DEPENDENT LIFE INSURANCE Nothing in this section will change or affect any of the terms of the Policy other than as specifically set out in this section. All the Policy provisions not in conflict with these provisions shall apply to this section. When an insured Dependent dies, we will pay the applicable benefit shown on the Schedule of Benefits to you. If you are deceased, then the benefit will be paid to your beneficiary. Only dependents who meet the definition of Dependents can be insured for this benefit. A person may not have coverage both as an Insured and as an insured Dependent. Only one eligible spouse may cover the eligible children as Insured Dependents. The spouse may be covered as a dependent if not covered as an Insured. EFFECTIVE DATE OF DEPENDENT INSURANCE If the Policyholder pays the entire premium, the insurance up to the guaranteed issue Amount of Insurance for Dependents will become effective on the later of: (1) the first of the month following the date you become eligible for Dependent Life Insurance; or (2) the first of the month following the date the dependent meets the definition of Dependent. Amounts of Insurance over the guaranteed issue Amount of Insurance shown on the Schedule of Benefits for the Dependent spouse must be applied for in writing and are subject to proof of good health. Insurance will be effective the first of the month following the date we approve such proof of good health. If you pay a portion of the dependent premium, you may insure your Dependents by making written application. In this case, the insurance for Dependents will take effect on the later of: (1) the first of the month following the date you become eligible for Dependent Life Insurance; or (2) the first of the month following the date the dependent meets the definition of Dependent, if application is made on or before that date; or (3) the first of the month following the date of application, if application is made within thirty-one (31) days from the date the Dependent first becomes eligible for this insurance; or (4) the first of the month following the date we approve any required proof of good health. 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. We require proof of good health if you make application for dependent insurance on your spouse : (a) after thirty-one (31) days from the date the Dependent first becomes eligible for this insurance; or (b) after a prior termination of insurance as long as you remained in a class eligible for dependent 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 (5) the date premium is remitted. If the Dependent spouse has been previously declined for coverage by us, had an application withdrawn or marked incomplete for any reason or voluntarily terminated his/her 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 the Dependent who voluntarily terminated his/her insurance coverage with us makes a future request for insurance coverage due to a life event change or during any approved enrollment period. After this insurance is in force for one Dependent child, application is not required for added Dependent children. LRS-6423-31 Ed. 04/16 Page 11.0
Class 6 Group Life (Basic and Term) Certificate Page 13 Page 15