LIFE INSURANCE: CONVERSION OPTION FOR YOUR DEPENDENTS If life insurance for a Dependent ends or is reduced for any of the reasons stated below, You or that Dependent will have the option to buy from Us an individual policy of life insurance on the life of the Dependent (“new policy”) during the Application Period in accordance with the conditions and requirements of this section. This is referred to as “the option to convert”. Evidence of the Dependent’s insurability will not be required. When You or a Dependent Will Have the Option to Convert You will have the option to convert life insurance for a Dependent when: A. life insurance for the Dependent ends because:  You cease to be eligible for PEBB benefits;  Your employment ends;  this Group Policy ends, provided You have been insured for life insurance for the Dependent for at least 5 continuous years; or  this Group Policy is amended to end all life insurance for Dependents for an eligible class of which You are a member, provided You have been insured for life insurance for the Dependent for at least 5 continuous years; or B. life insurance for the Dependent is reduced due to an amendment of this Group Policy. A Dependent will have the option to convert when:  life insurance for such Dependent ends because that Dependent ceases to qualify as a Dependent as defined in this certificate, or  You die. If You opt not to convert a reduction in the amount of life insurance for a Dependent, You will not have the option to convert that amount at a later date. A reduction in the amount of life insurance for a Dependent as a result of the payment of an accelerated benefit will not give rise to a right to convert under this section. You must notify Us in the event that a Dependent ceases to qualify as a Dependent as defined in this certificate. Application Period If You or a Dependent opt to convert as stated above, We must receive a completed conversion application form within 60 days of the date Life Insurance for the Dependent ends or is reduced. Option Conditions The option to convert is subject to the following: A. Our receipt within the Application Period of:  a Written application for the new policy for the Dependent; and  the premium due for such new policy; B. the premium rates for the new policy will be based on:  Our rates then in use;  the form and amount of insurance which is applied for;  the Dependent’s class of risk; and GCERT2024-WSHCA-WA-LIFE-EMPLOYEE1 69