ELIGIBILITY PROVISIONS: DEPENDENT LIFE AND DEPENDENT AD&D INSURANCE ELIGIBLE FOR PEBB BENEFITS: DEPENDENT INSURANCE 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 DEPENDENT LIFE AND DEPENDENT AD&D INSURANCE You may only become eligible for the Dependent 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 to enroll or to elect Dependent insurance on the later of: 1. January 1, 2024; or 2. the date You obtain a Dependent. If You become eligible for PEBB benefits after January 1, 2024, You will be eligible for Dependent insurance on the later of: 1. the date You become eligible for PEBB benefits; or 2. the date You obtain a Dependent. ENROLLMENT PROCESS In order to enroll for Life Insurance for Your Dependents, You must either (a) already be enrolled for Supplemental Life Insurance for You or (b) enroll at the same time for Supplemental Life Insurance for You. If You become eligible for Dependent insurance, You may enroll for such insurance by providing Us with the information We require for each Dependent to be insured. In addition, each of Your Dependents must give evidence of insurability satisfactory to Us at Your expense if required to do so under the section entitled EVIDENCE OF INSURABILITY. Once You have enrolled one Child for a Dependent insurance benefit, each succeeding Child will automatically be covered for such insurance on the date that Child becomes eligible as defined in this certificate. GCERT2024-WSHCA-WA-LIFE-EMPLOYEE1 48