RL-CI4-SPR2-20-IN 4 SPR-12969 (11/25) Systemic Sclerosis (Scleroderma) 10% 1 times the BENEFIT AMOUNT Occupational HIV 100% 1 times the BENEFIT AMOUNT Occupational Hepatitis B or C 100% 1 times the BENEFIT AMOUNT SPOUSE CRITICAL ILLNESS BENEFITS The benefit percentages and maximums for your Spouse are the same as the benefit percentages and maximums for you as shown in the SCHEDULE OF BENEFITS section of the Certificate. GENERAL PROVISIONS ELIGIBILITY If you are covered under the Policy, then your Spouse is eligible under this rider on the latest of the following: The Policy effective date. The date coverage under this rider is available to the eligible class of Insured Persons to which you belong. Your Critical Illness coverage effective date. The date of your marriage. If your Spouse is covered under the Policy as an Employee, then your Spouse is not eligible for coverage under this rider. ENROLLMENT If you have a Spouse eligible for Spouse coverage, you must enroll for any Spouse coverage before it will become effective. The Employer or we will provide you with the forms or information needed to complete your enrollment. You may enroll for Spouse coverage when you become newly eligible, or following a qualifying life event as allowed by the Employer, or during an enrollment period chosen by the Employer and approved by us. EFFECTIVE DATE OF COVERAGE Your Spouse will be covered at 12:01 a.m. standard time at the Policyholder’s address on the latest of the following: The date your Spouse is eligible for coverage, if you enroll for Spouse coverage on or before that date. The first day of the month that is on or next follows the date you enroll for Spouse coverage. The first day of the month that is on or next follows the date you return to Active Employment, if you are not in Active Employment when your Spouse’s coverage would otherwise become effective. Exception: Coverage starts on a non-working day if you were in Active Employment on your last scheduled working day before the non- working day. Non-working days include time off for the following: vacations, personal holidays, weekends and holidays, approved non-medical leave of absence and paid time off for non-medical-related absences. EFFECTIVE DATE OF CHANGES TO COVERAGE Once your Spouse’s coverage begins, any increased or additional coverage will take effect on the latest of the following: The date of the increased or additional coverage, if you are in Active Employment. The date you return to Active Employment, if you are not in Active Employment due to injury or sickness. DEFINITIONS General terms defined in the DEFINITIONS section of the Certificate regarding medical conditions and eligibility apply to your Spouse. Spouse means your lawful spouse.
Critical Illness Insurance Plan for Noblesville Schools Employees Page 25 Page 27