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TABLE OF CONTENTS SECTION BENEFIT HIGHLIGHTS 1 DEFINITIONS 2 ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF EMPLOYEE INSURANCE 3 ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF SPOUSE INSURANCE 4 ELIGIBILITY, EFFECTIVE DATES AND TERMINATION OF DEPENDENT CHILDREN 5 INSURANCE COVERED ACCIDENTBENEFITS 6 EXCLUSIONS 7 CLAIM PROVISIONS 8 INSURANCE CONTINUATION 9 PORTABILITY 10 GENERAL PROVISIONS 11 16-AC-C-01 Page3

Accident cert - Page 3 Accident cert Page 2 Page 4