GC 2510.1 TABLE OF CONTENTS TABLE OF CONTENTS (Continued) Dependent Insurance 20 Eligibility 20A Individual Effective Date--Non-Contributory Insurance (Basic) 20B Changes in Insurance Coverage 20C Waiver of Premium 20D Individual Terminations 20E Conversion Privilege 20F Dependent Spouse Accelerated Life Benefit 20H Payment of Death Benefits 20J General Policy Provisions 21

Certificate of Insurance: Class 3 - Page 3 Certificate of Insurance: Class 3 Page 2 Page 4