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Group Accident Insurance Our coverage includes Premier Plan If 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 bene ts directly to you to use however you like from medical costs to everyday expenses Whether you ve had a fall or a car accident these bene ts can offer nancial support when you need it ene ts payable directly to you No medical questions to qualify for coverage Coverage for simple and complex injuries ene ts payable regardless of other insurance Worldwide coverage BENEFITS STORY Works alongside your Health Savings Account HSA Milo was working in his yard when he tripped and injured his hand With Colonial Life accident bene ts Tilo was able to pay the annual deductible and co payments for his health insurance plan without using his savings or taking on debt MILO S ACCIDENT BENEFITS Tilo went to an urgent care facility and received immediate care Treatment in a physician s office or urgent care facility The doctor ordered an X ray and discovered Tilo had fractured his hand X ray Fracture hand The doctor also found that Tilo had a cut on his hand but did not require stitches Laceration no repair 75 Tilo was discharged with a splint Durable medical equipment 65 Zver the next several weeks Tilo had two follow up appointments with his doctor Physician follow up visits 2 visits 9 Total 150 60 1 200 50 x 2 100 1 650 GtZ P ACCID NT GAC Pt TI t PLAN

ive our ene s a oos We know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life Group Accident includes a ene t ooster to provide additional nancial support for serious accidents If you have more than in payable bene ts for a covered accident we will give you a boost to your bene ts to help you with whatever expenses you have Payable once per Insured per covered accident BENEFITS STORY Olivia was driving to the store when she got into a car accident Zlivia s bene ts helped her cover her medical expenses when she was injured in a car accident helping her to focus on her recovery OLIVIA S ACCIDENT BENEFITS 400 250 250 Olivia arrived by ambulance at the nearest emergency room and received immediate care Ambulance Emergency department visit Injury due to auto accident The doctor ordered an X ray and discovered Olivia had fractured her thigh femur He also ordered a CT scan of her head to check for brain injury X ray Tedical imaging Fracture thigh 60 400 4 200 Olivia required surgery for her leg Surgical repair thigh fracture General anesthesia 4 200 300 Olivia boarded her pet for two nights after her surgery Pet boarding 2 days 20 x 2 40 Olivia had eight sessions of physical therapy to help regain the strength in her leg and two follow up appointments with her doctor Therapy services 8 sessions Physician follow up visits 2 visits 55 x 8 440 50 x 2 100 Olivia s benefits for this accident totaled more than Benefit Booster 9 Total 500 11 140 Bene ts are per covered person per covered accident unless stated otherwise Anjury ene ts Burns based on size and degree 750 21 000 Concussion 500 Connec ive issue damage 100 200 Eye injury 400 Hearing loss injuries 120 Taximum once per lifetime per ear per insured Injury due o au o acciden 250 In ernal injuries 200 Nnee car ilage meniscus injury 200 Oacera ions 75 1 200 Ooss o a digi ar ial 400 800 Ooss o a digi 1 000 3 000 Ru ured or ernia ed disc 200 400

9racture ene ts Injury 200 5 000 nger 2 wrist 2 hip 2 Pros e ic device or ar i cial limb 1 750 3 500 S in gra s due o burns 50 Payable as a of the applicable burn bene t S in gra s no due o burns 375 750 Surgical re air o rac ure 100 Payable as an additional of the applicable fractures bene t Transfusions 500 C i rac ure 25 Payable as a of the applicable fractures bene t Trans or a ion 200 er ri Taximum one way trips islocation ene ts Trea men in a ysician s o ce or urgen care facili y 150 Taximum per year Injury 260 4 000 elbow ankle hip Surgical re air o disloca ion 100 Payable as an additional of the applicable dislocations bene t Incom le e disloca ion 25 Payable as a of the applicable dislocations bene t reat ent ene ts ray or ul rasound 60 wurgery ene ts Anes esia 150 300 Connec ive issue surgery 150 2 200 Eye surgery 400 General surgery Abdominal oracic or cranial 2 000 Air ambulance 2 000 Ex lora ory surgery 275 Ambulance ground or a er 400 Hernia surgery 400 urable medical e ui men 65 250 Nnee car ilage meniscus surgery 150 1 050 Emergency den al re air 200 600 Ou a ien surgical facili y 400 Emergency de ar men 250 Taximum per year Ru ured or ernia ed disc surgery 150 2 000 Family care 50 er day Taximum of one bene t per day for all insureds combined up to a maximum of three days per covered accident regardless of the number of children Injec ions o reven or limi in ec ion 50 Lodging 250 er day Taximum days Medical imaging 400 Pain managemen injec ions 150 Pe boarding 20 er day Taximum of one bene t per day for all insureds combined up to a maximum of three days per covered accident regardless of the number of pets that are boarded tecovery care ene ts A ome care 125 er day Taximum days Bene Boos er 500 P ysician follo u visi s 50 Taximum days per covered accident and 24 days per calendar year Re abili a ion or sub acu e re abili a ion uni con nemen 200 er day Taximum days per covered accident and days per calendar year T era y services s eec ysical era y occu a ional era y 55 er day Taximum days Options checked below have been chosen by your employer to enhance your Group Accident Coverage Recovery Plus package Be avioral eal era y 55 er day Taximum days Pos rauma ic s ress disorder PTS 200 Prescri ion drug 25 Addi ional era y services c iro rac ic acu unc ure al erna ive era y 55 Existing therapy services bene t maximum applies to additional therapy services maximum days Injury due o felonious ac of violence or sexual assaul 250 Taximum once per insured per calendar year with an accompanying police report unshot wound ene t This bene t can help pay your medical expenses if you receive a non fatal gunshot wound It offers you a lump sum for a covered injury regardless of any other insurance you may have and includes on off job coverage Guns o ound _________ This bene t covers a non fatal gunshot wound from a conventional rearm that requires treatment by a doctor and overnight hospitalization within 24 hours of the injury If you are shot more than once in a 24 hour period we can pay bene ts only for the rst wound

Con ac your Colonial Life bene s counselor o learn more CT We will pay the air ambulance or ambulance bene ts directly to the licensed professional ambulance company CT includes a bene t for outpatient emergency medical care for accidental ingestion of a controlled substance The at home care bene t maximum is 8 days KS Chiropractic therapy is not available NH NH includes a burn bene t for 2nd degree burns under of skin surface The minimum bene t for the loss or partial loss of a digit is MD The prescription drug bene t is not available PA The pet boarding bene t is not available TN The therapy services bene t includes chiropractic TX The concussion bene t is replaced by the concussion and acquired brain injuries bene t The therapy services bene t includes the following services cognitive communication therapy cognitive rehabilitation therapy community reintegration services neurobehavioral neurocognitive therapy and rehabilitation neurofeedback therapy neurophysiological neuropsychological post acute transition services psychophysiological testing or treatment and remediation HEALTH SAVINGS ACCOUNT HSA COMPATIBLE This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate It may also be offered to employees who do not have HSAs THIS INSURANCE PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance It is not a substitute for essential health bene ts or minimum essential coverage as de ned in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this insurance EXCLUSIONS We will not pay bene ts for claims that are caused by contributed to by or resulting from elective procedures felonies or illegal occupations hazardous avocations impaired driving incarceration racing semiprofessional or professional sports sickness suicide or self in icted injuries war or armed con ict ID Semi professional sports or professional sports exclusion is replaced by professional sports exclusion IL We will not pay bene ts for claims that are caused by or resulting from Exclusions MD Includes an exclusion for Prohibited referrals The felonies or illegal occupations and impaired driving exclusions apply only to Accidental Death and Dismemberment bene ts MI Impaired driving and suicide or self in icted injuries exclusions do not apply MN Suicide or self in icted injuries exclusion does not apply NH Incarceration and racing exclusions do not apply UT We will not pay bene ts for claims that are caused by or resulting from Exclusions VT Impaired driving exclusion does not apply This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any bene ts payable Applicable to policy form GAC4 P and certi cate form GAC4 C including state abbreviations where used for example GAC4 P TX and GAC4 CTX For cost and complete details of coverage call or write your Colonial Life bene ts counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC 2 2 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company ColonialLife com FOt ETPLO EES 2 2 2

15 000 30 000

Group Hospital Indemnity Insurance Plan 1 HSA Compliant Group Medical BridgeSM insurance can help with medical costs associated with a hospital stay that your health insurance may not cover These benefits are available for you your spouse and eligible dependent children Hospital confinement _______________ per day Maximum of one day per covered person per calendar year Waiver of premium Available after 30 continuous days of a covered confinement of the named insured Daily hospital confinement 100 per day Maximum of 365 days per covered person per confinement Re confinement for the same or related condition within 90 days of discharge is considered a continuation of a previous confinement Health savings account HSA compatible This plan is compatible with HSA guidelines and any other HSA plan that a covered family member may participate in It may also be offered to employees who do not have HSAs For more information talk with your benefits counselor Colonial Life Accident Insurance Company s Group Medical Bridge offers an HSA compatible plan in most states PA Hospital Confinement Admission benefit replaces the Hospital Confinement benefit THIS POLICY PROVIDES LIMITED BENEFITS EXCLUSIONS We will not pay any benefits for injuries received in accidents or for sicknesses which are caused by contributed to by or occur as a result of the following exclusions and limitations a alcoholism or drug addiction b dental procedures c elective procedures and cosmetic surgery d felonies or illegal occupations e mental or nervous disorders f pregnancy of a dependent child g suicide or injuries which any covered person intentionally does to himself or herself h war or i giving birth within the first nine months after the effective date of the certificate j We will not pay benefits for hospital confinement or daily hospital confinement if included of a newborn child following his birth unless he is injured or sick k The policy may have additional exclusions and limitations which may affect any benefits payable ColonialLife com PRE EXISTING CONDITION LIMITATIONS l We will not pay benefits for loss during the first 12 months after the certificate effective date due to a pre existing condition m A pre existing condition is a sickness or physical condition whether diagnosed or not for which a covered person was treated had medical testing received medical advice or had taken medication within the 12 months before the certificate effective date n This limitation applies to the following benefits if applicable Hospital Confinement and Daily Hospital Confinement This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P and certificate form GMB7000 C including state abbreviations where applicable such as policy forms GMB7000 P AU TX and GMB7000 P EE TX and certificate forms GMB7000 C AU TX and GMB7000 C EE TX Coverage may vary by state and may not be available in all states This form is not complete without form 101733 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 GMB7000 PLAN 1 11 18 101917

Group Hospital Indemnity Insurance Exclusions and Limitations STATE SPECIFIC EXCLUSIONS AK a Replaced by intoxicants and narcotics CA k Additional exclusions include intoxicants and controlled substances CT a Replaced by intoxication or drug addiction d Replaced by felonies f Exclusion does not apply DE a Exclusion does not apply IL a Replaced by alcoholism intoxication or drug addiction f Exclusion does not apply g Exclusion does not apply KS a Replaced by intoxicants and narcotics h Replaced by war or armed conflict i Exclusion does not apply KY a Replaced by intoxicants narcotics and hallucinogenics LA a Replaced by intoxicants and narcotics MI g Exclusion does not apply MO a Replaced by drug addiction d Replaced by illegal activities MS a Replaced by intoxicants and narcotics NC i Exclusion does not apply ND a Exclusion does not apply e Exclusion does not apply NV a Exclusion does not apply OH f Exclusion does not apply i Replaced by 270 days PA a Replaced by intoxicants and narcotics c Replaced by cosmetic surgery e Replaced by mental nervous or emotional disorders h Replaced by war or armed conflict SD a Exclusion does not apply TN f Exclusion does not apply TX a Replaced by intoxicants and narcotics VA i Pregnancy resulting from the rape of any covered person which was reported to the police within seven days following its occurrence will be covered to the same extent as any other covered accident The seven day requirement will be extended to 180 days in the case of an act of rape or incest of a female under 13 years of age STATE SPECIFIC PRE EXISTING CONDITION LIMITATIONS IN SD and WY m applies within the six months before the certificate effective date CA m A pre existing condition is a sickness or physical condition for which a covered person was diagnosed or treated within 12 months before the coverage effective date FL m A pre existing condition is a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date Genetic information is not a pre existing condition in the absence of a diagnosis of the condition related to such information IL m A pre existing condition is a sickness or physical condition whether diagnosed or not for which a covered person was treated had medical testing by a legally qualified physician or received medical advice produced symptoms or had taken medication within 12 months before the coverage effective date KS n Surgical Procedure replaces Outpatient Surgical Procedure ME m A pre existing condition is a sickness or physical condition whether diagnosed or not for which a covered person was treated had medical testing or received medical advice within 12 months before the coverage effective date MI l Applies during the first six months after the certificate effective date m applies within the six months before the certificate effective date MO m A pre existing condition means having a sickness or physical condition whether diagnosed or not for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date of this certificate NC m A pre existing condition is those conditions whether diagnosed or not for which a covered person received medical advice diagnosis care or treatment that was received or recommended within the one year period immediately preceding the coverage effective date If you are 65 or older when this certificate is issued preexisting conditions will include only conditions specifically eliminated by a rider ND m A pre existing condition is a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date NV m applies within the six months before the certificate effective date Additionally pre existing condition does not include genetic information in the absence of a diagnosis of the condition related to such information OR m A pre existing condition is a sickness or physical condition whether diagnosed or not for which a covered person was treated by a doctor received advice from a physician or had taken medication prescribed by a doctor within the 12 months period immediately preceding the coverage effective date PA m A pre existing condition is a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage effective date n Hospital Confinement Admission replaces Hospital Confinement CA Lic if applicable _________________ This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P and certificate form GMB7000 C including state abbreviations where applicable such as policy forms GMB7000 P AU TX and GMB7000 P EE TX and certificate forms GMB7000 C AU TX and GMB7000 C EE TX Coverage may vary by state and may not be available in all states 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 11 18 101733 2 GMB7000 EXCLUSIONS AND LIMITATIONS

Group Short Term Disability Insurance If a covered accident or covered sickness prevents you from earning a paycheck group short term disability insurance can provide a monthly bene t to help you cover your ongoing expenses often at a more reasonable rate than individual insurance Disability insurance worksheet ou can tailor disability coverage to t your speci c needs Talk with your bene ts counselor about your expenses and other paid leave bene ts such as state paid medical leave and use this worksheet to help determine the coverage that s right for you DISABILITY INSURANCE WHAT S RIGHT FOR ME 1 How much disability coverage do I need Tonthly bene t amount for off job accident and off job sickness Choose a monthly bene t amount between 4 and Subject to income requirements MONTHLY EXPENSES ROUND TO THE NEAREST HUNDRED Rent or mortgage insurance minor home repairs Transportation car note bus fare insurance gas maintenance Utilities cell phone Wi Fi electricity gas water Bene t period Food and household necessities toiletries cleaning supplies The partial disability bene t period is three months Partial disability bene t is of the total disability amount 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 If your plan includes on job accident sickness bene ts the on job bene t is of the off job amount 2 How long do I want bene ts coverage months 3 When would I like my total disability bene ts to start After an accident days After a sickness days our state s paid medical leave approximate benefits if any Monthly benefit Benefit period up to GROUP DISABILITY INSURANCE BASE

Frequently asked questions What is the de nition of total disability Totally disabled or total disability means you are unable to perform the material and substantial duties of your regular occupation not working at any occupation and under the regular and appropriate care of a doctor How does partial disability work If you are able to return to work part time after at least 4 days of being paid for a total disability you may be able to still receive of your total disability bene t What is waiver of premium We will waive your premium payments after consecutive days of a covered disability What are the age guidelines to qualify for this coverage Coverage is available from ages to 4 To learn more talk with your bene ts counselor Can I keep my coverage if I change jobs or employers Through a feature called portability you may be able to keep your coverage even if you change jobs Talk with your bene ts counselor for details What happens if I am disabled while traveling outside of the country If you are disabled while outside of the United States Canada Texico Puerto Rico Bahama Islands Virgin Islands Bermuda or Jamaica you may receive bene ts for up to days before you have to return to the U S in order to continue receiving bene ts State paid medical leave PTL bene ts fall under state speci c program names Not available in all states EXCLUSIONS AND LIMITATIONS We will not pay bene ts for losses that are caused by contributed to by or occur as the result of alcoholism or drug addiction felonies or illegal occupations ying hazardous avocations intoxicants and narcotics psychiatric or psychological conditions racing semi professional or professional sports suicide or injuries which you intentionally do to yourself war or armed con ict We will not pay for losses due to you giving birth within the rst nine months after the coverage effective date of the certi cate Pre existing condition means a sickness or physical condition whether diagnosed or not for which you were treated had medical testing received medical advice or had taken medication within 2 months before the coverage effective date We will not pay for loss when the disability is a pre existing condition as de ned in this certi cate unless you have satis ed the pre existing condition limitation period typically 2 months shown on the Certi cate Schedule on the date you suffer a loss due to a covered accident or covered sickness This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any bene ts payable Applicable to policy forms GDIS P EE TX GDIS P AU TX and certi cate forms GDIS C EE TX GDIS C AU TX and rider form R GDIS RPO TX For cost and complete details of coverage call or write your Colonial Life bene ts counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC ColonialLife com 2 2 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company FOR ETPLOYEES 8 2 2

Term Life Insurance Peace 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 financial security to help them cover their ongoing living expenses Advantages of term life insurance 1 in 3 married partnered consumers wish their spouse or partner would purchase more life insurance LIMRA 2018 Insurance Barometer Study of Americans would have trouble paying living expenses immediately or within several months if the primary wage earner died 54 Lower cost when compared to cash value life insurance Same benefit payout throughout the duration of the policy Several term period options for flexibility during high need years Benefit for the beneficiary that is typically tax free Benefits 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 benefit amount into cash value life insurance Flexibility to keep the policy if you change jobs or retire Built in terminal illness accelerated death benefit that provides up to 75 of the policy s death benefit up to 150 000 if you re diagnosed with a terminal illness1 Premium savings for face amounts over 250 000 based on your health LIMRA 2017 Insurance Barometer Study TERM LIFE ITL5000

How much coverage do you need Optional riders At an additional cost you can purchase the following riders for even more financial protection Spouse term life rider 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 year Select any optional riders Spouse term life rider _____________ face amount for ________ year term period Children s term life rider _____________ face amount Accidental death benefit rider Your spouse may receive a maximum death benefit of 50 000 10 year and 20 year spouse term riders are available Children s term life rider You 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 benefit rider The beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70 The benefit 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 benefit rider If a licensed health care practitioner certifies that you have a chronic illness you may receive an advance on all or a portion of the death benefit 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 benefit period Chronic care accelerated death benefit rider Critical illness accelerated death benefit rider Critical illness accelerated death benefit rider If you suffer a heart attack myocardial infarction stroke or end stage renal kidney failure a 5 000 benefit is payable 1 A subsequent diagnosis benefit is included Waiver of premium benefit rider Waiver of premium benefit rider Premiums 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 3 To learn more talk with your Colonial Life benefits counselor 1 Any payout would reduce the death benefit Benefits may be taxable as income Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits 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 LIMITATIONS ColonialLife com 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 benefit We will terminate this policy and return the premiums paid without interest Product may vary by state For cost and complete details of the coverage call or write your Colonial Life benefits counselor or the company This brochure is applicable to policy forms ICC18 ITL5000 ITL5000 and rider forms ICC18 R ITL5000 STR R ITL5000STR ICC18 R ITL5000 CTR R ITL5000 CTR ICC18 R ITL5000 WP R ITL5000 WP ICC18 R ITL5000 ACCD R ITL5000ACCD ICC18 R ITL5000 CI R ITL5000 CI ICC18 R ITL5000 CC R ITL5000 CC and applicable state variations Underwritten by Colonial Life Accident Insurance Company Columbia SC 2019 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 6 19 101895 1

Whole Life Insurance You can t predict your family s future but you can be prepared for it You like to think that you ll be there for your family in the years to come But if something happened to you would your family have the income they need In the U S medical spending in the last 12 months of life is nearly 80 000 per person HealthAffairs org End Of Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported July 2017 It s not easy to think about such serious circumstances but it s important to make sure your family is financially protected You can gain peace of mind with whole life insurance from Colonial Life Advantages of whole life insurance Permanent coverage that stays the same throughout the life of the policy Guaranteed level premiums that do not increase because of changes in health or age Access to the policy s cash value through a policy loan for emergencies1 Benefit for the beneficiary that is typically tax free Benefits and features Two plan options to choose what age your premium payments will end Paid Up at Age 70 or Paid Up at Age 100 Stand alone spouse policy available whether or not you buy a policy for yourself Your cost will vary based on the level of coverage you select Talk with your benefits counselor for information about what level of coverage would work best for you Flexibility to keep the policy if you change jobs or retire Built in terminal illness accelerated death benefit that provides up to 75 of the policy s death benefit up to 150 000 if you re diagnosed with a terminal illness2 Immediate 3 000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses Pays cash surrender value at age 100 when the policy endows WHOLE LIFE IWL5000

Benefits worksheet For use with your benefits counselor HOW 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 ____________ Paid Up at Age 70 Paid Up at Age 100 Select any optional riders Spouse term life rider _____________ face amount for ________ year term period Children s term life rider _____________ face amount Accidental death benefit rider Chronic care accelerated death benefit rider Additional coverage options Spouse term life rider Cover your spouse up to a maximum death benefit of 50 000 10 year and 20 year spouse term riders are available Juvenile whole life policy You can purchase a policy while children are young and premiums are low whether or not you buy a policy on yourself You may also increase the coverage when the child is 18 21 and 24 without providing proof of good health The plan is paid up at age 70 Children s term life rider You may 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 benefit rider The beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70 The benefit 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 benefit rider If a licensed health care practitioner certifies that you have a chronic illness you may receive an advance on all or a portion of the death benefit available in a one time lump sum or monthly payments 2 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 bathing continence dressing eating toileting and transferring Premiums are waived during the benefit period Critical illness accelerated death benefit rider If you suffer a heart attack myocardial infarction stroke or end stage renal kidney failure a 5 000 benefit is payable 2 A subsequent diagnosis benefit is included Guaranteed purchase option rider If you are age 50 or younger when you purchase the policy you can add the rider which allows you to purchase additional whole life coverage without having to answer health questions at three different points in the future You may purchase up to your initial face amount not to exceed a total combined maximum of 100 000 for all options Critical illness accelerated death benefit rider Waiver of premium benefit rider Premiums 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 Once you are no longer disabled premium payments will resume Guaranteed purchase option rider 1 Loan should be repaid to protect the policy s value Waiver of premium benefit rider 2 Any payout would reduce the death benefit Benefits may be taxable as income Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits EXCLUSIONS AND LIMITATIONS To learn more talk with your benefits counselor ColonialLife com 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 benefit We will terminate this policy and return the premiums paid without interest minus any loans and loan interest to you Product may vary by state For costs and complete details of the coverage call or write your Colonial Life benefits counselor or the company This brochure is applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms 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 RIWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 RIWL5000 GPO R IWL5000 GPO and applicable state variations Underwritten by Colonial Life Accident Insurance Company Columbia SC 2019 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 6 19 101935

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How can Why my claim still be won t in process I called my they pay insurance my claim It s been two carrier but now months Services I m just more denied confused Do I have mail order prescription benefits Call the Benefit Resource Center BRC We re Here To Help We speak insurance Our Benefits Specialists can help you with Deciding which plan is the best for you Medicare basics with your employer plan Benefit plan policy questions Coordination of benefits Eligibility claim problems with carriers Finding in network providers Information about claim appeals process Access to care issues Allowable family status election changes Obtaining case management services Transition of care when changing carriers Group disability claims Claim escalation appeal resolution Filing claims for out of network services Benefit Resource Center BRC Southwest usi com Toll Free 855 874 0110 Monday through Friday 8 00am to 5 00pm Eastern Central Standard Time

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