SCHEDULE OF BENEFITS - nib

Item No Benefit Item No Benefit Item No Benefit Item No Benefit
38427 $1,505.95 38505 $365.55 38709 $2,814.45 39128 $945.35
38430 $776.10 38506 $2,144.40 38712 $3,379.65 39130 $965.70
38436 $317.80 38507 $2,517.45 38715 $2,249.80 39131 $183.05
38438 $1,949.50 38508 $3,149.75 38718 $2,814.45 39133 $228.35
38440 $1,459.85 38509 $3,149.75 38721 $1,972.25 39134 $487.85
38441 $2,309.85 38512 $2,767.10 38724 $2,814.45 39135 $228.35
38446 $1,505.95 38515 $3,523.50 38727 $1,972.25 39136 $228.35
38447 $1,949.50 38518 $3,782.00 38730 $2,814.45 39137 $867.10
38448 $461.95 38550 $2,829.80 38733 $1,972.25 39138 $965.70
38449 $2,727.25 38553 $3,586.10 38736 $2,814.45 39139 $1,296.45
38450 $1,090.10 38556 $4,093.65 38739 $2,537.00 39140 $419.45
38452 $730.00 38559 $3,337.20 38742 $2,537.00 39300 $506.10
38453 $2,189.85 38562 $4,093.65 38745 $2,814.45 39303 $667.65
38455 $2,962.05 38565 $4,591.50 38748 $2,814.45 39306 $969.50
38456 $1,949.50 38568 $2,456.35 38751 $2,814.45 39309 $1,023.25
38457 $1,820.05 38571 $2,705.30 38754 $3,523.10 39312 $570.90
38458 $970.15 38572 $2,620.00 38757 $2,814.45 39315 $1,475.75
38460 $350.40 38577 $731.20 38760 $2,814.45 39318 $915.60
38462 $415.35 38588 $548.60 38763 $2,814.45 39321 $678.45
38464 $451.45 38600 $2,020.00 38766 $2,814.45 39323 $396.45
38466 $1,219.05 38603 $1,263.70 38800 $48.80 39324 $396.45
38468 $1,878.45 38609 $631.75 38803 $97.40 39327 $678.60
38469 $2,189.85 38612 $708.15 38806 $169.30 39330 $396.45
38470 $1,216.20 38613 $888.80 38809 $208.60 39331 $396.45
38473 $728.00 38615 $2,020.00 38812 $265.15 39333 $570.90
38475 $1,096.70 38618 $2,517.90 39000 $107.85 39500 $1,820.50
38477 $2,641.50 38621 $1,005.20 39003 $122.65 39503 $1,367.95
38478 $1,279.55 38624 $1,129.50 39006 $228.35 39600 $678.45
38480 $2,641.50 38627 $882.85 39009 $85.00 39603 $1,712.75
38481 $3,007.15 38637 $731.20 39012 $340.35 39606 $1,141.80
38483 $2,269.10 38640 $1,263.70 39013 $156.30 39609 $1,367.95
38485 $1,077.40 38643 $1,407.40 39015 $538.55 39612 $1,604.95
38487 $2,269.10 38647 $2,814.45 39018 $538.55 39615 $1,712.75
38488 $2,517.90 38650 $2,517.90 39100 $340.35 39640 $4,342.60
38489 $2,994.50 38653 $2,517.90 39106 $1,702.05 39642 $4,565.50
38490 $731.20 38654 $1,614.65 39109 $635.55 39646 $5,233.60
38493 $2,581.20 38656 $1,263.70 39112 $2,208.10 39650 $3,785.85
38496 $822.70 38670 $2,517.35 39115 $107.85 39653 $6,737.00
38497 $2,700.15 38673 $2,833.35 39118 $426.60 39654 $4,899.65
38498 $2,700.15 38677 $2,650.70 39121 $904.90 39656 $3,674.60
38500 $2,901.15 38680 $3,144.10 39124 $2,315.95 39658 $4,342.60
38501 $2,901.15 38700 $1,407.40 39125 $426.90 39660 $4,342.60
38503 $3,149.95 38703 $2,537.00 39126 $518.40 39662 $4,342.60
38504 $3,149.95 38706 $2,402.90 39127 $678.45 39700 $797.25
38427 to 39700
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