ELIGIBILITY PROVISIONS: INSURANCE FOR YOU ELIGIBLE FOR PEBB BENEFITS All Actively at Work employees of an Employing Agency, except for employees of an Employer Group that do not contract with the Policyholder for the insurance benefits described in this certificate. Totally Disabled Patrolmen, Disability Leave Patrolmen and Disability Status Patrolmen deemed disabled in the line of duty by the Chief of Washington State Patrol (WSP); Actively at Work requirements do not apply to Totally Disabled Patrolmen, Disability Leave Patrolmen and Disability Status Patrolmen. DATE YOU ARE ELIGIBLE FOR INSURANCE You may only become eligible for the insurance available for Your eligible class as shown in the SCHEDULE OF BENEFITS. If You are eligible for PEBB benefits on January 1, 2024, You will be eligible for the insurance described in this certificate on that date. If You become eligible for PEBB benefits after January 1, 2024, You will be eligible for the insurance described in this certificate on the date You become eligible for PEBB benefits. Previous Employment With The Employing Agency If You were employed by an Employing Agency and insured by Us under a policy of group life insurance when Your employment ended, You will not be eligible for life insurance under this Group Policy if You are re-hired by the Employing Agency within 2 years after such employment ended, unless You surrender:  any individual policy of life insurance to which You converted when Your employment ended; and  any certificate of insurance continued as ported insurance when such employment ended. The cash value, if any, of such surrendered insurance will be paid to You. ENROLLMENT PROCESS You are automatically enrolled for Employer-Paid Insurance if You become eligible for PEBB benefits. If You are eligible for Employee-Paid Life Insurance, You may enroll by completing the required form. In addition, You must give evidence of Your Insurability satisfactory to Us at Your expense if You are required to do so under the section entitled EVIDENCE OF INSURABILITY. DATE YOUR INSURANCE TAKES EFFECT Requirements for Employer-Paid Insurance: Basic Life Insurance and Basic Accidental Death and Dismemberment Insurance Employer-Paid Insurance will take effect on the first day of the month following the date You become eligible for PEBB benefits. If You become eligible for PEBB benefits on the first working day of the month, Employer- Paid Insurance will take effect on that date. Employer-Paid Insurance for Faculty hired on a quarter/semester to quarter/semester basis will take effect the first day of the month following the beginning of the second consecutive quarter/semester of half-time or more employment. If the first day of the second consecutive quarter/semester is the first working day of the month, Employer-Paid Insurance will take effect at the beginning of the second consecutive quarter/semester. GCERT2024-WSHCA-WA-LIFE-EMPLOYEE1 44