shall be deemed to have exercised its discretion properly unless it is proved duly that the Planholder has acted arbitrarily and capriciously. As a covered Member of the plan, your rights and benefits are determined by the provisions of the Plan Document. This booklet briefly describes those rights and benefits. It outlines what you must do to be covered.

4 It explains how to file claims. FUTURE OF PLAN. It is expected that this plan will be continued indefinitely. However, the Planholder does have the right to change or terminate the plan at any time. PLEASE READ YOUR BOOKLET CAREFULLY. We suggest that you start with a review of the terms listed in the DEFINITIONS Section (at the back of the booklet). The meanings of these terms will help you understand the provisions of your plan. Administered by: PRINCIPAL LIFE INSURANCE COMPANY Des Moines, IA 50392-0001 GH 851 GB H72252 TABLE OF CONTENTS Page SHORT TERM DISABILITY COVERAGE SUMMARY 1 HOW TO BE COVERED Eligibility 3 Effective Dates 4 Termination, Continuation.

5 And Reinstatement 6 DESCRIPTION OF BENEFITS Benefit Qualification 8 Benefits Payable 9 Rehabilitation Services and Benefits 10 Survivor Benefit 11 Weekly Payment Limit 12 Benefit Payment Period and Recurring Disability 13 Limitations 15 CLAIM PROCEDURES 17 DEFINITIONS 22 GH 852 -1 - GB H72252 SUMMARY OF BENEFITS (effective March 1, 2017) This section highlights the benefits provided under your plan. The purpose is to give you quick access to the information you will most often want to review. Please read the other sections of this booklet for a more detailed explanation of your benefits and any limitations or restrictions that might apply.

6 SHORT TERM DISABILITY COVERAGE (Non-Occupational) Minimum Hours Requirement Employees must be working at least 30 hours a week for Class 1, 2, and 3 employees and 20 hours a week for Class 4 employees Who Pays for Coverage Class 1, 2, and 3 Members: You are not required to pay the contribution for coverage under the plan.

7 Class 4 Members: You are required to pay all of the contribution for coverage under the plan. Elimination Period A Benefit Payment Period will begin on the later of: 8th day for Disability Due to Injury; or 8th day for Disability Due to Sickness; or The date accumulated sick leave expires. Note: For pregnancy claims for Class 1 and Class 3 Members: STD benefits and sick leave paid by the Planholder may be integrated (see definition of Other Income Sources). Benefits will begin on the earlier of completion of an Elimination Period or on the first day of Hospitalization if you are Hospitalized for any Disability.

8 Primary Benefit 66 2/3% of Predisability Earnings Maximum Weekly Benefit* $1,173 Minimum Weekly Benefit $15 Maximum Benefit Payment Period 26 weeks Rehabilitation Services and Benefits Rehabilitation Services Included Predisability Intervention Services Included GH 852 -2 - GB H72252 SHORT TERM DISABILITY COVERAGE (Non-Occupational) Other Coverage Features Work Incentive Benefit Included Survivor Benefit 3 times Primary Benefit NOTE: Benefits may be reduced by other sources of income and disability earnings.

9 Some disabilities may not be covered or may be limited under this coverage. *The Maximum Weekly Benefit amount payable may change annually based on the state average weekly wage. GH 854 - 3 - GB H72252 HOW TO BE COVERED SHORT TERM DISABILITY COVERAGE Eligibility You will be eligible for coverage on the later of: a. March 1, 2017; or b. the first of the calendar month following the date you become a Member as described in this booklet. GH 855 -4 - GB H72252 HOW TO BE COVERED SHORT TERM DISABILITY COVERAGE Effective Dates Actively at Work Your effective date for Short Term Disability Coverage will be as explained in this booklet, if you are Actively at Work on that date.

10 If you are not Actively at Work on the date coverage would otherwise be effective, such coverage will not be in force until the day of return to Active Work. This Actively at Work requirement may be waived as described in Replacement of Prior Plan on page 15 of this booklet. Effective Date Unless Proof of Good Health is required, coverage for which you contribute no part of contributions will be in force on the date you are eligible. If you are to contribute a part, coverage must be requested on a form provided by the Planholder.