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2024 - 2025 Plan Year
Group Critical Illness and Cancer Insurance* Plan 2When life takes an unexpected turn, your focus should be on recovery — not nances. Colonial Life’s group critical illness and cancer insurance helps relieve nancial worries by providing a lump-sum benet payable directly to you to use as needed.Coverage amount: ____________________________Critical illness and cancer benetsCOVERED CONDITION1PERCENTAGE OF APPLICABLE COVERAGE AMOUNTBenign brain tumor 100%Coma 100%End stage renal (kidney) failure 100%Heart attack (myocardial infarction) 100%Loss of hearing 100%Loss of sight 100%Loss of speech 100%Major organ failure requiring transplant 100%Occupational infectious HIV or occupational infectious hepatitis B, C, or D100%Permanent paralysis due to a covered accident 100%Stroke 100%Sudden cardiac arrest 100%Coronary artery disease 25%COVERED CANCER CONDITION¹PERCENTAGE OF APPLICABLE COVERAGE AMOUNTInvasive cancer (including all breast cancer) 100%Non-invasive cancer 25%Skin cancer initial diagnosis ............................$400 per lifetimeBENEFITS STORYPreparing for a lifelong journeyRebecca was born with Down syndrome. Her parents’ critical illness and cancer coverage provided a benet that can help cover expenses related to Rebecca’s care and her changing needs. How their coverage helpedA hospital stay and treatment for corrective heart surgeryPhysical therapy to build muscle strengthSpecial needs daycareFor illustrative purposes only.GCI6000 – PLAN 2 387100-1-AZ
Key benets• Available coverage for spouse and eligible dependent children at 50% of your coverage amount • Cover your eligible dependent children at no additional cost • No medical underwriting to qualify for coverage• Works alongside your health savings account (HSA)• Benets payable regardless of other insuranceSubsequent diagnosis of a different critical illness2If you receive a benet for a critical illness, and are later diagnosed with a different critical illness, 100% of the coverage amount may be payable for that particular critical illness.Subsequent diagnosis of the same critical illness2If you receive a benet for a critical illness, and are later diagnosed with the same critical illness,3 25% of the coverage amount is payable for that critical illness. Reoccurrence of invasive cancer (including all breast cancer)If you receive a benet for invasive cancer and are later diagnosed with a reoccurrence of invasive cancer, 25% of the coverage amount is payable if treatment-free for at least 12 months and in complete remission prior to the date of reoccurrence; excludes non-invasive or skin cancer.Additional covered conditions for dependent childrenCOVERED CONDITION1PERCENTAGE OF APPLICABLE COVERAGE AMOUNTCerebral palsy 100%Cleft lip or palate 100%Cystic fibrosis 100%Down syndrome 100%Spina bifida 100%For more information, talk with your benets counselor.1. Please refer to the certicate for complete denitions of covered conditions. 2. Dates of diagnoses of a covered critical illness must be separated by more than 180 days. 3. Critical illnesses that do not qualify include: coronary artery disease, loss of hearing, loss of sight, loss of speech, and occupational infectious HIV or occupational infectious hepatitis B, C, or D.* The led product name is Group Critical Illness and Cancer Specied Disease Insurance.THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benet, Benets Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benet for Dependent Children that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conict; or pre-existing condition, unless the covered person has satised the pre-existing condition limitation period shown on the Certicate Schedule on the date the covered person is diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Invasive Cancer (including all Breast Cancer) Benet, Non-Invasive Cancer Benet, Benet Payable Upon Reoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benet for a covered person’s invasive cancer or non-invasive cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satised the pre-existing condition limitation period shown on the Certicate Schedule on the date the covered person is initially diagnosed as having invasive or non-invasive cancer. No pre-existing condition limitation will be applied for dependent children who are born or adopted while the named insured is covered under the certicate, and who are continuously covered from the date of birth or adoption.PRE-EXISTING CONDITION LIMITATION We will not pay a benet for a pre-existing condition that occurs during the 12-month period after the coverage effective date. Pre-existing condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GCI6000-P and certicate form GCI6000-C-AZ. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 1-23 | 387100-1-AZColonialLife.com387100-1-AZ
For more information, talk with your benefits counselor.Group Hospital Confinement Indemnity InsurancePlan 1THIS INSURANCE PROVIDES LIMITED BENEFITS. EXCLUSIONSWe will not pay benefits for losses which are caused by: alcoholism, drug addiction, dental procedures, elective procedures, cosmetic surgery, felonies or illegal occupations, pregnancy of a dependent child, psychiatric or psychological conditions, suicide, intentional injuries, war or armed forces service. We will not pay benefits for hospital confinement due to giving birth within the first nine months aer the certificate eective date or for a newborn who is neither injured nor sick. We will not pay benefits for loss during the first 12 months aer the eective date due to a pre-existing condition, which means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the certificate eective date.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GMB1.0-P-R and certificate form GMB1.0-C-AZ-R-1. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.GROUP MEDICAL BRIDGE – PLAN 1 | 12-21 | 100205-5-AZColonialLife.comGroup Medical BridgeTM insurance can help with medical costs associated with a hospital stay that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement benefit ....................................................... $_______________ per dayMaximum of one day per covered person per calendar yearHealth savings account (HSA) compatibleThis plan is compatible with HSA guidelines. This plan may also be oered to employees who do not have HSAs.Colonial Life & Accident Insurance Company’s Group Medical Bridge oers an HSA-compatible plan in most states.100205-5-AZUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
Group Short Term Disability Insurance*If a covered accident or covered sickness prevents you from earning a paycheck, group short term disability insurance can provide a monthly benet to help you cover your ongoing expenses, often at a more reasonable rate than individual insurance.Disability insurance worksheet You can tailor disability coverage to t your specic needs. Talk with your benets counselor about your expenses and other paid leave benets, such as state paid medical leave, and use this worksheet to help determine the coverage that’s right for you.1MONTHLY EXPENSES ROUND TO THE NEAREST HUNDREDRent or mortgage (insurance, minor home repairs)$Transportation (car note, bus fare, insurance, gas, maintenance)$ Utilities (cell phone, Wi-Fi, electricity/gas, water)$ Food and household necessities (toiletries, cleaning supplies)$ Childcare (daycare, after school care)$ Health (medical needs and prescription drugs)$ Other (gym/fitness, streaming/cable, extracurricular)$ Total monthly expenses (add lines 1-7 together)$ Your state’s paid medical leave approximate benefits (if any):Monthly benefit: Benefit period up to: DISABILITY INSURANCE: WHAT’S RIGHT FOR ME?1. How much disability coverage do I need? Monthly benet amount for off-job accident and off-job sickness: $ Choose a monthly benet amount between $400 and $7,500. Subject to income requirements. If your plan includes on-job accident/sickness benets, the on-job benet is 50% of the off-job amount.2. How long do I want benetscoverage? Benet period: months The partial disability benet period is three months. Partial disability benet is 50% of the total disability amount.3. When would I like my totaldisabilitybenets to start? After an accident: days After a sickness: daysGROUP DISABILITY INSURANCE - BASE
Frequently asked questions Whatisthedenitionoftotaldisability?“Totally disabled” or “total disability” means you are unable to perform the material and substantial duties of your occupation, not working at any occupation, and under the regular and appropriate care of a physician.How does partial disability work? If you are able to return to work part time after at least 14 days of being paid for a total disability, you may be able to still receive 50% of your total disability benet.What is waiver of premium? We will waive your premium payments after 90 consecutive days of a covered disability.What are the age guidelines to qualify for this coverage? Coverage is available from ages 17 to 74.Can I keep my coverage if I change jobs or employers? Through a feature called “portability,” you may be able to keep your coverage even if you change jobs. Talk with your benets counselor for details.What happens if I am disabled while traveling outside of the country? If you are disabled while outside of the United States, Canada or Mexico, you may receive benets for up to 60 days before you have to return to the U.S. in order to continue receiving benets.To learn more, talk with your benetscounselor.* The led product name in ID is Group Short Term Disability Income Protection Insurance Policy. In NH it is Group Disability Income Protection Coverage Policy. In PA it is Group Short Term Disability Insurance Non-Participating.1 State paid medical leave (PML) benets fall under state-specic program names. For example, in New Jersey, it may be referred to as Temporary Disability Insurance (TDI). Not available in all states.EXCLUSIONS AND LIMITATIONSWe will not pay benets for losses that are caused by, contributed to by or occur as the result of: alcoholism or drug addiction, felonies or illegal occupations, ying, hazardous avocations, intoxicants and narcotics, psychiatric or psychological conditions, racing, semi-professional or professional sports, suicide or injuries which you intentionally do to yourself, war or armed conict. We will not pay for losses due to you giving birth within the rst nine months after the coverage effective date of the certicate.Pre-existing condition means a sickness or physical condition, whether diagnosed or not, for which you were treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date.We will not pay for loss when the disability is a pre-existing condition as dened in this certicate, unless you have satised the pre-existing condition limitation period (typically 12 months) shown on the Certicate Schedule on the date you suffer a loss due to a covered accident or covered sickness.For policies issued or delivered in the Commonwealth of Virginia, THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GDIS-P and certicate form GDIS-C (including state abbreviations where used, for example: GDIS-P-TX and GDIS-C-TX). This form is not complete without form number 1675200 in applicable states. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. An insurance producer may contact you.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 8-23 | 101136-7ColonialLife.com
Group Accident InsurancePremier PlanIf you are in an accident, your focus should be on recovery, not how you’re going to pay your bills. Colonial Life accident insurance can pay benets directly to you to use however you like — from medical costs to everyday expenses. Whether you’ve had a fall or a car accident, these benets can offer nancial support when you need it.Our coverage includes:• Benets payable directly to you• No medical questions to qualify for coverage• Coverage for simple and complex injuries• Benets payable regardless of other insurance• Worldwide coverage• Works alongside your Health Savings Account (HSA)BENEFITS STORY Milo was working in his yard when he tripped and injured his hand.With Colonial Life accident benets, Milo was able to pay the annual deductible and co-payments for his health insurance plan without using his savings or taking on debt.MILO’S ACCIDENT BENEFITSMilo went to an urgent care facility and received immediate care.Treatment in a physician’s office or urgent care facility$150The doctor ordered an X-ray and discovered Milo had fractured his hand.• X-ray• Fracture (hand)$60$1,200The doctor also found that Milo had a cut on his hand but did not require stitches. Laceration (no repair) $75Milo was discharged with a splint. Durable medical equipment $65Over the next several weeks, Milo had two follow-up appointments with his doctor. Physician follow-up visits (2 visits)$50 x 2 = $100Total $1,650For illustrative purposes only. Benet amounts may vary and may not cover all expenses. GROUP ACCIDENT (GAC4100) — PREMIER PLAN
Give your benets a boostWe know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life. Group Accident includes a Benet Booster* to provide additional nancial support for serious accidents. If you have more than $5,000 in payable benets for a covered accident, we will give you a $500 boost to your benets to help you with whatever expenses you have. *Payable once per Insured per covered accidentBENEFITS STORY Olivia was driving to the store when she got into a car accident.Olivia’s benets helped her cover her medical expenses when she was injured in a car accident, helping her to focus on her recovery.OLIVIA’S ACCIDENT BENEFITSOlivia arrived by ambulance at the nearest emergency room and received immediate care.• Ambulance• Emergency department visit• Injury due to auto accident$400$250 $250The doctor ordered an X-ray and discovered Olivia had fractured her thigh (femur). He also ordered a CT scan of her head to check for brain injury.• X-ray• Medical imaging• Fracture (thigh)$60$400 $4,200Olivia required surgery for her leg.• Surgical repair (thigh fracture)• General anesthesia$4,200 $300Olivia boarded her pet for two nights after her surgery. Pet boarding (2 days) $20 x 2 = $40Olivia had eight sessions of physical therapy to help regain the strength in her leg and two follow-up appointments with her doctor.• Therapy services (8 sessions)• Physician follow-up visits (2 visits)$55 x 8 = $440$50 x 2 = $100Olivia’s benefits for this accident totaled more than $5,000.Benefit Booster $500Total $11,140For illustrative purposes only. Benet amounts may vary and may not cover all expenses. Benets are per covered person per covered accident unless stated otherwiseInjury benets • Burns (based on size and degree) ............. $750–$21,000• Concussion ........................................ $500• Connective tissue damage ......................$100–$200• Eye injury .......................................... $400 • Hearing loss injuries ..................................$120(Maximum once per lifetime per ear per insured)• Injury due to auto accident ........................... $250 • Internal injuries ..................................... $200 • Knee cartilage (meniscus) injury ...................... $200 • Lacerations ...................................$75–$1,200• Loss of a digit — partial .........................$400–$800• Loss of a digit ..............................$1,000–$3,000• Ruptured or herniated disc ......................$200–$400
Fracture benets• Injury .......................................$200–$5,000 Examples: nger: $200 | wrist: $1,200 | hip: $4,200• Surgical repair of fracture ............................100%(Payable as an additional % of the applicable fractures benet)• Chip fracture ........................................25% (Payable as a % of the applicable fractures benet)Dislocation benets• Injury .......................................$260–$4,000 Examples: elbow: $600 | ankle: $1,600 | hip: $4,000• Surgical repair of dislocation ..........................100%(Payable as an additional % of the applicable dislocations benet)• Incomplete dislocation ................................25%(Payable as a % of the applicable dislocations benet)Treatment benets• Air ambulance .....................................$2,000 • Ambulance (ground or water) ......................... $400 • Durable medical equipment ......................$65–$250• Emergency dental repair ........................$200–$600• Emergency department .............................. $250(Maximum 4 per year) • Family care ................................... $50 per day (Maximum of one benet per day for all insureds combined, up to a maximum of three days per covered accident, regardless of the number of children)• Injections to prevent or limit infection ...................$50 • Lodging ..................................... $250 per day (Maximum 30 days)• Medical imaging ..................................... $400 • Pain management injections ..........................$150 • Pet boarding .................................. $20 per day (Maximum of one benet per day for all insureds combined, up to a maximum of three days per covered accident, regardless of the number of pets that are boarded)• Prosthetic device or articial limb ............$1,750–$3,500• Skin grafts (due to burns) .............................50%(Payable as a % of the applicable burn benet)• Skin grafts (not due to burns) .................... $375–$750• Transfusions ........................................ $500 • Transportation ............................... $200 per trip (Maximum 6 one-way trips)• Treatment in a physician’s oce or urgent care facility ...$150(Maximum 4 per year) • X-ray or ultrasound ....................................$60Surgery benets• Anesthesia ....................................$150–$300• Connective tissue surgery ..................... $150–$2,200• Eye surgery .........................................$400• General surgery –Abdominal, thoracic, or cranial ...................$2,000 –Exploratory surgery ...............................$275 • Hernia surgery ......................................$400 • Knee cartilage (meniscus) surgery ..............$150–$1,050• Outpatient surgical facility ............................$400 • Ruptured or herniated disc surgery ............ $150–$2,000Recovery care benets• At-home care ................................ $125 per day(Maximum 5 days) • Benet Booster .....................................$500• Physician follow-up visits ............................. $50 (Maximum 6 days per covered accident and 24 days per calendar year)• Rehabilitation or sub-acute rehabilitation unit connement .............................$200 per day (Maximum 15 days per covered accident and 30 days per calendar year)• Therapy services (speech, physical therapy, occupational therapy) ..........................$55 per day(Maximum 15 days)Options checked below have been chosen by your employer to enhance your Group Accident Coverage. Recovery Plus package• Behavioral health therapy ...................$55 per day (Maximum 15 days)• Post-traumatic stress disorder (PTSD) ............ $200 • Prescription drug .................................$25 • Additional therapy services (chiropractic, acupuncture, alternative therapy) ......$55 (Existing therapy services benet maximum applies to additional therapy services, maximum 15 days)• Injury due to felonious act of violence or sexual assault ................................ $250(Maximum once per insured per calendar year, with an accompanying police report) Gunshot wound benetThis benet can help pay your medical expenses if you receive a non-fatal gunshot wound. It offers you a lump sum for a covered injury regardless of any other insurance you may have and includes on/off-job coverage.• Gunshot wound .............................$_________This benet covers a non-fatal gunshot wound from a conventional rearm that requires treatment by a doctor and overnight hospitalization within 24 hours of the injury. If you are shot more than once in a 24-hour period, we can pay benets only for the rst wound.
Contact your Colonial Life benets counselor to learn more.CT: We will pay the air ambulance or ambulance benets directly to the licensed professional ambulance company. CT includes a benet for “outpatient emergency medical care for accidental ingestion of a controlled substance.” The at-home care benet maximum is 80 days. KS: Chiropractic therapy is not available. NH: NH includes a burn benet for 2nd degree burns under 5% of skin surface. The minimum benet for the loss or partial loss of a digit is $1,000.MD: The prescription drug benet is not available.PA: The pet boarding benet is not available. TN: The therapy services benet includes chiropractic. TX: The concussion benet is replaced by the “concussion and acquired brain injuries” benet. The therapy services benet includes the following services: cognitive communication therapy; cognitive rehabilitation therapy; community reintegration services; neurobehavioral; neurocognitive therapy and rehabilitation; neurofeedback therapy; neurophysiological; neuropsychological; post-acute transition services; psychophysiological testing or treatment; and remediation.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate.It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONSWe will not pay benets for claims that are caused by, contributed to by, or resulting from elective procedures, felonies or illegal occupations, hazardous avocations, impaired driving, incarceration, racing, semi-professional or professional sports, sickness, suicide or self-inicted injuries, war, or armed conict. ID: ”Semi-professional sports or professional sports” exclusion is replaced by “professional sports” exclusion. IL: We will not pay benets for claims that are caused by or resulting from Exclusions.MD: Includes an exclusion for “Prohibited referrals.” The “felonies or illegal occupations” and “impaired driving” exclusions apply only to Accidental Death and Dismemberment benets.MI: “Impaired driving” and “suicide or self-inicted injuries” exclusions do not apply. MN: “Suicide or self-inicted injuries” exclusion does not apply.NH: “Incarceration” and “racing” exclusions do not apply.UT: We will not pay benets for claims that are caused by or resulting from Exclusions.VT: “Impaired driving” exclusion does not apply. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GAC4100-P and certicate form GAC4100-C (including state abbreviations where used, for example: GAC4100-P-TX and GAC4100-C-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 3-23 | 1212553ColonialLife.com
Deductions per year: 12 These rates were prepared on 5/15/2024 and are valid for 90 days.Group Disability for AZ AA Risk ClassApplicable to policy forms GDIS-P & GDIS-ClOff-Job Accident and Off-Job Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $500* $1,000* $1,500* $2,000* $2,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $13.60 $27.20 $40.80 $54.40 $68.0050-64 $15.65 $31.30 $46.95 $62.60 $78.2565-74 $18.95 $37.90 $56.85 $75.80 $94.756 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $500* $1,000* $1,500* $2,000* $2,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $17.10 $34.20 $51.30 $68.40 $85.5050-64 $22.75 $45.50 $68.25 $91.00 $113.7565-74 $29.55 $59.10 $88.65 $118.20 $147.75Group Medical Bridge (GMB7000) for AZ Composite - CFTIApplicable to Policy Forms GMB7000–P & GMB7000-ClWithout Wellbeing AssistanceHOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 2: $100017-99 $12.10 $25.96 $16.55 $30.41HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-99 $24.09 $51.70 $32.94 $60.55Group Critical Illness (GCI6000) for AZApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $100 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $10.65 $16.05 $10.65 $16.0525-29 $12.35 $18.65 $12.35 $18.6530-34 $14.15 $21.25 $14.15 $21.2535-39 $18.15 $27.35 $18.15 $27.3540-44 $22.15 $33.35 $22.15 $33.3545-49 $28.75 $43.55 $28.75 $43.5550-54 $35.25 $53.75 $35.25 $53.7555-59 $44.25 $67.45 $44.25 $67.4560-64 $57.95 $88.25 $57.95 $88.2565-69 $69.55 $106.05 $69.55 $106.0570-74 $69.55 $106.05 $69.55 $106.05Page 1 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice
Group Critical Illness (GCI6000) for AZApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $100 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$20,000 17-24 $14.65 $21.75 $14.65 $21.7525-29 $18.05 $26.95 $18.05 $26.9530-34 $21.65 $32.15 $21.65 $32.1535-39 $29.65 $44.35 $29.65 $44.3540-44 $37.65 $56.35 $37.65 $56.3545-49 $50.85 $76.75 $50.85 $76.7550-54 $63.85 $97.15 $63.85 $97.1555-59 $81.85 $124.55 $81.85 $124.5560-64 $109.25 $166.15 $109.25 $166.1565-69 $132.45 $201.75 $132.45 $201.7570-74 $132.45 $201.75 $132.45 $201.75$30,000 17-24 $18.65 $27.45 $18.65 $27.4525-29 $23.75 $35.25 $23.75 $35.2530-34 $29.15 $43.05 $29.15 $43.0535-39 $41.15 $61.35 $41.15 $61.3540-44 $53.15 $79.35 $53.15 $79.3545-49 $72.95 $109.95 $72.95 $109.9550-54 $92.45 $140.55 $92.45 $140.5555-59 $119.45 $181.65 $119.45 $181.6560-64 $160.55 $244.05 $160.55 $244.0565-69 $195.35 $297.45 $195.35 $297.4570-74 $195.35 $297.45 $195.35 $297.45Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $13.05 $19.45 $13.05 $19.4525-29 $15.85 $23.65 $15.85 $23.6530-34 $18.65 $27.85 $18.65 $27.8535-39 $25.05 $37.45 $25.05 $37.4540-44 $31.45 $47.15 $31.45 $47.1545-49 $41.95 $63.45 $41.95 $63.4550-54 $52.35 $79.75 $52.35 $79.7555-59 $66.75 $101.75 $66.75 $101.7560-64 $88.65 $135.05 $88.65 $135.0565-69 $107.25 $163.35 $107.25 $163.3570-74 $107.25 $163.35 $107.35 $163.45(Continued...)Page 2 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice
Group Critical Illness (GCI6000) for AZApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $100 BenefitTobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$20,000 17-24 $19.45 $28.55 $19.45 $28.5525-29 $25.05 $36.95 $25.05 $36.9530-34 $30.65 $45.35 $30.65 $45.3535-39 $43.45 $64.55 $43.45 $64.5540-44 $56.25 $83.95 $56.25 $83.9545-49 $77.25 $116.55 $77.25 $116.5550-54 $98.05 $149.15 $98.05 $149.1555-59 $126.85 $193.15 $126.85 $193.1560-64 $170.65 $259.75 $170.65 $259.7565-69 $207.85 $316.35 $207.85 $316.3570-74 $207.85 $316.35 $208.05 $316.55$30,000 17-24 $25.85 $37.65 $25.85 $37.6525-29 $34.25 $50.25 $34.25 $50.2530-34 $42.65 $62.85 $42.65 $62.8535-39 $61.85 $91.65 $61.85 $91.6540-44 $81.05 $120.75 $81.05 $120.7545-49 $112.55 $169.65 $112.55 $169.6550-54 $143.75 $218.55 $143.75 $218.5555-59 $186.95 $284.55 $186.95 $284.5560-64 $252.65 $384.45 $252.65 $384.4565-69 $308.45 $469.35 $308.45 $469.3570-74 $308.45 $469.35 $308.75 $469.65Group Accident (GAC4100) for AZApplicable to policy forms GAC4100-P,GAC4100-ClAdditional Benefits: Active Lifestyles, Wellbeing Assistance Max - $100, Personal Safety Benefit, Building BenefitOn/Off-Job Accident CoverageBENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE ANDSPOUSEEMPLOYEE ANDDEPENDENTCHILD(REN)EMPLOYEE, SPOUSEAND DEPENDENTCHILD(REN)Premier 17-99 $18.82 $31.07 $42.33 $54.72Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2024 Colonial Life & Accident Insurance Company"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.Mark | mark@colonialtx.com | (281) 714-8150(Continued...)Page 3 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice