TABLE OF CONTENTS Page SCHEDULE OF BENEFITS ....................................................................................................................................... 1.0 DEFINITIONS ............................................................................................................................................................. 2.0 CERTAIN RESPONSIBILITIES OF THE POLICYHOLDER ...................................................................................... 3.0 GENERAL PROVISIONS ........................................................................................................................................... 4.0 INDIVIDUAL ELIGIBILITY, EFFECTIVE DATE AND TERMINATION ....................................................................... 5.0 DEPENDENT INSURANCE ....................................................................................................................................... 6.0 PORTABILITY ............................................................................................................................................................ 7.0 BENEFIT PROVISIONS ............................................................................................................................................ 8.0 WELLNESS BENEFIT ............................................................................................................................................... 9.0 BENEFICIARY AND FACILITY OF PAYMENT ....................................................................................................... 10.0 CLAIMS PROVISIONS ............................................................................................................................................. 11.0 PREMIUMS .............................................................................................................................................................. 12.0 EXTENSION OF COVERAGE UNDER THE FAMILY AND MEDICAL LEAVE ACT AND UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA) ................................................... 13.0 EXCLUSIONS .......................................................................................................................................................... 14.0 LRS-9547-0318-IN