Prudential Insurance Company of America.

Check One: (All terms and conditions of the policy apply) New Hire Change (IMPORTANT) If you fail to enroll when eligible or are increasing coverage, you are required to furnish evidence of insurability (EOI) to The Prudential Insurance Company of America (Prudential). Coverage subject to EOI is not effective until approved by Prudential. Reclassification (IMPORTANT) Employees have 31 days from the date of reclassification to move into any level of the exempt plan without having to furnish EOI. Important information concerning pre-existing conditions: Please read your certificate carefully or contact your Human Resource Representative for further information. Your certificate shows the pre-existing condition exclusion and describes how the exclusion works.