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SUNNYISLES 1703779 • EFFECTIVE DATE City of Sunny Isles Beach DENTAL INSURANCE PROPOSAL General Information The policy will become effective no earlier than the date the application is signed and the first month's premium, shown in the COST SUMMARY of this proposal, is received in Jefferson Pilot Financial's Omaha Office. ELIGIBLE EMPLOYEES All active, full -time permanent employees may be covered. "Active, full- time" means the employee works at least 30 hours per week. (Lower minimum hours may apply in certain states). Retired, temporary and seasonal employees are not eligible. For employees who enroll within 31 days of the date they become eligible, coverage usually becomes effective on the later of: - the first of the month following the date the employee completes the eligibility waiting period established by the employer; or - the first of the month following the date the employee enrolls and makes any required premium contribution. Employees who enroll more than 31 days after becoming eligible will be subject to the policy's late entrant 40 imitation. Newly hired employees will become eligible upon completion of the company's eligibility waiting period -- for example, 30 days of full -time employment. New employees can be covered by the dental plan on the first of the month following completion of that eligibility waiting period, provided they enroll and make any required premium contributions within 31 days of the date they become eligible. ELIGIBLE DEPENDENTS Dependents eligible for coverage include the employee's lawful spouse and unmarried children from birth through age 18 (through age 22, for full -time students). Higher age limits may apply in certain states. Stepchildren are eligible if they live in the employee's home and are chiefly dependent upon the employee for support. Foster children and dependent grandchildren may also be eligible under certain conditions. Dependents' coverage usually becomes effective on the same date as the employee's, if they are enrolled. Dependents acquired after the employee's coverage begins may be enrolled immediately, subject to payment of any increase in premium. Dependents enrolled more than 31 days after they are first eligible will be subject to the policy's late entrant limitation. • Jefferson Pilot Financial Insurance Company FL 26 11/02/01