Group Critical Illness Insurance Certificate

If the Spouse is eligible for coverage, and the Employee applies for coverage and agrees to make required contributions within 31 days after the date the Spouse becomes eligible and, subject to the Deferred Effective Date Provisions section below, coverage becomes effective on the later of: 1. the effective date of this Policy; 2. the date the Employee becomes eligible; 3. the date the Employee’s coverage becomes effective; 4. the date the dependent meets the definition of Spouse as applicable; 5. the first of the month following the date We or the Employer receive the completed enrollment form. For all Dependent Child coverage, Evidence of Insurability is not required. If the Dependent Child is eligible for coverage, and the Employee applies for coverage and agrees to make required contributions within 31 days after the date the Dependent Child becomes eligible and, subject to the Deferred Effective Date Provisions section below, coverage becomes effective on the later of: 1. the effective date of this Policy; 2. the date the Employee becomes eligible; 3. the date the Employee’s coverage becomes effective; 4. the date the dependent meets the definition of Dependent Child as applicable; 5. the first of the month following the date We or the Employer receive the completed enrollment form for Dependent Child coverage. If coverage for a Dependent Child is in force and another Dependent Child becomes eligible, coverage for that child is effective on the date the child qualifies as a Dependent Child. Effective Date of Certain Changes Any increase or decrease in the amount of coverage for the Covered Person resulting from: 1. a change in benefits provided by this Policy; or 2. a change in the Employee’s Covered Class, will take effect on the date of such change and not result in any change in Age for Premium purposes. Increases will take The effective date of coverage will be deferred for any Employee or any eligible Spouse or Dependent Child who is not in Active Service on the date coverage would otherwise become effective. Coverage will become effective on the later of the date He returns to Active Service, or the date coverage would otherwise have become effective. INDIVIDUAL ENROLLMENT EVENTS Life Status Change A Life Status Change is an event that the Employer has determined qualifies an Employee to apply for coverage or to increase coverage on Himself, His Spouse or Dependent Child due to a Life Status Change under this Policy. Life Status Changes that qualify an Employee to apply or increase coverage for Himself include: 1. marriage; 2. loss of a Spouse; whether by death, divorce, annulment or legal separation; 3. birth or adoption of a child, or acquiring a child through marriage; 4. a change in the group benefit plan available to the Employee’s Spouse; 5. a change in the Employee’s employment status that affects eligibility for group benefits for either the Employee or His Spouse; 6. termination of a Spouse’s employment; and 7. an event as specified in the Employer’s Plan which this Policy insures. Life Status Changes that qualify an Employee to apply or increase coverage for His eligible Spouse and Dependent Child include: 1. marriage; effect subject to any Active Service requirement. DEFERRED EFFECTIVE DATE PROVISIONS Not in Active Service

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