TABLE OF CONTENTS Page SCHEDULE OF BENEFITS ................................................................................................................................................. 1.0 DEFINITIONS ....................................................................................................................................................................... 2.0 CERTAIN RESPONSIBILITIES OF THE POLICYHOLDER ................................................................................................ 3.0 TRANSFER OF INSURANCE COVERAGE ........................................................................................................................ 4.0 GENERAL PROVISIONS ..................................................................................................................................................... 5.0 INDIVIDUAL ELIGIBILITY, EFFECTIVE DATE AND TERMINATION ................................................................................. 6.0 DEPENDENT CRITICAL ILLNESS INSURANCE ................................................................................................................ 7.0 PORTABILITY ...................................................................................................................................................................... 8.0 BENEFIT PROVISIONS ....................................................................................................................................................... 9.0 WELLNESS BENEFIT ........................................................................................................................................................ 10.0 BENEFICIARY AND FACILITY OF PAYMENT ................................................................................................................. 11.0 CLAIMS PROVISIONS ....................................................................................................................................................... 12.0 PREMIUMS ........................................................................................................................................................................ 13.0 EXTENSION OF COVERAGE UNDER THE FAMILY AND MEDICAL LEAVE ACT AND UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA) ................................................................................. 14.0 EXCLUSIONS .................................................................................................................................................................... 15.0 LRS-9537-0118