EFFECTIVE DATE AND TERMINATION EFFECTIVE DATE OF INDIVIDUAL INSURANCE: If the Policyholder pays the entire premium, the insurance up to the guaranteed issue Amount of Insurance, if applicable, for an Eligible Person will go into effect on the date stated on the Schedule of Benefits. Amounts of Insurance over the guaranteed issue Amount of Insurance shown on the Schedule of Benefits must be applied for in writing and are subject to proof of good health. Insurance will be effective on the first of the month following the date we approve such proof of good health. If you pay a part of the premium, you must apply in writing for the insurance to go into effect. You will become insured on the later of: (1) the Individual Effective Date stated on the Schedule of Benefits, if you apply on or before that date; or (2) the first of the month following the date you apply, if you apply within thirty-one (31) days from the date you first met the eligibility requirements; or (3) the first of the month following the date we approve any required proof of good health. We require proof of good health if you apply: (a) after thirty-one (31) days from the date you first become eligible; or (b) after you terminated this insurance but you remained in a class eligible for this insurance; or (c) for an Amount of Insurance greater than the guaranteed issue Amount of Insurance shown on the Schedule of Benefits, if applicable; or (d) for an Amount of Insurance greater than you were insured for under the prior group life insurance plan carrier, if applicable; or (e) after being eligible for coverage under a prior group life insurance plan for more than thirty-one (31) days but did not elect to be covered under that prior plan; or (4) the date premium is remitted. Proof of good health forms are available from us upon request. It is the Policyholder's responsibility to provide proof of good health forms to you when required. If you have been previously declined for coverage by us, had an application withdrawn or marked incomplete for any reason, or voluntarily terminated your insurance coverage with us, all future requests for coverage are subject to submission and our approval of proof of good health. However, proof of good health will not be required if after you voluntarily terminated your insurance coverage with us you make a future request due to a life event change or during any approved enrollment period. Changes in your Amount of Insurance are effective as shown on the Schedule of Benefits. If you are not Actively at Work on the day your insurance is to go into effect, the insurance will go into effect on the day you return to Active Work in an Eligible Class for one full day. TERMINATION OF INSURANCE: Your insurance will terminate on the first of the following to occur: (1) the date the Policy terminates; or (2) the date you cease to be in a class eligible for this insurance; or (3) the end of the period for which premium has been paid for you; or (4) the date you enter military service on active duty (not including Reserve or National Guard). LRS-6423-4 Ed. 04/16 Page 5.0