TABLE OF CONTENTS Section Page CERTIFICATE FACE PAGE .............................................................................................................................. 1 NOTICES ......................................................................................................................................................... 17 SCHEDULE OF BENEFITS ............................................................................................................................. 19 DEFINITIONS .................................................................................................................................................. 21 ELIGIBILITY PROVISIONS: INSURANCE FOR YOU ..................................................................................... 23 PEBB Eligible ............................................................................................................................................... 23 Date You Are Eligible for Insurance ............................................................................................................. 23 Enrollment Process ...................................................................................................................................... 23 Date Your Insurance Takes Effect ............................................................................................................... 23 Date Insurance Ends .................................................................................................................................... 24 LIFE INSURANCE: FOR YOU ......................................................................................................................... 25 LIFE INSURANCE: CONVERSION OPTION FOR YOU ................................................................................. 26 FILING A CLAIM: CLAIMS FOR LIFE INSURANCE BENEFITS .................................................................... 28 GENERAL PROVISIONS ................................................................................................................................. 29 Assignment ................................................................................................................................................... 29 Beneficiary .................................................................................................................................................... 29 Entire Contract .............................................................................................................................................. 29 Incontestability: Statements Made by You ................................................................................................... 29 Misstatement of Age ..................................................................................................................................... 30 Conformity with Law ..................................................................................................................................... 30 GCERT2024-WSHCA-WA-LIFE-RETIREE1 18