If a person becomes an eligible Dependent through marriage, birth, adoption or Placement for Adoption, the Employee, spouse, and newly acquired Dependent(s) who are not already enrolled may enroll for health coverage under this Plan during a special enrollment period. The Employee must request and apply for coverage within 31 calendar days of the marriage, birth, adoption, or Placement for Adoption. EFFECTIVE DATE OF COVERAGE UNDER SPECIAL ENROLLMENT PROVISION If an eligible person properly applies for coverage during this special enrollment period, the coverage will become effective as follows: • In the case of marriage, on the date of the marriage (note that eligible individuals must submit their enrollment forms prior to the Effective Dates of coverage in order for salary reductions to have preferred tax treatment from the date coverage begins); or • In the case of a Dependent's birth, on the date of such birth; or • In the case of a Dependent's adoption, the date of such adoption or Placement for Adoption; or • In the case of eligibility for premium assistance under a state’s Medicaid plan or state child health plan, on the date the approved request for coverage is received; or • In the case of loss of coverage, on the date following loss of coverage. RELATION TO SECTION 125 CAFETERIA PLAN This Plan may also allow additional changes to enrollment due to change in status events under the employer’s Section 125 Cafeteria Plan. Refer to the employer’s Section 125 Cafeteria Plan for more information. -40- 7670-00-413597