COVERAGE OUTLINE This section contains many of the features of your long term disability (LTD) insurance. Other provisions, including exclusions, limitations, and Deductible Income, appear in other sections. Please refer to the text of each section for full details. The Table of Contents and the Index of Defined Terms help locate sections and definitions. GENERAL POLICY INFORMATION Group Policy Number: 377661-B Policyholder: Washington State Health Care Authority Employer(s): See Definitions Group Policy Effective Date: July 1, 1992 State of Issue: Washington BECOMING INSURED To become insured you must: (a) Be a Member; and (b) Meet the requirements in Active Work Provisions and When Your Insurance Becomes Effective. You are a member if you are an employee who meets eligibility criteria established by the Policyholder, consistent with applicable state statutes, regulations and PEBB rules. Your employing agency will determine whether you are eligible for benefits upon employment or change in status. You may request eligibility information from your personnel, payroll or benefits offices, including the Member definition and any waiting period for your insurance to become effective. An employee will not cease to be a Member solely due to a reduction in workhours under the State of Washington's mandated Furlough program (from June 28, 2020, through the date the program ends or December 31, 2020, whichever is later as directed by the Washington State Health Care Authority.) Evidence of Insurability requirements and decisions to approve or decline satisfactory Evidence of Insurability are made by Standard Insurance Company. Definition of Member for: Employer-Paid State agency employees eligible for PEBB benefits and employer group Insurance and employees as described in the employer group’s contract with the Health Employee-Paid LTD Care Authority, with the exception of the following employees who are Insurance eligible for Employer-Paid Insurance only: • Seasonal employees who work a season of less than 9 months months • Port Commissioners Retirement Members enrolled in Employee-Paid LTD Insurance and not eligible to be Supplement covered under the higher education retirement plan. Higher Education Retirement Plan Members enrolled in Employee-Paid LTD Insurance and eligible to be Contribution Benefit covered under the higher education retirement plan. Persons not eligible for Persons not eligible for an Employer contribution under the policy any plan established by the Public Employees Benefits Board Program. Evidence Of Insurability Required for: 377661-B - 1 - 6/29/2022