2025 Cigna Dental Plan SPD – High Option

NOTE: Cigna considers one month to equal 30 days regardless of the number of days within a Calendar month. WARNING: Any person who knowingly and with intent to defraud any insurance company or other person: files an application for insurance or statement of claim containing any materially false information; or conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act.

Effective Date of Your Insurance You will become insured on the date that You elect the insurance by completing the Employer’s specified enrollment process, but no earlier than the date You become eligible. You will become insured on Your first day of eligibility, following Your election, if You are in Active Service on that date, or if You are not in Active Service on that date due to Your health status. Late Entrant You are a Late Entrant if: • You elect the insurance more than 31 days after You initially become eligible; or • You again elect it after You cancel Your payroll deduction (if required). If You are a Late Entrant: • You will not be able to enroll in the plan until the next annual enrollment period, except due to a life status change event. Dependent Insurance For Your Dependents to be insured, You will have to pay the required contribution, if any, toward the cost of Dependent Insurance. Eligibility for Dependent Insurance Your Dependent will become eligible for Dependent Insurance on the later of: • the day You meet the eligibility requirements noted above; or

HCDFB-CLM59

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Eligibility - Effective Date Eligible Class Each Employee as reported to Us by Your Employer. Eligibility for Dental Insurance You will become eligible for insurance on the day You complete the Eligibility Waiting Period, if any, and: • You are an eligible Full-Time Employee; • You normally work at least 30 hours a week; and • You pay any required contribution. If you were previously insured and your insurance ceased because you were no longer employed, you must satisfy the New Employee Group Waiting Period to become insured again unless you are rehired within 12 months and met the New Employee Group Waiting Period in your previous employment. If your insurance ceased because you were no longer employed in a Class of Eligible Employees, you are not required to satisfy the 30-day Waiting Period if you again become a member of a Class of Eligible Employees. You will become eligible for insurance on the first of the month on or after the date you become a member of a Class of Eligible Employees. Eligibility Waiting Period – New Hire Your Eligibility Waiting Period is: • First of the month on or after 30 days of Active Service. If you are a rehire and have met the applicable 30 day waiting period during your previous employment, the waiting period will be waived upon rehire and you will be eligible the first of the month on or after your rehire date if you are rehired within 12 months.

• the day You acquire Your first Dependent. Effective Date of Dependent Insurance

Insurance for Your Dependents will become effective on the date You elect it by completing the Employer’s specified enrollment process, but no earlier than the day You become eligible for Dependent Insurance. All of Your Dependents as defined will be included. Your Dependents will be insured only if You are insured. Late Entrant - Dependent You are a Late Entrant for Dependent Insurance if: • You elect that insurance more than 31 days after You initially become eligible for it; or

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