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AFSCME2024 Voluntary Benefits BookletNS-15576 (9-17)
Welcome to Your Voluntary Benefits .The information contained in this booklet is only a summary of coverage and is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. If there are differences between the information in the booklet and the contract, the contract will govern.At AFSCME our greatest asset is people like you. We value your membership and like to do what we can to reward you. Thatʼs why we are pleased to offer you these valuable benefits.Please review the information in this booklet to learn about the plans being offered anddetermine what coverage is right for you.
Voluntary BenefitsYou never know when an unexpected illness or injury could leave you and your family with financial difficulties. Health insurance can help, but you can still have deductibles, co-payments and other out-of-pocket expenses.That’s where voluntary benefits come in. Sometimes called supplemental insurance, voluntary benefits are designed to complement your health insurance and help provide extra financial protection. This year, AFSCME is helping you protect your way of life by giving you the opportunity to purchase the following voluntary benefits from Colonial Life: Accident insurance Cancer insurance Critical illness insurance Dental insurance Disability insurance Term and Whole life insuranceTo learn more, talk to a Colonial Life benefits counselor.
Choose the benets that are right for youYOU WILL ALSO HAVE THE OPTION OF SELECTING THESE NEW VOLUNTARY BENEFITS DURING YOUR ENROLLMENT:Accident insurance provides a benet for a range of accidental injuries.Cancer insurance provides a benet to help offset the out-of-pocket medical and indirect, non-medical expenses related to cancer.Critical illness insurance provides a benet to help you manage the nancial impacts of a critical illness.(May also be referred to as specied disease insurance or specied critical illness insurance in some states.)Dental insurance provides benets for a variety of procedures, from routine cleanings to more advanced procedures.Disability insurance helps replace a portion of your income to help make ends meet if you become disabled from a covered accident or sickness.Term and Whole life insurance provides a benet to help protect your family’s way of life in the event of your death.“We are always working hard to make sure that we have the best possible benets for our members and our families. We are proud to offer a new, completely free $10,000 AD&D insurance benet* to all of our members in good standing. This complimentary benet will be provided for 1 year to all members who participate in a benets counseling session. To learn more about this free benet and additonal voluntary benets that will be offered during enrollment, contact Colonial Life or our own Smart Center with any questions”. — Fred Yungbluth, Oregon AFSCME PresidentThe policies, their names or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benets payable. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Policy forms marketed by the company vary by product and are too numerous to list in the advertisement, but a list can be provided upon request. Colonial Life Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 12-22 | NS-1376807-ORColonialLife.comTo learn more,visit yourbenets website:https://Learn.ColonialLife.com/afscmeorTo schedule a session with a benets counselor:https://Calendly.com/Oregon-afscmeDuring your benet counseling session, benet counselors will review these benets, answer questions and help you enroll, if desired. There are three (3) convenient ways for members to pay for the cost of this coverage. Be ready to designate your payment method during your benet counseling session. - Monthly bank draft- Monthly credit card draft- Direct deposit from your employer’s paycheck*Accidental Death and Dismemberment insurance coverageis underwritten by Federal Insurance Company, a memberinsurer of the Chubb Group of Insurance Companies. Thiscoverage may not be available in all states.
Accident InsurancePreferred 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 — offering 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 STORYJacob was running on the playground when he tripped and injured his hand.With Colonial Life accident benets, Jacob’s parents were able to pay the annual deductible and co-payments.JACOB’S ACCIDENT BENEFITSJacob went to an urgent care facility and received immediate care.Accident emergency treatment $125The doctor ordered an X-ray and discovered Jacob had fractured his hand.• X-ray• Fracture (hand)$40$475The doctor also found that Jacob had a cut on his hand.Laceration (no stitches) $30Jacob was discharged with a splint. Medical equipment (splint) $40Over the next several weeks, Jacob had three follow-up appointments with his doctor.Accident follow-up treatment (3 visits)$165Total $875For illustrative purposes only for covered accidents. Benefit amounts may vary and may not cover all expenses.IAC4000 – PREFERRED PLAN
BENEFITS STORYOlivia was driving to the store when she got into a car accident.Olivia’s accident benets helped cover her annual deductible and co-payments.OLIVIA’S ACCIDENT BENEFITSOlivia arrived by ambulance at the nearest emergency room and received immediate care.• Ambulance• Accident emergency treatment• Injury due to auto accident$250$125$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 a brain injury.• X-ray• Medical imaging (CT)• Thigh fracture — femur (surgical)$40$250 $5,600Olivia was admitted to the hospital for surgery on her leg. She was confined for three days.• Hospital admission• Surgery (exploratory/arthroscopic)• Hospital connement (3 days)$1,250$350$900Olivia had eight sessions of physical therapy to help regain the strength in her leg.• Physical therapy (8 days)• Medical equipment (crutches)$360$125Over the next several weeks, she had six follow-up appointments with her doctor.Accident follow-up treatment (6 visits) $330Total $9,830For illustrative purposes only for covered accidents. Benefit amounts may vary and may not cover all expenses. Summary of BenetsBenets are per covered person per covered accident unless stated otherwise.Initial careAccident emergency treatment .........................$125Hospital emergency room, urgent care facility or physician’s oceAccidental injury due to an automobile accident1 ........ $250Air ambulance ..................................... $2,400Ambulance — ground or water ......................... $250Observation room ..............................$175 per day(up to two days per calendar year)X-ray ................................................. $40Common accidental injuriesBurn .......................................$1,000–$15,000(based on size and degree)Burn — skin graft ..............50% of applicable burn benetComa .............................................$15,000(lasting for seven or more consecutive days)Concussion .......................................... $200Dislocation — separated joint• Non-surgical — repair ....................... $125–$2,750 Examples: elbow: $600 | ankle: $1,250 | hip: $2,750• Incomplete dislocation — or dislocation without anesthesia ................................. 25% (payable as a % of the applicable dislocation benefit)• Surgical — repair ............................$250–$5,500 Examples: elbow: $1,200 | ankle: $2,500 | hip: $5,500Emergency dental work .......................... $125–$350Dental extraction or dental crown, denture or implantEye injury — with surgical repair or removal of a foreign object ............................ $350Fracture — complete • Non-surgical — repair .......................$300–$3,750 Examples: hand/foot: $475 | collarbone: $775 | leg: $1,250 • Chip fracture .......................................25% (payable as a % of the applicable fracture benefit )• Surgical — repair ............................ $600–$7,500 Examples: hand/foot: $950 | collarbone: $1,550 | leg: $2,500
Hearing-loss injuries2 ..................................$140Knee cartilage — torn — with surgical repair ............. $800Laceration ......................................$30–$750(based on repair and length)Ruptured disc — with surgical repair ................... $950Tendon/ligament/rotator cuff — with surgical repair• One ............................................... $800• Two or more ......................................$1,600Hospital careHospital admission ..................................$1,250Hospital connement .........................$300 per day(up to 365 days)Hospital sub-acute intensive care unit connement .............................$400 per day(up to 30 days)Intensive care unit admission ........................$2,500Intensive care unit connement ................$550 per day(up to 15 days)Surgical careBlood/plasma/platelets — transfusion .................$400Surgery ...................................... $250–$1,900(based on type of repair and surgery)Transportation and lodgingTransportation for hospital connement ..$700 per round trip(up to three round trips, 50+ miles from home)Lodging–companion .......................... $150 per day(up to 30 days)Follow-up careAccident follow-up treatment, including transportation/telemedicine ............................$55(up to six benefits per covered person per covered accident and up to 12 benefits per covered person per calendar year)Medical equipment• Tier 1 ............................................... $40Arm sling, cane, medical ring cushion, neck brace or wrist/ankle splint• Tier 2 ..............................................$125Bedside commode, cold therapy system (cryotherapy), crutches, leg brace, shower chair, walker or walking boot• Tier 3 ............................................. $250Back brace, body jacket, continuous passive movement (CPM), halo, electric scooter, hospital bed (including rental), knee scooter, stair lift chair or wheelchairMedical imaging study — CT, CAT scan, EEG, EMG, MR or MRI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $250(one per calendar year)Pain management for epidural anesthesia — non-surgical ..$125Post-traumatic stress disorder (PTSD) ................. $250Prosthetic device/articial limb• One ............................................... $950• More than one ....................................$1,900• Repair/replacement3 ..........................$475/$950Rehabilitation unit connement .................$175 per day(up to 15 days, not to exceed 30 days per calendar year)Therapy — occupational, physical or speech ......$45 per day(up to 10 days)Accidental dismembermentAccidental dismemberment ...................$600–$25,000• Loss, loss of use or paralysis – hand, arm, foot, leg, sight of eye• Loss, loss of use – finger, toe, partial dismemberment of finger or toeAccidental dismemberment due to a catastrophic accident• Named insured, spouse or child ..................$30,0004• Total and irrecoverable loss, loss of use or paralysis – 180-day elimination period• Loss of both hands, arms, feet, legs or the sight of both eyes; or any combination; or • Loss of hearing in both ears, or loss of ability to speakAccidental deathAccidental death• Named insured, spouse .......................... $40,000• Child ............................................$10,000Accidental death common carrierExamples of common carriers are mass transit trains, buses and planes• Named insured, spouse ..........................$160,000• Child ........................................... $30,000
For more information, contact your Colonial Life benets counselor. 1 Requires transportation by a licensed professional air ambulance or ambulance (ground or water).2 One benet for each injured ear per covered person per lifetime.3 One repair or replacement per prosthetic device/articial limb per covered person per lifetime.4 Payable once per lifetime per covered person.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 POLICY 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 coverage.EXCLUSIONSWe will not pay benets for losses that are caused by, contributed to by or occur as the result of a covered personʼs felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness, suicide or injuries which any covered person intentionally does to himself, war or armed conict. In addition, we will not pay Accidental Dismemberment Due to Catastrophic Accident benets for injuries a child sustains during birth, or for injuries that are the result of intoxication or use of narcotics.STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONSKS: Not applicable to “for injuries a child sustains during birth.”MI: Not applicable to “suicide or injuries which any covered person intentionally does to himself” or for injuries that are the result of intoxication or use of narcotics.” OR: Replace “felonies or illegal occupations” with “felonies.”PA: Not applicable to “injuries a child sustains during birth” or “injuries that are the result of intoxication or use of narcotics.”SC: Not applicable to “hazardous avocations, racing, semi-professional or professional sports.”VT: Not applicable to “hazardous avocations, racing, semi-professional or professional sports.” The additional exclusions for Accidental Dismemberment due to Catastrophic Accident “for injuries a child sustains during birth, or for injuries that are the result of intoxication or use of narcotics” do not apply. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IAC4000 (including state abbreviations where used, for example: IAC4000-SC). For cost and complete details of the coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 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 7-24 | 101954-3ColonialLife.com
Accident InsuranceActive Lifestyles BenetThis benefit increases the amount you receive by 20% for your covered eligible benefits, giving you more financial protection for the unexpected. The active lifestyles benefit is available to you with accident coverage, as well as all your covered family members.Eligible benets1• Concussion• Dislocation• Emergency dental work• Eye injuries• Fractures• Knee cartilage (torn)• Laceration• Medical imaging study• Ruptured disc with surgical repair• Surgery ‐ cranial, open abdominal, thoracic/hernia ‐ exploratory and arthroscopic• Tendon/ligament/rotator cuff with surgical repair• X-rayExample of a benets calculation$2,500 Eligible benefits$2,500x 20%$500Eligible benefit amountActive lifestyles benefitActive lifestyles benefit calculation $2,500+ $500$3,000Eligible benefit amountActive lifestyles benefitTotalFor illustrative purposes onlyTo learn more, talk with your Colonial Life benets counselor.IAC4000 – ACTIVE LIFESTYLES BENEFIT
Accident InsuranceWellbeing Assistance Basic BenetThis benet can help reduce the risk of serious illness through early detection of disease or other risk factors, giving you more protection from the unexpected.The wellbeing assistance benet is available to you with individual accident coverage, as well as your covered family members.Wellbeing assistance basic ......................$_____________________Payable once per covered person per calendar year; subject to a 30-day waiting period1• Blood test for triglycerides• Bone marrow testing• Breast ultrasound• CA 15-3 (blood test for breast cancer)• CA 125 (blood test for ovarian cancer)• Carotid Doppler• CEA (blood test for colon cancer)• Chest X-ray• Colonoscopy• Echocardiogram (ECHO)• Electrocardiogram (EKG, ECG)• Fasting blood glucose test• Flexible sigmoidoscopy• Hemoccult stool analysis• Immunizations2• Mammography• Pap smear• Physicals• PSA (blood test for prostate cancer)• Serum cholesterol test for HDL and LDL levels• Serum protein electrophoresis (blood test for myeloma)• Skin cancer biopsy• Stress test on a bicycle or treadmill• Thermography• ThinPrep pap test• Virtual colonoscopyTo learn more, talk with your Colonial Life benets counselor.IAC4000 – WELLBEING ASSISTANCE BASIC BENEFIT
1 No waiting period in Vermont.2 Immunizations do not include inuenza (u) vaccinations and allergy shots.THIS POLICY 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 coverage.ADDITIONAL DISCLOSURES FOR KENTUCKYWaiting Period: Waiting period means the rst 30 days following each covered person’s coverage effective date during which no benets are payable.Eligibility for Benets: We will pay the benets for a covered accident if any covered person sustains an injury as a result of a covered accident if:• The covered accident occurs while the policy is in force;• The covered accident occurs on or after the policy coverage effective date; • The covered accident is on an accident type listed on the policy schedule; and• The covered accident is not excluded by name or specic description in the policy. What is not covered by this policy: We will not pay benets for losses that are caused by, contributed to by or occurs as a result of the covered person’s felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness or injuries which any covered person intentionally does to himself, war or armed conict. In addition, we also will not pay the Accidental Dismemberment due to Catastrophic Accident benet for injuries that are caused by or are the result of birth or intoxicants, narcotics, and Hallucinogencis. See policy for complete details.Noncancellable: This policy is noncancellable. We have no right to change the premiums we charge on this policy. Any riders attached to this policy may be subject to a change in premium. The premium can be changed following the approval of the Commissioner of Insurance only if we change it on all riders of the same kind in force in the state where the policy was issued.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 information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IAC4000 (including state abbreviations where used, for example: IAC4000-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. © 2024 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 3-24 | 101780-5ColonialLife.com
Cancer InsuranceLevel 2 benetsCancer insurance helps provide nancial protection through a variety of benets. These benets are not only for you but also for your covered family members.BENEFIT DESCRIPTION BENEFIT AMOUNTAir ambulance ............................. $2,000 per tripTransportation to or from a hospital or medical facility [max. of two trips per connement]Ambulance ..................................$250 per tripTransportation to or from a hospital or medical facility [max. of two trips per connement]AnesthesiaAdministered during a surgical procedure for cancer treatment • General anesthesia .... 25% of surgical procedures benet• Local anesthesia ..................... $30 per procedureAnti-nausea medication .......... $40 per day administered or per prescription lledDoctor-prescribed medication for radiation or chemotherapy [$160 monthly max.]Blood/plasma/platelets/immunoglobulins .......$150 per dayA transfusion required during cancer treatment [$10,000 calendar year max.]Bone marrow donor screening ..........................$50Testing in connection with being a potential donor [once per lifetime]Bone marrow or peripheral stem cell donation ......... $500Receiving another person’s bone marrow or stem cells for a transplant [once per lifetime]Bone marrow or peripheral stem cell transplant .......................$4,000 per transplantTransplant you receive in connection with cancer treatment [max. of two bone marrow transplant benets per lifetime]Cancer vaccine .......................................$50An FDA-approved vaccine for the prevention of cancer [once per lifetime]BENEFIT DESCRIPTION BENEFIT AMOUNTCompanion transportation ...................$0.50 per mileCompanion travels by plane, train or bus to accompany a covered cancer patient more than 50 miles one way for treatment [up to $1,000 per round trip]Egg(s) extraction or harvesting/sperm collection and storageExtracted/harvested or collected before chemotherapy or radiation [once per lifetime]• Egg(s) extraction or harvesting/sperm collection ......$700• Egg(s) or sperm storage (cryopreservation) ...........$200Experimental treatment ......................$250 per dayHospital, medical or surgical care for cancer [$12,500 lifetime max.]Family care ...................................$40 per dayInpatient or outpatient treatment for a covered dependent child [$2,000 calendar year max.]Hair/external breast/ voice box prosthesis ................$200 per calendar yearProsthesis needed as a direct result of cancerHome health care services1 ..................... $75 per dayExamples include physical therapy, occupational therapy, speech therapy and audiology; prosthesis and orthopedic appliances; rental or purchase of durable medical equipment [up to 30 days per calendar year or twice the number of days hospital conned, whichever is greater]Hospice (initial or daily care)2 An initial, one-time benet and a daily benet for treatment [$15,000 lifetime max. for both]• Initial hospice care [once per lifetime] ............. $1,000• Daily hospice care ...........................$50 per dayCANCER ASSIST — LEVEL 2
BENEFIT DESCRIPTION BENEFIT AMOUNTHospital connementHospital stay (including intensive care) required for cancer treatment• 30 days or less .............................$150 per day• 31 days or more .............................$300 per dayLodging ...................................... $50 per dayHotel/motel expenses when being treated for cancer more than 50 miles from home [70-day calendar year max.]Medical imaging studies .....................$125 per studySpecic studies for cancer treatment [$250 calendar year max.]Outpatient surgical center ....................$200 per daySurgery at an outpatient center for cancer treatment [$600 calendar year max.]Private full-time nursing services ............... $75 per dayServices while hospital conned other than those regularly furnished by the hospitalProsthetic device/articial limb ....$1,500 per device or limbA surgical implant needed because of cancer surgery [payable one per site, $3,000 lifetime max.]Radiation/chemotherapyWeekly benet [max. once per week]• Injected chemotherapy by medical personnel .........$500• Radiation delivered by medical personnel ............$500Monthly chemotherapy benet [max. once per month]• Self-injected ......................................$200• Pump ............................................$200• Topical ...........................................$200• Oral hormonal [1–24 months] ........................$200• Oral hormonal [25+ months] ........................$100• Oral non-hormonal .................................$200BENEFIT DESCRIPTION BENEFIT AMOUNTReconstructive surgery3 ...............$40 per surgical unitA surgery to reconstruct anatomic defects that result from cancer treatment [up to $2,500 per procedure, including 25% for general anesthesia]Second medical opinion4 ............................. $200A second physician’s opinion on cancer surgery or treatment [once per lifetime]Skilled nursing care facility. . . . . . . . . . . . . . . . . . . . $100 per dayConnement to a covered facility after hospital release [up to the number of days paid for hospital connement]Skin cancer initial diagnosis .......................... $300A skin cancer diagnosis while the policy is in force [once per lifetime]Supportive or protective care drugs and colony stimulating factors ................ $100 per dayDoctor-prescribed drugs to enhance or modify radiation/chemotherapy treatments [$800 calendar year max.] Surgical procedures ...................$50 per surgical unitInpatient or outpatient surgery for cancer treatment [$3,000 max. per procedure]Transportation ..............................$0.50 per mileTravel expenses when being treated for cancer more than 50 miles from home [up to $1,000 per round trip]Waiver of premium .............................Is availableNo premiums due if the named insured is disabled longer than 90 consecutive daysFor more information, talk with your Colonial Life benets counselor.In MD, Tobacco cessation benet available. $20 per prescription lled, maximum of two 90-day prescriptions per covered person.In MT, Mammography benet available. $70 for one baseline mammogram for ages 35–39; one mammogram every two years for ages 40–49; one mammogram each year for ages 50+.1. In CO, Home health care services maximum is up to 60 days per calendar year or twice the number of days hospital conned, whichever is greater. In WI, Home health care services maximum is up to 40 days per calendar year or twice the number of days hospital conned, whichever is greater.2. In CO, no hospice benet available.3. In OK, Reconstructive surgery is $20 per surgical unit.4. In MD, Second medical opinion is $50 maximum of one per covered person per hospital connement. THIS POLICY PROVIDES LIMITED BENEFITS.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form CanAssist (including state abbreviations where used, for example: CanAssist-TX). This chart is not complete without form number 1170702 (Exclusions & Limitations) in states CO, ID, MD, MN, MO, NC, OK, SC, SD, VT and WA. 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© 2022 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 7-22 | 101483-4ColonialLife.com
Cancer InsuranceLevel 3 benetsCancer insurance helps provide nancial protection through a variety of benets. These benets are not only for you but also for your covered family members.BENEFIT DESCRIPTION BENEFIT AMOUNTAir ambulance ............................. $2,000 per tripTransportation to or from a hospital or medical facility [max. of two trips per connement]Ambulance ..................................$250 per tripTransportation to or from a hospital or medical facility [max. of two trips per connement]AnesthesiaAdministered during a surgical procedure for cancer treatment • General anesthesia .... 25% of surgical procedures benet• Local anesthesia ..................... $40 per procedureAnti-nausea medication ...........$50 per day administered or per prescription lledDoctor-prescribed medication for radiation or chemotherapy [$200 monthly max.]Blood/plasma/platelets/immunoglobulins .......$175 per dayA transfusion required during cancer treatment [$10,000 calendar year max.]Bone marrow donor screening ..........................$50Testing in connection with being a potential donor [once per lifetime]Bone marrow or peripheral stem cell donation ......... $750Receiving another person’s bone marrow or stem cells for a transplant [once per lifetime]Bone marrow or peripheral stem cell transplant ....................... $7,000 per transplantTransplant you receive in connection with cancer treatment [max. of two bone marrow transplant benets per lifetime]Cancer vaccine .......................................$50An FDA-approved vaccine for the prevention of cancer [once per lifetime]BENEFIT DESCRIPTION BENEFIT AMOUNTCompanion transportation ...................$0.50 per mileCompanion travels by plane, train or bus to accompany a covered cancer patient more than 50 miles one way for treatment [up to $1,200 per round trip]Egg(s) extraction or harvesting/sperm collection and storageExtracted/harvested or collected before chemotherapy or radiation [once per lifetime]• Egg(s) extraction or harvesting/sperm collection .... $1,000• Egg(s) or sperm storage (cryopreservation) ...........$350Experimental treatment ......................$300 per dayHospital, medical or surgical care for cancer [$15,000 lifetime max.]Family care ................................... $50 per dayInpatient or outpatient treatment for a covered dependent child [$2,500 calendar year max.]Hair/external breast/ voice box prosthesis ................$350 per calendar yearProsthesis needed as a direct result of cancerHome health care services1 .................... $100 per dayExamples include physical therapy, occupational therapy, speech therapy and audiology; prosthesis and orthopedic appliances; rental or purchase of durable medical equipment [up to 30 days per calendar year or twice the number of days hospital conned, whichever is greater]Hospice (initial or daily care)2 An initial, one-time benet and a daily benet for treatment [$15,000 lifetime max. for both]• Initial hospice care [once per lifetime] ............. $1,000• Daily hospice care ...........................$50 per dayCANCER ASSIST — LEVEL 3
BENEFIT DESCRIPTION BENEFIT AMOUNTHospital connementHospital stay (including intensive care) required for cancer treatment• 30 days or less .............................$250 per day• 31 days or more .............................$500 per dayLodging ...................................... $75 per dayHotel/motel expenses when being treated for cancer more than 50 miles from home [70-day calendar year max.]Medical imaging studies .....................$175 per studySpecic studies for cancer treatment [$350 calendar year max.]Outpatient surgical center ....................$300 per daySurgery at an outpatient center for cancer treatment [$900 calendar year max.]Private full-time nursing services ...............$125 per dayServices while hospital conned other than those regularly furnished by the hospitalProsthetic device/articial limb ....$2,000 per device or limbA surgical implant needed because of cancer surgery [payable one per site, $4,000 lifetime max.]Radiation/chemotherapyWeekly benet [max. once per week]• Injected chemotherapy by medical personnel .........$750• Radiation delivered by medical personnel ............$750Monthly chemotherapy benet [max. once per month]• Self-injected ......................................$300• Pump ............................................$300• Topical ...........................................$300• Oral hormonal [1–24 months] ........................$300• Oral hormonal [25+ months] ........................$150• Oral non-hormonal .................................$300BENEFIT DESCRIPTION BENEFIT AMOUNTReconstructive surgery3 ............... $60 per surgical unitA surgery to reconstruct anatomic defects that result from cancer treatment [up to $3,000 per procedure, including 25% for general anesthesia]Second medical opinion4 ............................. $300A second physician’s opinion on cancer surgery or treatment [once per lifetime]Skilled nursing care facility. . . . . . . . . . . . . . . . . . . . $100 per dayConnement to a covered facility after hospital release [up to the number of days paid for hospital connement]Skin cancer initial diagnosis .......................... $400A skin cancer diagnosis while the policy is in force [once per lifetime]Supportive or protective care drugs and colony stimulating factors .................$150 per dayDoctor-prescribed drugs to enhance or modify radiation/chemotherapy treatments [$1,200 calendar year max.] Surgical procedures ...................$60 per surgical unitInpatient or outpatient surgery for cancer treatment [$5,000 max. per procedure]Transportation ..............................$0.50 per mileTravel expenses when being treated for cancer more than 50 miles from home [up to $1,200 per round trip]Waiver of premium .............................Is availableNo premiums due if the named insured is disabled longer than 90 consecutive daysFor more information, talk with your Colonial Life benets counselor.In MD, Tobacco cessation benet available. $20 per prescription lled, maximum of two 90-day prescriptions per covered person.In MT, Mammography benet available. $70 for one baseline mammogram for ages 35–39; one mammogram every two years for ages 40–49; one mammogram each year for ages 50+.1. In CO, Home health care services maximum is up to 60 days per calendar year or twice the number of days hospital conned, whichever is greater. In WI, Home health care services maximum is up to 40 days per calendar year or twice the number of days hospital conned, whichever is greater.2. In CO, no hospice benet available.3. In OK, Reconstructive surgery is $30 per surgical unit.4. In MD, Second medical opinion is $75 maximum of one per covered person per hospital connement. THIS POLICY PROVIDES LIMITED BENEFITS.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form CanAssist (including state abbreviations where used, for example: CanAssist-TX). This chart is not complete without form number 1170702 (Exclusions & Limitations) in states CO, ID, MD, MN, MO, NC, OK, SC, SD, VT and WA. 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© 2022 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 7-22 | 101484-4ColonialLife.com
*Critical illness benetFOR THE DIAGNOSIS OF THIS COVERED CRITICAL ILLNESS CONDITION:¹ THIS PERCENTAGE OF THE FACE AMOUNT IS PAYABLE: 100%2 100% 100% 100% 100% 100% 100% 100% 25%Subsequent diagnosis of a different critical illness⁴ Subsequent diagnosis of the same critical illness4
For more information, talk with your Colonial Life benets counselor. THIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONS AND LIMITATIONS FOR SPECIFIED CRITICAL ILLNESS ColonialLife.com
*Critical illness benetFOR THE DIAGNOSIS OF THIS COVERED CRITICAL ILLNESS CONDITION:¹ THIS PERCENTAGE OF THE FACE AMOUNT IS PAYABLE: 100% 100% 100% 100% 100% 100% 100% 100% 100% 25%in situ 25%
Subsequent diagnosis of a different critical illness4 Subsequent diagnosis of the same critical illness4 in situCancer vaccine benet . . . . . . . . . . . $50 For more information, talk with your Colonial Life benets counselor. .THIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONS AND LIMITATIONS FOR SPECIFIED CRITICAL ILLNESS ColonialLife.com
Specied Critical Illness Insurance* Exclusions, limitations and additional disclosuresState-specic variations on exclusionsAK: Alcoholism or Drug Addiction Exclusion does not applyCT: Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction; Felonies or Illegal Occupations replaced with FeloniesDE: Alcoholism or Drug Addiction Exclusion does not applyFL: Alcoholism or Drug Addiction Exclusion does not apply; Psychiatric or Psychological Condition Exclusion does not applyID: Alcoholism or Drug Addiction Exclusion does not apply; Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional DisordersIN: Accidents or Sicknesses Occurring While the Policy is not In Force Exclusion addedKY: Alcoholism or Drug Addiction Exclusion does not apply; Hallucinogenics added to Intoxicants and Narcotics ExclusionMD: Alcoholism or Drug Addiction Exclusion does not apply; Felonies or Illegal Occupations Exclusion does not apply; Intoxicants and Narcotics Exclusion does not apply; Suicide or Self-Inicted Injuries Exclusion replaced with Self-Destruction or Self-Inicted InjuriesMO: Alcoholism or Drug Addiction Exclusion replaced with Drug Addiction; Felonies or Illegal Occupations Exclusion replaced with Illegal Activities NH: Intoxicants and Narcotics exclusion does not applyNJ: Alcoholism or Drug Addiction replaced with Drug Addiction; Felonies or Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs; Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional Disease or DisorderOR: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion does not apply; Suicide or Self-Inicted Injuries Exclusion does not apply; Felonies or Illegal Occupations Exclusion replaced with FeloniesSC: Alcoholism or Drug Addiction Exclusion does not apply; Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional Disorders SD: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion does not applyTX: Alcoholism or Drug Addiction Exclusion does not applyUT: Alcoholism or Drug Addiction Exclusion replaced with Alcoholism VT: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion does not apply; Psychiatric or Psychological Condition Exclusion does not apply; War or Armed Conict Exclusion replaced with WarState-specic pre-existing condition limitationsFL: (12/12) Pre-existing Condition means having a sickness or physical condition that during the 12 months immediately preceding the Policy Coverage Effective Date of this policy had manifested itself in such a manner as would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment or for which medical advice, diagnosis, care, or treatment was recommended or received.IA: (12/12) Pre-existing Condition means having a condition for which medical advice or treatment or medication was recommended by a physician or received from a physician within 12 months preceding the Policy Coverage Effective Date of the covered person’s policy.MD: (12/12) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the Policy Coverage Effective Date of this policy. A condition admitted or disclosed on the application will be covered unless the disease or condition is excluded by name or specic description effective on the date of loss. NC: (12/12) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the Policy Coverage Effective Date of this policy. If a covered person is 65 or older when this policy is issued, pre-existing conditions for that covered person will include only conditions specically eliminated by rider.NH: (6/6) Pre-existing condition means having a sickness or physical condition for which any covered person was diagnosed, treated, had medical testing, or received medical advice within 6 months before the Policy Coverage Effective Date of this policy.NJ: (6/6) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken medication within six months before the Policy Coverage Effective Date of this policy. NV: (6/12) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken medication within six months before the Policy Coverage Effective Date of this policy.CRITICAL ILLNESS 1.0
OR: (6/12) Pre-existing Condition means a sickness or physical condition for which any covered person was treated by a doctor, received advice from a doctor or had taken medication prescribed by a doctor within the 6-month period immediately preceding the Policy Coverage Effective Date of this policy.SC: (12/12) Pre-existing Condition means having a sickness or physical condition misrepresented or not revealed in the application for which any covered person was treated, had medical testing, received medical advice, or had taken medication within 12 months before the Policy Coverage Effective Date of this policy.TX: (12/12) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the Policy Coverage Effective Date of this policy (or six months if any covered person is age 65 or older on the Policy Coverage Effective Date of this policy).UT: (6/6) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice, or had taken medication within six months before the Policy Coverage Effective Date of this policy.WY: (6/12) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken medication within six months before the Policy Coverage Effective Date of this policy.Additional disclosures for KentuckyEligibility for benets: We will pay the benet if a covered person is diagnosed with one of the Specied Critical Illnesses shown on the Policy Schedule if: • the Date of Diagnosis is while this policy is in force; and • it is not excluded by name or specic description in this policy. Guaranteed renewable: The policy is guaranteed renewable as long as you pay the premiums when they are due or within the grace period, up to date of payment of the Maximum Benet Amount for Specied Critical Illness as shown on the Policy Schedule. Your premium can be changed only if we change it on all policies of this kind in force in the state where the policy was issued.Benet reduction: The Face Amount(s) will reduce by 50% on the rst Policy Anniversary Date after the named insured attains age 75. What is not covered by this policy: We will not pay benets for a Specied Critical Illness that occurs as a result of a covered person’s: felonies or illegal occupations; intoxicants, narcotics and hallucinogenics; pre-existing condition; psychiatric or psychological condition; suicide or self-inicted injuries; war or armed conict. See policy for complete details.We will not pay benets for a Specied Critical Illness that occurs as a result of a covered person’s having a pre-existing condition as dened in this policy and limited by the Time Limits on Certain Defenses provision of this policy. Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the Policy Coverage Effective Date of this policy.ColonialLife.com* Specied Critical Illness Insurance and Critical Illness 1.0 are marketing names of the insurance policy led as “Limited Benet Health Coverage for Specied Critical Illness.” In NH the policy is called “Limited Benet Health Coverage for Specied Disease.” In SC the policy is called “Individual Specied Disease Policy.” In VT, the policy is called “Individual Limited Benet Insurance Policy.” In WY, the policy is called “Limited Benet Coverage for Specied Critical Illness.” In CT and NJ, the policy is called “Limited Policy.” THIS POLICY 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 coverage. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form CI-1.0 (including state abbreviations where used, for example: CI-1.0-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. This form is not complete without base form 101822, 101823, 101824 or 101825.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 10-23 | 1347052-1
For more information, talk with your benefits counselor.Dental InsuranceLevel 1EXCLUSIONS AND LIMITATIONS We will not pay benefits for: coding convention errors, misrepresentations or upcoding, crown replacement services within five years of last placement, inlay or onlay replacement services within five years of last placement, procedures prior to the eective date, procedures prior to the expiration of the waiting period, prosthetic replacement services within five years of last placement, repairs within six months of the initial procedure, sealant limitation (limited to secondary molars for dependent children under age 16 and will not be payable more oen than every five years), teeth missing before the policy coverage eective date, treatment outside of the United States, unlisted procedures, or unrecommended or unrequired services. This list does not include a complete description of each limitation and exclusion. To obtain a complete description of benefits, limitations and exclusions, please refer to the policy or see your Colonial Life benefits counselor.Applicable to policy Dental (including state abbreviations where used, for example: Dental-TX). Coverage may vary by state and may not be available in all states. This is not an insurance contract and only the actual policy provisions will control. IDFS – LEVEL 1 | 11-18 | 101574-2ColonialLife.comDental insurance can help with a variety of dental costs, from routine cleanings to more advanced procedures. These benefits are available for you, your spouse and eligible dependent children. The calendar year maximum for level 1 is $1,400.Dental wellness and radiographic image procedure (X-ray) benefits are not subject to the calendar year maximum. Dental wellness ................................................................................................$25Two wellness exams per covered person per calendar year; exams must be separated by 150 daysNo waiting periodRadiographic image procedure (X-ray) ....................................................................$15One X-ray benefit per calendar year per covered person No waiting periodFillings and basic services .......................................................................... $10 – $2253-month waiting periodPain management and adjunctive services .......................................................$25 – $553-month waiting periodOther preventive services ........................................................................... $15 – $1006-month waiting periodOral surgery, gum treatments and prosthetic repair ......................................... $20 – $1,0006-month waiting periodCrowns and major services ......................................................................... $10 – $35012-month waiting periodMajor prosthetic services .........................................................................$75 – $1,00024-month waiting periodUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
Sample of 400+ covered dental benefits*Dental Wellness and Radiographic Image Procedure (X-ray) benefit categories are not subject to the calendar year maximum. Dental Wellness benefits are limited to two visits per calendar year per covered person. We will pay for one service per visit per covered person, regardless of the number of services performed. The visits must be separated by at least 150 days. Radiographic Image Procedure (X-ray) benefits are limited to one benefit per calendar year per covered person.IDFS – LEVEL 1 | 11-18 | 101574-2Procedure CodesDental DescriptionWaiting PeriodBenefit AmountDental Wellness (Cleanings)*D0120 periodic oral evaluation - established patient None $25D1110 prophylaxis – adult None $25D1120 prophylaxis – child None $25Radiographic Image Procedure (X-ray)*D0210 intra-oral – complete series of radiographic images None $15D0272 bite-wings – two radiographic images None $15D0330 panoramic radiographic images None $15FillingsD2140 amalgam – one surface, primary or permanent 3 months $45D2150 amalgam – two surfaces, primary or permanent 3 months $50D2420 gold foil – two surfaces 3 months $225Pain Management & Adjunctive ServicesD9230 inhalation of nitrous oxide/analgesia, anxiolysis 3 months $25D9223deep sedation/general anesthesia – each subsequent 15-minute increment3 months $55Other Preventive ServicesD1351 sealant – per tooth 6 months $15D1516 space maintainer – fixed – bilateral, maxillary 6 months $100D1517 space maintainer – fixed – bilateral, mandibular 6 months $100Oral Surgery, Gum Treatments, and Prosthetic RepairD7140extraction, erupted tooth or exposed root (elevation and/or forceps removal)6 months $40D7240 removal of impacted tooth – completely bony 6 months $130D7412 excision of benign lesion, complicated 6 months $325D7710 maxilla – open reduction 6 months $1,000Crowns and Major ServicesD2950 core build-up, including any pins when required 12 months $50D2740 crown – porcelain/ceramic 12 months $250D2750 crown – porcelain fused to high noble metal 12 months $250D2530 inlay - metallic – three or more surfaces 12 months $350Major Prosthetic ServicesD6750 retainer crown – porcelain fused to high noble metal 24 months $250D5110 complete denture – maxillary 24 months $350D5140 immediate denture – mandibular 24 months $350D6050 surgical placement – transosteal implant 24 months $1,000For more information, talk with your benefits counselor.ColonialLife.comFor a full listing of the dental codes and benefits available under this plan, visit ColonialLife.com/DentalBenefits or refer to your dental policy.
Dental InsuranceLevel 2EXCLUSIONS AND LIMITATIONS We will not pay benefits for: coding convention errors, misrepresentations or upcoding, crown replacement services within five years of last placement, inlay or onlay replacement services within five years of last placement, procedures prior to the eective date, procedures prior to the expiration of the waiting period, prosthetic replacement services within five years of last placement, repairs within six months of the initial procedure, sealant limitation (limited to secondary molars for dependent children under age 16 and will not be payable more oen than every five years), teeth missing before the policy coverage eective date, treatment outside of the United States, unlisted procedures, or unrecommended or unrequired services. This list does not include a complete description of each limitation and exclusion. To obtain a complete description of benefits, limitations and exclusions, please refer to the policy or see your Colonial Life benefits counselor.Applicable to policy Dental (including state abbreviations where used, for example: Dental-TX). Coverage may vary by state and may not be available in all states. This is not an insurance contract and only the actual policy provisions will control.The policy has exclusions and limitations which may aect any benefits payable. See the actual policy or your Colonial Life benefits counselor for specific provisions. IDFS – LEVEL 2The calendar year maximum for level 2 is $1,600.Dental wellness and radiographic image procedure (X-ray) benefits are not subject to the calendar year maximum. Dental wellness ................................................................................................$50Two wellness exams per covered person per calendar year; exams must be separated by 150 daysNo waiting periodRadiographic image procedure (X-ray) ....................................................................$35One X-ray benefit per calendar year per covered person No waiting periodFillings and basic services .......................................................................... $15 – $2503-month waiting periodPain management and adjunctive services .......................................................$30 – $603-month waiting periodOther preventive services ........................................................................... $20 – $1106-month waiting periodOral surgery, gum treatments and prosthetic repair ......................................... $30 – $1,2006-month waiting periodCrowns and major services ......................................................................... $15 – $37512-month waiting periodMajor prosthetic services .........................................................................$90 – $1,20024-month waiting periodFor more information, talk with your benefits counselor.ColonialLife.comDental insurance can help with a variety of dental costs, from routine cleanings to more advanced procedures. These benefits are available for you, your spouse and eligible dependent children.
*Dental Wellness and Radiographic Image Procedure (X-ray) benefit categories are not subject to the calendar year maximum. Dental Wellness benefits are limited to two visits per calendar year per covered person. We will pay for one service per visit per covered person, regardless of the number of services performed. The visits must be separated by at least 150 days. Radiographic Image Procedure (X-ray) benefits are limited to one benefit per calendar year per covered person.4-18 | 101592-2Procedure CodesDental DescriptionWaiting PeriodBenefit AmountDental Wellness (Cleanings)*D0120 periodic oral evaluation - established patient None $50D1110 prophylaxis – adult None $50D1120 prophylaxis – child None $50Radiographic Image Procedure (X-ray)*D0210 intra-oral – complete series of radiographic images None $35D0272 bite-wings – two radiographic images None $35D0330 panoramic radiographic images None $35FillingsD2140 amalgam – one surface, primary or permanent 3 months $60D2150 amalgam – two surfaces, primary or permanent 3 months $65D2420 gold foil – two surfaces 3 months $250Pain Management & Adjunctive ServicesD9230 inhalation of nitrous oxide/analgesia, anxiolysis 3 months $30D9223deep sedation/general anesthesia – each 15 minute increment3 months $60Other Preventive ServicesD1351 sealant – per tooth 6 months $20D1515 space maintainer – fixed – bilateral 6 months $110Oral Surgery, Gum Treatments, and Prosthetic RepairD7140extraction, erupted tooth or exposed root (elevation and/or forceps removal)6 months $45D7240 removal of impacted tooth – completely bony 6 months $150D7412 excision of benign lesion, complicated 6 months $375D7710 maxilla – open reduction 6 months $1,200Crowns and Major ServicesD2950 core build-up, including any pins when required 12 months $60D2740 crown – porcelain/ceramic substrate 12 months $325D2750 crown – porcelain fused to high noble metal 12 months $325D2530 inlay - metallic – three or more surfaces 12 months $375Major Prosthetic ServicesD6750 retainer crown – porcelain fused to high noble metal 24 months $325D5110 complete denture – maxillary 24 months $425D5140 immediate denture – mandibular 24 months $425D6050 surgical placement – transosteal implant 24 months $1,200For a full listing of the dental codes and benefits available under this plan, visit ColonialLife.com/DentalBenefits or refer to your dental policy.ColonialLife.comSample of 400+ covered dental benefitsUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
Dental InsuranceLevel 3EXCLUSIONS AND LIMITATIONS We will not pay benefits for: coding convention errors, misrepresentations or upcoding, crown replacement services within five years of last placement, inlay or onlay replacement services within five years of last placement, procedures prior to the eective date, procedures prior to the expiration of the waiting period, prosthetic replacement services within five years of last placement, repairs within six months of the initial procedure, sealant limitation (limited to secondary molars for dependent children under age 16 and will not be payable more oen than every five years), teeth missing before the policy coverage eective date, treatment outside of the United States, unlisted procedures, or unrecommended or unrequired services. This list does not include a complete description of each limitation and exclusion. To obtain a complete description of benefits, limitations and exclusions, please refer to the policy or see your Colonial Life benefits counselor.Applicable to policy Dental (including state abbreviations where used, for example: Dental-TX). Coverage may vary by state and may not be available in all states. This is not an insurance contract and only the actual policy provisions will control. IDFS – LEVEL 3 The calendar year maximum for level 3 is $1,800.Dental wellness and radiographic image procedure (X-ray) benefits are not subject to the calendar year maximum. Dental wellness ................................................................................................$50Two wellness exams per covered person per calendar year; exams must be separated by 150 daysNo waiting periodRadiographic image procedure (X-ray) ....................................................................$35One X-ray benefit per calendar year per covered person No waiting periodFillings and basic services .......................................................................... $15 – $2753-month waiting periodPain management and adjunctive services .......................................................$35 – $653-month waiting periodOther preventive services ........................................................................... $20 – $1206-month waiting periodOral surgery, gum treatments and prosthetic repair ......................................... $30 – $1,4006-month waiting periodCrowns and major services ......................................................................... $20 – $42512-month waiting periodMajor prosthetic services ....................................................................... $110 – $1,40024-month waiting periodFor more information, talk with your benefits counselor.ColonialLife.comDental insurance can help with a variety of dental costs, from routine cleanings to more advanced procedures. These benefits are available for you, your spouse and eligible dependent children.
*Dental Wellness and Radiographic Image Procedure (X-ray) benefit categories are not subject to the calendar year maximum. Dental Wellness benefits are limited to two visits per calendar year per covered person. We will pay for one service per visit per covered person, regardless of the number of services performed. The visits must be separated by at least 150 days. Radiographic Image Procedure (X-ray) benefits are limited to one benefit per calendar year per covered person.5-18 | 101593-2Procedure CodesDental DescriptionWaiting PeriodBenefit AmountDental Wellness (Cleanings)*D0120 periodic oral evaluation - established patient None $50D1110 prophylaxis – adult None $50D1120 prophylaxis – child None $50Radiographic Image Procedure (X-ray)*D0210 intra-oral – complete series of radiographic images None $35D0272 bite-wings – two radiographic images None $35D0330 panoramic radiographic images None $35FillingsD2140 amalgam – one surface, primary or permanent 3 months $75D2150 amalgam – two surfaces, primary or permanent 3 months $80D2420 gold foil – two surfaces 3 months $275Pain Management & Adjunctive ServicesD9230 inhalation of nitrous oxide/analgesia, anxiolysis 3 months $35D9223deep sedation/general anesthesia – each subsequent 15 minute increment3 months $65Other Preventive ServicesD1351 sealant – per tooth 6 months $20D1515 space maintainer – fixed – bilateral 6 months $120Oral Surgery, Gum Treatments, and Prosthetic RepairD7140extraction, erupted tooth or exposed root (elevation and/or forceps removal)6 months $50D7240 removal of impacted tooth – completely bony 6 months $160D7412 excision of benign lesion, complicated 6 months $400D7710 maxilla – open reduction 6 months $1,400Crowns and Major ServicesD2950 core build-up, including any pins when required 12 months $65D2740 crown – porcelain/ceramic 12 months $375D2750 crown – porcelain fused to high noble metal 12 months $375D2530 inlay - metallic – three or more surfaces 12 months $400Major Prosthetic ServicesD6750 retainer crown – porcelain fused to high noble metal 24 months $375D5110 complete denture – maxillary 24 months $525D5140 immediate denture – mandibular 24 months $525D6050 surgical placement – transosteal implant 24 months $1,400For a full listing of the dental codes and benefits available under this plan, visit ColonialLife.com/DentalBenefits or refer to your dental policy.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.ColonialLife.comSample of 400+ covered dental benefits
Dental InsuranceLevel 4THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONS AND LIMITATIONS We will not pay benefits for: coding convention errors, misrepresentations or upcoding, crown replacement services within five years of last placement, inlay or onlay replacement services within five years of last placement, procedures prior to the eective date, procedures prior to the expiration of the waiting period, prosthetic replacement services within five years of last placement, repairs within six months of the initial procedure, sealant limitation (limited to secondary molars for dependent children under age 16 and will not be payable more oen than every five years), teeth missing before the policy coverage eective date, treatment outside of the United States, unlisted procedures, or unrecommended or unrequired services. This list does not include a complete description of each limitation and exclusion. To obtain a complete description of benefits, limitations and exclusions, please refer to the policy or see your Colonial Life benefits counselor.IDFS – LEVEL The calendar year maximum for level 4 is $2,000.Dental wellness and radiographic image procedure (X-ray) benefits are not subject to the calendar year maximum. Dental wellness ................................................................................................$75Two wellness exams per covered person per calendar year; exams must be separated by 150 daysNo waiting periodRadiographic image procedure (X-ray) ....................................................................$35One X-ray benefit per calendar year per covered person No waiting periodFillings and basic services .......................................................................... $20 – $3753-month waiting periodPain management and adjunctive services ........................................................$45 – $853-month waiting periodOther preventive services .......................................................................... $35 – $1506-month waiting periodOral surgery, gum treatments and prosthetic repair ......................................... $45 – $1,6006-month waiting periodCrowns and major services ......................................................................... $30 – $52012-month waiting periodMajor prosthetic services ....................................................................... $110 – $1,60024-month waiting periodFor more information, talk with your benefits counselor.ColonialLife.comDental insurance can help with a variety of dental costs, from routine cleanings to more advanced procedures. These benefits are available for you, your spouse and eligible dependent children.
*Dental Wellness and Radiographic Image Procedure (X-ray) benefit categories are not subject to the calendar year maximum. Dental Wellness benefits are limited to two visits per calendar year per covered person. We will pay for one service per visit per covered person, regardless of the number of services performed. The visits must be separated by at least 150 days. Radiographic Image Procedure (X-ray) benefits are limited to one benefit per calendar year per covered person. This information is not intended to be a complete description of the insurance coverage available. This policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may aect any benefits payable. Applicable to policy form Dental (including state abbreviations where used, for example: Dental-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. An insurance producer may contact you.3-24 | 101594-3Procedure CodesDental DescriptionWaiting PeriodBenefit AmountDental Wellness (Cleanings)*D0120 periodic oral evaluation – established patient None $75D1110 prophylaxis – adult None $75D1120 prophylaxis – child None $75Radiographic Image Procedure (X-ray)*D0210 intra-oral – complete series of radiographic images None $35D0272 bite-wings – two radiographic images None $35D0330 panoramic radiographic images None $35FillingsD2140 amalgam – one surface, primary or permanent 3 months $100D2150 amalgam – two surfaces, primary or permanent 3 months $110D2420 gold foil – two surfaces 3 months $375Pain Management & Adjunctive ServicesD9230 inhalation of nitrous oxide/analgesia, anxiolysis 3 months $50D9223deep sedation/general anesthesia – each subsequent 15 minute increment3 months $85Other Preventive ServicesD1351 sealant – per tooth 6 months $35D1515 space maintainer – fixed – bilateral 6 months $150Oral Surgery, Gum Treatments, and Prosthetic RepairD7140extraction, erupted tooth or exposed root (elevation and/or forceps removal)6 months $60D7240 removal of impacted tooth – completely bony 6 months $230D7412 excision of benign lesion, complicated 6 months $500D7710 maxilla – open reduction 6 months $1,600Crowns and Major ServicesD2950 core build-up, including any pins when required 12 months $85D2740 crown – porcelain/ceramic 12 months $520D2750 crown – porcelain fused to high noble metal 12 months $520D2530 inlay – metallic – three or more surfaces 12 months $520Major Prosthetic ServicesD6750 retainer crown – porcelain fused to high noble metal 24 months $520D5110 complete denture – maxillary 24 months $665D5140 immediate denture – mandibular 24 months $665D6050 surgical placement – transosteal implant 24 months $1,600For a full listing of the dental codes and benefits available under this plan, visit ColonialLife.com/DentalBenefits or refer to your dental policy.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.ColonialLife.comSample of 400+ covered dental benefits
For more information, talk with your benefits counselor.Dental InsuranceOrthodontic and Vision Benefit RidersTHIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONSOrthodontic benefit rider — This benefit is not payable for dental services when the initial treatment occurs prior to the eective date or before the waiting period ended. The $500 initial treatment benefit is not payable for periodic orthodontic treatment visit (CDT Code D8670). Periodic orthodontic treatment visits are payable as continued orthodontic treatment, subject to all other terms.Vision benefit rider — What is not covered: examinations not performed by an optometrist or ophthalmologist; non-prescribed vision correction materials; services received outside of the United States and refractive error-correction surgeries, including but not limited to laser-assisted in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), radial keratotomy (RK) or intracorneal rings (Intacs).Coverage type and taxability status for both riders will match base policy coverage type and taxability status.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may aect any benefits payable. Applicable to policy form Dental and rider forms R-Ortho and R-Vision. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten 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.IDFS – ORTHODONTIC AND VISION BENEFIT RIDERS | 11-21 | 101588-2ColonialLife.comDental insurance oers two optional benefit riders that can help pay for covered orthodontic and vision expenses. For an additional cost, these riders can provide added protection for you, your spouse and eligible dependent children.Orthodontic benefit riderInitial orthodontic treatment ............................................................................ $500A maximum payment of one per covered person per lifetimeContinued orthodontic treatment ........................................................................$50A maximum payment of one subsequent treatment per month per covered personA lifetime maximum of 18 treatments per covered person The orthodontic benefit rider is subject to a 24-month waiting period. Orthodontic treatment is available for all covered adults and eligible dependents. Lifetime maximum of $1,400 per covered person. Calendar year maximum of $2,800 for all covered persons.Vision benefit riderVision examination ...........................................................................................$50Maximum of one visit per covered person per calendar yearVision correction materials .................................................................................$50Maximum of one benefit for vision correction materials per covered person per calendar yearExamples of covered prescribed vision correction materials: Eyeglasses Sunglasses Sports glasses Spare pairs of glasses Contact lensesThe vision benefit rider is subject to a 30-day waiting period.
1 Active lifestyles benefit applies to any combination of these injuries or services due to a covered accident.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 POLICY PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance.It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this coverage.ADDITIONAL DISCLOSURES FOR KENTUCKYEligibility for benets: We will pay benefits for a covered accident if any covered person sustains an injury as a result of a covered accident if:• the covered accident occurs while the policy is in force; • the covered accident occurs on or after the policy coverage effective date;• the covered accident is an accident type listed on the policy schedule; and• the covered accident is not excluded by name or specific description in the policy.Noncancellable: This policy is noncancellable. We have no right to change the premiums we charge on this policy. Any riders attached to this policy may be subject to a change in premium. The premium can be changed following the approval of the Commissioner of Insurance only if we change it on all riders of the same kind in force in the state where the policy was issued. What is not covered by this policy: We will not pay benefits for losses that are caused by, contributed to by or occur as a result of the covered person’s felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness or injuries which any covered person intentionally does to himself, war or armed conict. In addition, we also will not pay the Accidental Dismemberment due to Catastrophic Accident benefit for injuries that are caused by or are the result of birth or intoxicants, narcotics and hallucinogencis. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. Applicable to policy form IAC4000 (including state abbreviations where used, for example: IAC4000-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. An insurance producer may contact you.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 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 3-24 | 101778-3ColonialLife.com
Individual Short Term Disability InsuranceIf a covered accident or covered sickness prevents you from earning a paycheck, Individual Short Term Disability Insurance can provide a monthly benet to help you cover your ongoing expenses. Use the worksheet on this page to see how this coverage can help ll gaps so you can focus on recovery.Disability Insurance Worksheet You can tailor disability coverage to t your specic needs. Talk with your benets counselor about your expenses and other disability benets to help determine the coverage that’s right for you.MONTHLY 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) $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 $6,500. Subject to income requirements. If your plan includes on-job accident/on-job 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: daysISTD 3000 DISABILITY INSURANCE
Frequently asked questions Whatisthedenitionoftotaldisability?“Totally disabled” or “total disability” means you are unable to perform the material and substantial duties of your job, not working at any job, 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.Whatiswaiverofpremium?We will waive your premium payments after 90 consecutive days of a covered disability.Whataretheageguidelinestoqualifyforthiscoverage?Coverage is available from ages 17 to 74.CanIkeepmycoverageifIchangejobsoremployers?You can keep your coverage to age 75, even if you change jobs, as long as you pay your premiums when they are due.WhathappensifIamdisabledwhiletravelingoutsideofthecountry?If you are disabled while outside of the United States, Canada, Mexico, Puerto Rico, Bahama Islands, Virgin Islands, Bermuda or Jamaica, 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.ColonialLife.comEXCLUSIONS AND LIMITATIONSWe will not pay benets for losses that are caused by, contributed to by or occur as the result of: cosmetic surgery, felonies or illegal occupations, ying, hazardous avocations, intoxicants and narcotics, psychiatric or psychological conditions, racing, semi-professional or professional sports, substance abuse, 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 policy. We will not pay for loss when the disability is a pre-existing condition as described in the policy.Pre-existing condition means a sickness or physical condition, whether diagnosed or not, for which you were treated by a physician, had medical testing, received medical advice from a physician or had taken medication prescribed by a physician within 12 months before the policy coverage effective date.After this policy has been in force for 12 months from the policy coverage effective date shown on the policy schedule, we will pay benets for any pre-existing condition not excluded by name or specic description if the covered disability began at least 12 months after the policy coverage effective date and the elimination period has been satised.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form ISTD3000-OR and rider form ISTD3000-ADIB-OR. 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 10-23 | 101629-3-OR
Term Life InsurancePeace of mind for you and your loved ones You want what’s best for your family, and that includes making sure they’re prepared for the future. With term life insurance from Colonial Life & Accident Insurance Company, you can provide nancial security to help them cover their ongoing living expenses.Advantages of term life insurance Lower cost when compared to cash value life insurance Same benet payout throughout the duration of the policy Several term period options for exibility during high-need years Benet for the beneciary that is typically tax freeBenets and features• Stand-alone spouse policy available whether or not you buy a policy for yourself• Guaranteed premiums that do not increase during the selected term• Ability to convert all or a portion of the benet amount into cash value life insurance• Flexibility to keep the policy if you change jobs or retire• Built-in terminal illness accelerated death benet that provides up to 75% of the policy’s death benet (up to $150,000) if you’re diagnosed with a terminal illness1• Premium savings for face amounts over $250,000 based on your health44% of Americans say their household would face nancial hardship within six months should a wage earner die unexpectedly.LIMRA, 2022 Life Insurance Barometer Study.GAP54% of Americans have life insurance coverage, with an average coverage gap of $200,000.LIMRA, 2021 “Industry Associations Unite to Help Address the Life Insurance Coverage Gap in the United States.”TERM LIFE (ITL5000)
Optional ridersAt an additional cost, you can purchase the following riders for even more nancial protection.Spouse term life riderYour spouse can have up to $50,000 of coverage for a 10-year or 20-year term period.Children’s term life riderYou can purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy — not both.Accidental death benet riderThe beneciary may receive an additional benet if the covered person dies as a result of an accident before age 70. The benet doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benet riderIf a licensed health care practitioner certies that you have a chronic illness, you may receive an advance on all or a portion of the death benet, available in a one-time lump sum or monthly payments.1 A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living.² Premiums are waived during the benet period. Critical illness accelerated death benet riderIf you suffer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benet is payable.1 A subsequent diagnosis benet is included.Waiver of premium benet riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period.3How much coverage do you need? YOU $ _________________Select the term period: 10-year 15-year 20-year 30-year SPOUSE $ _____________Select the term period: 10-year 15-year 20-year 30-yearSelect any optional riders: Spouse term life rider $ _____________ face amount for ______-year term period Children’s term life rider $ _____________ face amount Accidental death benet rider Chronic care accelerated death benet rider Critical illness accelerated death benet rider Waiver of premium benet riderTo learn more, talk with your Colonial Life benets counselor.1. Any payout would reduce the death benet. Benets may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benets. 2. Activities of daily living are bathing, continence, dressing, eating, toileting and transferring. 3. You must resume premium payments once you are no longer disabled.EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage effective date or the date of reinstatement, we will not pay the death benet. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy forms ICC18-ITL5000/ITL5000 and rider forms ICC18-R-ITL5000-STR/R-ITL5000-STR, ICC18-R-ITL5000-CTR/R-ITL5000-CTR, ICC18-R-ITL5000-WP/R-ITL5000-WP, ICC18-R-ITL5000-ACCD/R-ITL5000- ACCD, ICC18-R-ITL5000-CI/R-ITL5000-CI, ICC18-R-ITL5000-CC/R-ITL5000-CC (plus state abbreviations where applicable, for example ITL5000-TX). For cost and complete details of the coverage, call or write your Colonial Life benets counselor or the company.Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2022 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 6-22 | 101895-3ColonialLife.com
Whole Life Plus Insurance*You can’t predict your family’s future, but you can prepare for it.Help give your family more peace of mind and coverage for nal expenses with Colonial Life Individual Whole Life Plus insurance.Benets and features Choose the age when your premium payments end — Paid-Up at Age 70 or Paid-Up at Age 100 Stand-alone spouse policy available even without buying a policy for yourself Ability to keep the policy if you change jobs or retire Built-in terminal illness accelerated death benet that provides up to 75% of the policy’s death benet (up to $150,000) if you’re diagnosed with a terminal illness1 Immediate $3,000 claim payment that can help your designated beneciary pay for funeral costs or other expenses Provides cash surrender value at age 100 (when the policy endows)Additional coverage optionsSpouse term riderCover your spouse with a death benet up to $50,000, for 10 or 20 years.Juvenile Whole Life Plus policyPurchase a policy (Paid-Up at Age 70) while children are young and premiums are low — whether or not you buy a policy for yourself. You may also increase the coverage when the child is 18, 21 and 24 without proof of good health. Children’s term riderYou may purchase up to $20,000 in term life insurance coverage for all of your eligible dependent children and pay one premium. The children’s term rider may be added to either your policy or your spouse’s policy — not both.Advantages of Whole Life Plus insurance• Permanent life insurance coverage that stays the same through the life of the policy• Premiums will not increase due to changes in health or age.• Accumulates cash value based on a nonforfeiture interest rate of 3.75%2• Policy loans available, which can be used for emergencies• Benet for the beneciary that is typically tax-freeYour cost will vary based on the amount of coverage you select.WHOLE LIFE PLUS (IWL5000)
Additional coverage options (Continued)Accelerated death benet for long term care services rider3Talk with your benets counselor for more details.Accidental death benet riderAn additional benet may be payable if the covered person dies as a result of an accident before age 70, and doubles if the injury occurs while riding as a fare-paying passenger using public transportation. An additional 25% is payable if the injury occurs while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benet riderIf a licensed health care practitioner certies that you have a chronic illness, you may receive an advance on all or a portion of the death benet, available in a one-time lump sum or monthly payments.1 Talk with your benets counselor for more details.Critical illness accelerated death benet riderIf you suffer a heart attack, stroke or end-stage renal (kidney) failure, a $5,000 benet is payable.1 A subsequent diagnosis benet is included.Guaranteed purchase option riderThis rider allows you to purchase additional whole life coverage — without having to answer health questions — at three different points in the future. The rider may only be added if you are age 50 or younger when you purchase the policy. You may purchase up to your initial face amount, not to exceed a total combined maximum of $100,000 for all options.Waiver of premium benet riderPolicy and rider premiums are waived if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period. Once you are no longer disabled, premiums will resume.Benets worksheetFor use with your benets counselorHow much coverage do you need? YOU $ _______________________Select the option: Paid-Up at Age 70 Paid-Up at Age 100 SPOUSE $ __________________ Select the option: Paid-Up at Age 70 Paid-Up at Age 100 DEPENDENT STUDENT $ ____________________________ Select the option: Paid-Up at Age 70 Paid-Up at Age 100Select any optional riders: Spouse term rider $ _____________ face amount for _________-year term period Children’s term rider $ ______________ face amount Accelerated death benet for long term care services rider Accidental death benet rider Chronic care accelerated death benet rider Critical illness accelerated death benet rider Guaranteed purchase option rider Waiver of premium benet riderTo learn more, talk with your benets counselor.ColonialLife.com* Whole Life Plus is a marketing name of the insurance policy led as “Whole Life Insurance” in most states.1 Any payout would reduce the death benet. Benets may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benets. 2 Accessing the accumulated cash value reduces the death benet by the amount accessed, unless the loan is repaid. Cash value will be reduced by any outstanding loans against the policy.3 The rider is not available in all states. This life insurance does not specically cover funeral goods or services and may not cover the entire cost of your funeral at the time of your death. The beneciary of this life insurance may use the proceeds for any purpose, unless otherwise directed.EXCLUSIONS AND LIMITATIONS: If the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage effective date or the date of reinstatement, we will not pay the death benet. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy forms ICC19-IWL5000-70/IWL5000-70, ICC19-IWL5000-100/IWL5000-100, ICC19-IWL5000J/IWL5000J and rider forms ICC23-IWL5000-LTC/IWL5000-LTC, ICC19-R-IWL5000-STR/R-IWL5000-STR, ICC19-R-IWL5000-CTR/R-IWL5000-CTR, ICC19-R-IWL5000-WP/R-IWL5000-WP, ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD, ICC19-R-IWL5000-CI/R-IWL5000-CI, ICC19-R-IWL5000-CC/R-IWL5000-CC, ICC19-R-IWL5000-GPO/R-IWL5000-GPO (including state abbreviations where applicable). For cost and complete details of the 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 8-23 | 642298-2
Filing online means never waiting for mail or dealing with fax machines and complex paper forms . Our guided question wizard walks you through the process and checks for missing information that could cause delays. Opting for direct deposit can also get approved payments to you up to a week faster than paper check. NEED TO FILE A CLAIM?Here’s what you can do on Colonial Life for Policyholders:Update yourpersonal info& preferencesFile claimswith a simple,guided form Opt for instant alerts by email or textView claim statusor policy details anytimeCheck your claim status by logging into your account at ColonialLife.com/access. You can also sign up for text or email alerts so you know instantly if status changes or more information is needed. For your convenience, you can login anytime with a mobile device to photograph and upload documents with your camera.AFTER YOU FILE:Find out how simple your claims and benefits experience can be by learning more about the Colonial Life for Policyholders portal. Just visit ColonialLife.com to see what this online account administration platform can do for you.LEARN MOREBECOME A MEMBER TODAY:Go to ColonialLife.com/access to register.Click “create an account”, fill out the required information and click Submit.Enjoy faster service and improved benefits awareness.123THE PORTALOFFERS YOU:Faster service than calling/emailingConfirmation when a claim has been submittedSimplified bill payment and managementAnswers to frequently asked questions and live chat assistance if you don’t see what you are looking for.Colonial Life for Policyholders PortalA faster, simpler way to manage your benefitsColonial Life for Policyholders is an online portal created with you in mind. It’s the most convenient and ecient way to file a claim and manage your benefits. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.ADR-1314950Set up directdeposit forapproved payments
OTHER WAYS TO FILE A CLAIM:Fax: 1.800.880.9325Mail: P.O. Box 100195, Columbia, SC 29202Colonial Life is committed to providing you, our valued customer, a market-leading claims experience. We look forward to serving you on ColonialLife.com. Here you’ll find a copy of your policy to see what’s covered and benefit amountsFollow your claim from start to finish and receive alerts if we need additional informationOn thepolicyholdersite you can:View benefit details Track your claim Sign up for direct deposit and receive payment fasterColonial Life products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. Colonial Life & Accident Insurance Company is not licensed in New York. In New York, insurance products are underwritten by The Paul Revere Life Insurance Company, Worcester, MA, and administered by Colonial Life & Accident Insurance Company.©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.ColonialLife.comHow to File a claim for Colonial Life benefitsDIGITALLY FILE ALL TYPES OF CLAIMSDisabilityInsurance Accident, CriticalIllness, HospitalInsurance, CancerInsurance Leaves ofabsence(disability, FMLAmaternity,etc.) LifeInsurance Wellnessbenefits forscreening tests Not sure which type of claim to file? No problem. Just answer a few questions on the website and we’ll help you figure everything out.BEFORE YOU FILE:Review the appropriate claims checklist at ColonialLife.com and have this information handy to make the process go smoothly. Proper documentation must be submitted when filing your claim.AFTER YOU FILE:Check your claim status and manage your claim by logging into your account at ColonialLife.com. If you need to talk to someone, give us a call.FOR FASTEST RESULTS, FILE ONLINE:Go to ColonialLife.com and click Register or Login in the upper-right corner.After selecting Policyholder, fill out the required information and click Submit.Enjoy streamlined claims management and faster service online.1233-21 | NS-598839
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The information contained in this booklet is only a summary of coverage and is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. If there are differences between the information in the booklet and the contract, the contract will govern.NS-15576 (9-17)9-17 | NS-15576ColonialLife.comUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.