Amtex Auto Insurance - Benefits Guide : simplebooklet.com

What Do You Need to Do? 1. Review the “4 Steps to Enroll” flyer. 2. Scan the QR code or click on the link to view your benefits. 3. Also scan the QR code to set up a call with an Enrollment Counselor who can review all lines of coverage with you and a spouse if applicable. 4. All eligible employees must schedule a time to speak with an Enrollment Counselor as new benefits are being offered and everyone must accept or decline via Enrollment Counselor. Please set up your call time as quickly as possibly as time slots may fill up quickly. Open Enrollment is Here! It is time for our Medical Benefit Open Enrollment! It applies to Full Time / W2 employees working 30+ hours per week. The Annual Open Enrollment period allows you to make changes to your benefit enrollment, such as plan selections and adding or removing coverage for yourself or your dependents without a Qualifying Event. Qualifying Events include Death, Divorce, Birth, Marriage, Loss of Coverage or Adoption. If you experience a qualifying event, you have 30 days from the date of the qualifying event to make a change. With out a qualifying event, this is your only time to make a change. Enrollments and changes requested during the Annual Open Enrollment period are effective on: Effective Date: October 1, 2023 Open Enrollment begins September 25, 2023, and ends September 29, 2023. Enrollment will be done via Enrollment Counselors (no paper forms) Please review the next few pages for more information about our Benefits. For questions, be sure to schedule a time with your enrollment counselor as soon as possible!

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(Waived forPreventive Care)Office VisitOral ExamPreventative Care Bite-wing x-raysCleaningFillingsBasic Services Extractions Crown RepairCrownsInlays & BridgesOrthodontia - (Child Only) Lifetime Max.Periodontics / EndodonticsBasicMajorYour Cost Per MonthYour Cost Per Paycheck (52)Your Cost Per MonthYour Cost Per Paycheck (52)$35.52 $8.20 $28.14 $6.49$70.32 $16.23 $55.55 $12.82$92.06 $21.24 $68.59 $15.83$137.33 $31.69 $103.49 $23.88YouYou + Your SpouseYou + Your Child(ren)You + Your Spouse + Child(ren)**These Rates are Not Guaranteed and are Subject to Change Based on Final Enrollment*** This spreadsheet is meant for comparison purposes only. Please see Carrier Plan Summary for complete benefit details.Carryover BenefitUp to $400/year; $1,500 MaxUp to $350/year; $1,250 MaxCost to Cover:Waiting PeriodsN/AN/AN/AN/A$1,000.00N/AMajorMajor80% After Deductible80% After DeductibleMajor Services 50% After Deductible50% After Deductible$0.00$0.00100%100%Annual Deductible $50.00$50.00Annual Maximum$2,000.00$1,500.00UnumUnum90th U&C - Passive PPOFee Schedule - Passive MACAmtex Auto InsuranceAnalysis of Employee BenefitsEffective Date: September 1, 2023Presented by: AssuredPartners of Houston, LLCPrepared by: Carter HulseyYour Vol. Dental Plan - Option 1Your Vol. Dental Plan - Option 2

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EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceAmtex Auto InsuranceWhat else is included?Pregnancy benefitAn extra cleaning for expecting mothers in their 2nd or 3rd trimester.Wellness benefitsOral cancer screenings for patients 40 and older with high risk factors.Unumdentalcare.comUse unumdentalcare.com to search for providers, manage your benefits and learn about good dental health. Features include easy access to ID Cards, claims history and coverage information.Virtual Dental Visits24/7 dental care for dental emergencies when an in-person visit isn’t an option. Available for active dental members*.Visit unumdentalcare.com and click Virtual Dental Visits to get started. Carryover benefitsMembers who take care of their teeth, but use only part of their annual maximum benefit during a benefit period are rewarded with extra benefits in future years! Carryover benefits will be accrued and stored in the insured’s carryover account to be used in the next benefit year.The limits for this policy/certificate are:Passive PPO Passive MAC***Carryover benefit $400 $350Threshold limit $800 $700Carryover account limit$1,500 $1,250Unum Dental™Dental Insurance can help you pay for dental exams, cleanings and other services.Why is this coverage so valuable?Routine dental care keeps your mouth and whole body healthy.Your plan is backed by Unum’s commitment to excellence in customer service.Personalized website to manage your benefits including claims information, ID cards and more.There’s no waiting period for preventive and basic services.How does it work?Good dental care is critical to your overall well-being. With Unum Dental insurance, you can get the attention your teeth need — at a cost you can afford.Unum Dental allows you to see any dentist you choose. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards. You can find in-network providers at unumdentalcare.com.*Virtual dental visits are a preventiveservice and subject to policy year benefit maximum.

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EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceDental carryover benet and how it worksEach benefit year a member must have: • One cleaning, •One regular exam, and •Total dental claims for preventive, basic and major covered procedures paid during the year below the threshold limit. •If all three criteria above are met, a portion of the annual maximum will carry over to the next year.Other Specifications: •Each covered family member receives their own carryover benefit. •Group carryover benefit rider must be in effect for one benefit year before any members can utilize carryover benefits. •A member must be on the plan for a minimum of three months before accruing carryover benefits. •Carryover benefit may be used toward preventive, basic and major covered services only •A member’s carryover account will be eliminated, and the accrued carryover benefits lost if the insured has a break in coverage for any length of time or any reason.Dependent childrenDependent age guidelines vary by state. Please refer to your policy certificate or call our Contact Center at (888) 400-9304.Services not listedIf you expect to require a dental service not included on this brochure, it may still be covered. Please call our Contact Center at (888) 400-9304 to confirm your exact benefits.Alternate treatmentUnum covers the least expensive most commonly used and accepted American Dental Association treatments. Plan members may elect a more expensive treatment, but will be responsible for the cost difference resulting from the more expensive procedure.Coverage details and costsOverview Passive PPO Passive MAC***Benefit Year Maximum*$2,000 $1,500Deductible**$50 in-network and out-of-network Maximum 3 per family$50 in-network and out-of-network Maximum 3 per familyPlan CoinsuranceIn- networkOut-of-NetworkIn- networkOut-of-NetworkClass A Preventive100% 100% 100% 100%Class B Basic80% 80% 80% 80%Class C Major50% 50% 50% 50%Class D Orthodontics50% 50% N/A N/A*Applies to Class A, B and C Services, if applicable **Waived for Class A (applies to Class B and C Services) ***MAC plan - out-of-network providers are reimbursed based on the same discounted fees that are agreed upon for in-network providers. You may pay a lower premium, but your out-of-pocket costs when visiting an out-of-network provider could be greater.Dental CoveragePassive PPO Passive MAC***You$8.20 $6.49You and your spouse$16.23 $12.82You and your children$21.24 $15.83Family$31.69 $23.88†Rates guaranteed for 12 months from the effective date.Weekly cost † Weekly cost †

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EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceCovered Procedures & Waiting PeriodsPassive PPO Passive MAC***CLASS A PREVENTIVE SERVICESWaiting Period: None Waiting Period: None •Routine exams (2 per 12 months) • Routine exams (2 per 12 months) • Prophylaxis (2 per 12 months) – (1 additional cleaning or periodontal maintenance per 12 months, if member is in 2nd or 3rd trimester of pregnancy) • Prophylaxis (2 per 12 months) – (1 additional cleaning or periodontal maintenance per 12 months, if member is in 2nd or 3rd trimester of pregnancy) • Bitewing x-rays (maximum of 4 films; 1 per 12 months) • Bitewing x-rays (maximum of 4 films; 1 per 12 months) • Fluoride treatment for children up to age 16 (1 per 12 months) • Fluoride treatment for children up to age 16 (1 per 12 months) • Sealants for children up to age 16 (permanent molars, 1 per 36 months) • Sealants for children up to age 16 (permanent molars, 1 per 36 months) • Space Maintainers • Space Maintainers • Full mouth/panoramic x-rays (1 per 36 months) • Full mouth/panoramic x-rays (1 per 36 months) • Adjunctive pre-diagnostic oral cancer screening (1 per 12 months for ages 40+) • Adjunctive pre-diagnostic oral cancer screening (1 per 12 months for ages 40+)CLASS B BASIC SERVICESWaiting Period: None Waiting Period: None •Emergency Treatment (1 per 12 months) • Emergency Treatment (1 per 12 months) • Simple restorative services (fillings; Benefit allowed for amalgam restorations on posterior teeth) • Simple restorative services (fillings; Benefit allowed for amalgam restorations on posterior teeth) • Simple extractions • Simple extractions • Oral Surgery (extractions and impacted teeth) • Oral Surgery (extractions and impacted teeth) • Anesthesia (subject to review, covered with complex oral surgery) • Anesthesia (subject to review, covered with complex oral surgery)CLASS C MAJOR SERVICESWaiting Period: None Waiting Period: None •Repair of crown, denture or bridge • Repair of crown, denture or bridge • Inlays and onlays • Inlays and onlays • Non-Surgical periodontics • Non-Surgical periodontics • Surgical periodontics (gum treatments) • Surgical periodontics (gum treatments) • Periodontal maintenance (2 per 12 month in combination with prophylaxis) • Periodontal maintenance (2 per 12 month in combination with prophylaxis) • Endodontics (root canals) • Endodontics (root canals) • Crowns, bridges, dentures and implants • Crowns, bridges, dentures and implantsCLASS D ORTHODONTICSWaiting Period: None •Separate Lifetime Maximum: $1,000 • Up to 25% of lifetime allowance may be payable on initial banding • Dependent children to age 19 only Refer to your certificate of coverage for the services covered under your plan.

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Exclusions and LimitationsThe following dental services are not covered unless stated otherwise in the Certificate of Coverage:• any treatment which is elective or primarily cosmetic in nature and not generally recognized as a generally accepted dental practice by the American Dental Association, as well as any replacement of prior elective or cosmetic restorations;• replacement of a removable device or appliance that is lost, missing or stolen, and for the replacement of removable appliances that have been damaged due to abuse, misuse, or neglect. This may include but not be limited to removable partial dentures or dentures;• replacement of any permanent or removeable device or appliance unless the device or appliance is no longer functional and is older than the limitation in the Schedule of Covered Procedures. This may include but not be limited to bridges, dentures and crowns;• any appliance, service, or procedure performed for the purpose of splinting, to alter vertical dimension or to restore occlusion;• any appliance, service or procedure performed for the purpose of correcting attrition, abrasion, erosion, abfraction, bite registration, or bite analysis;• charges for implants (except noted above), removal of implants, precision or semi-precision attachments, denture duplication, or dentures and any associated surgery, or other customized services or attachments;• services provided for any type of temporomandibular joint (TMJ) dysfunction, muscular, skeletal deficiencies involving TMJ or related structures, myofascial pain.Limitations:• Multiple restorations on one surface are payable as one surface. Multiple surfaces on a single tooth will not be paid as separate restorations. On any given day, more than 8 periapical x-rays or a panoramic film in conjunction with bitewings will be paid as a full mouth radiograph. Pre-estimates are recommended for any treatment expected to exceed $300.Takeover benefits:Takeover benefits apply if we are taking over a comparable benefits plan from another carrier and only if there is no break in coverage between the original plan and the takeover date. Takeover is available to those individuals insured under the employer’s dental plan in effect at the time of the employer’s application. If takeover benefits are included in your benefits, then waiting periods for service will be waived for the individuals currently insured under the employer’s previous plan during the month prior to coverage moving to us. Application of takeover benefits is subject to Underwriting review and approval. New hires with prior-like dental coverage (lapse in coverage must be less than 63 days) will receive takeover credit for the length of time they had with the prior carrier and must provide proof of coverage (including coverage dates) to receive takeover credit (i.e. one page benefit summary, Certificate of Creditable Coverage, etc.). A Network Access plan is available. THIS POLICY PROVIDES LIMITED BENEFITS This brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series Dental 20-GDN or contact your Unum Dental representative. Underwritten by Starmount Life Insurance Company, Baton Rouge, LA.© 2023 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-2026 FOR EMPLOYEES (2-23)unum.com

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EN-376255 FOR EMPLOYEES (1-23) Unum | Vision Insurance Amtex Auto InsuranceUnum Vision® Powered by EyeMedHow much does it cost? Weekly premiumYou $1.47You and your spouse $2.93You and your children $3.31Family $5.16Plan features:Members have the freedom to choose any provider from EyeMed’s Insight Network. Our network offers the right mix of independent, national retail and regional retail providers like Lens Crafters, Pearle Vision, Target Optical and many more. Members can also purchase glasses and contact lenses online at Glasses.com and ContactsDirect.com.Covered benets:Exam: Each member is entitled to a comprehensive vision exam. An exam co-pay applies and is outlined in the grid at right.Materials: Each member has coverage for covered services and materials. Purchases are subject to benefit frequencies and co-pays. Plan features include: • Frame benefit: You may choose any frame within a provider’s collection, subject to the retail frame allowance listed at right. If the cost is greater than the plan’s benefits, you are responsible for the difference. • Eyeglass lens benefit: Standard plastic (CR-39 Plastic Material) single vision, bifocal, trifocal, and specialty lenses are generally covered after any applicable materials copay. If covered by plan allowance, you are responsible for any cost greater than the plan’s benefit. • Contact lens benefit: Members electing contact lenses instead of eye glass lenses may apply the contact lens allowance to any lenses in the provider’s collection. If the cost is greater than the plan’s benefits, you are responsible for the difference.Laser vision correction: Discounts are available with participating surgery providers across the country (not an insured benefit)EyeMed benets:Vision Care ServicesIn-network Member CostOut-of-network ReimbursementsExam (1 per 12 months)$10 co-pay Up to $40Retinal Imaging BenefitUp to $39 Not coveredStandard Plastic Lenses (1 per 12 months)Single Vision$10 co-pay Up to $30Bifocal$10 co-pay Up to $50Trifocal$10 co-pay Up to $70Lenticular$10 co-pay Up to $70Standard Progressive $75 co-pay Up to $50Premium Progressive LensPremium Progressive Tier 1$95 co-pay Up to $50Premium Progressive Tier 2$105 co-pay Up to $50Premium Progressive Tier 3$120 co-pay Up to $50Premium Progressive Tier 4$75 co-pay (80% of charge less than $120 allowance)Up to $50Lens OptionsPolycarbonate Lenses (under age 19)Covered Up to $32Frames (1 per 24 months)Members may select any frame available$150 allowance Up to $105Contact Lenses (1 per 12 months) In lieu of eyeglass lensesElective$150 allowance Up to $150Non-ElectiveCovered Up to $210Standard Contact Lens Fitting Exam Fee*Up to $40 Not covered*The standard contact lens fitting exam fee applies to a new or existing contact lens user who wears spherical disposable, daily wear, or extended wear lenses only.

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EN-376255 FOR EMPLOYEES (1-23) Unum | Vision Insurance Unum Vision Powered by EyeMed members will receive the following discounts on materials at in-network providers only: • 40% off for a complete second pair of glasses. • 20% off non-prescription sunglasses. • 20% off remaining balance beyond plan coverage.Laser Vision Correction NetworkMembership provides access to preferred pricing. Transactions are handled directly between members and providers. Refractive surgery is an elective procedure and may involve potential risks to patients. This is not an insured benefit. Unum cannot and does not guarantee the outcome of any refractive surgical procedure or a total elimination of the need for glasses or contacts. Providers may not be available in all metropolitan areas. Login to www.eyemedvisioncare.com/unum for a list of participating laser vision correction providers.Hearing Savings Plan included at no additional cost to the member!Unum offers a Hearing Savings Plan at no additional cost, to all of its Unum Vision Powered by EyeMed members. Partnering with Amplifon, the Hearing Savings Plan provides: • 40% off hearing exams at thousands of convenient locations nationwide • Discounted set pricing on thousands of hearing aids, including those with the newest, most advanced technology • Low price guarantee – if you find the same product at a lower price elsewhere, Amplifon will beat it by 5% • 60-day hearing aid trial period with no restocking fees • Free batteries for 2 years with initial purchase • 3-year warranty plus loss and damage coverageOther Unum Vision SpecicationsDependent children: Dependent age guidelines vary by state. Please refer to your policy certificate or contact customer service at (855) 652-8686.Services not listed: If you expect to require a vision service not included on this brochure, it may still be covered. Refer to the member portal at www.eyemedvisioncare.com/unum, to confirm your exact benefits. This is a primary vision care benefit and is intended to cover only eye examinations and/or corrective eyewear. Medical or surgical treatment of eye disease or injury is not provided under this plan. Coverage may not exceed the lesser of actual cost of covered services and materials or the limits of the policy.No benets will be paid for services, materials connected with, or charges arising from:Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; Medical and/or surgical treatment of the eye, eyes or supporting structures; services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; any Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear; Plano (non-prescription) lenses; Non-prescription sunglasses; Two pair of glasses in lieu of bifocals; Services or materials provided by any other group benefit plan providing vision care; Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order; Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Member receives a 20% discount on items not covered by the plan at EyeMed In-Network locations. Discount does not apply to EyeMed Provider’s professional services, or contact lenses. Plan discounts cannot be combined with any other discounts or promotional offers. In certain states, members may be required to pay the full retail rate and not the negotiated discount rate with certain participating providers. Please see EyeMed’s online provider locator to determine which participating providers have agreed to the discounted rate. Discounts on vision materials may not be applicable to certain manufacturers’ products EyeMed Vision Care reserves the right to make changes to the products on each tier and the member out-of-pocket costs. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Service and amounts listed above are subject to change at any time. Fees charged by a Provider for services other than a covered benefit must be paid in full by the Insured Person to the Provider. Such fees or materials are not covered under the Policy. Benefit allowances provide no remaining balance for future use within the same Benefit Frequency.A Network Access plan is available.THIS POLICY PROVIDES LIMITED BENEFITSThis brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series VI-2002, VI-2007 and VI-2019 or contact your Unum Vision representative.Vision plans are marketed by Unum and EyeMed, administered by First American Administrators and underwritten by Starmount Life Insurance Company, Baton Rouge, LA.© 2023 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

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Unum | Term Life Insurance EN-1976 FOR EMPLOYEES (6-22) Amtex Auto InsuranceWho can get Term Life coverage?If you are actively at work at least 30 hours per week, you may apply for coverage for:You: Choose from $10,000 to $400,000 in $10,000 increments, up to 5 times your earnings.You can get up to $130,000. This is the amount of coverage you can qualify for with no medical underwriting.Your spouse:Get up to $100,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.Your spouse can get up to $25,000 with no medical underwriting, if eligible (see delayed effective date).Your children:Get up to $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.The maximum benefit for children live birth to 6 months is $1,000.How does it work?You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.Why is this coverage so valuable?If you buy a minimum of $10,000 of coverage now, you can increase your coverage in the future up to $130,000 to meet your growing needs. There would be no medical underwriting to qualify for coverage.What else is included?A ‘Living’ Benefit — If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit, and may be taxable. These benefit payments may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlements, and may be taxable. Recipients should consult their tax attorney or advisor before utilizing living benefit payments.Waiver of premium — Your cost may be waived if you are totally disabled for a period of time.Portability — You may be able to keep coverage if you leave the company, retire or change the number of hours you work.Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.Term Life and Accidental Death & Dismemberment (AD&D) InsuranceWho can get Term Life coverage?If you are actively at work at least 30 hours per week, you may apply for coverage for:You:Choose from $10,000 to $400,000 in $10,000 increments, up to 5 times your earnings.You can get up to $130,000. This is the amount of coverage you can qualify for with no medical underwriting.Your spouse:Get up to $100,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.Your spouse can get up to $25,000 with no medical underwriting, if eligible (see delayed effective date).Your children:Get up to $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.The maximum benefit for children live birth to 6 months is $1,000.Who can get Accidental Death & Dismemberment (AD&D) coverage?You:Get up to $400,000 of AD&D coverage for yourself in $10,000 increments to a maximum of 5 times your earnings.Your spouse:Get up to $100,000 of AD&D coverage for your spouse in $5,000 increments, if eligible (see delayed effective date).Your children:Get up to $10,000 of coverage for your children in $2,000 increments if eligible (see delayed effective date).No medical underwriting is required for AD&D coverage.

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Unum | Term Life Insurance EN-1976 FOR EMPLOYEES (6-22) 1. Enter the coverage amount you want.2. Divide by the amount shown.3. Multiply by the rate. Use the rate table (at right) to find the rate based on age.(Choose the age you will be when your coverage becomes effective on 09/01/2023. To determine your spouse rate, choose the age the spouse will be when coverage becomes effective on 09/01/2023.)4. Enter your cost.Billed amount may vary slightly.If you apply for coverage above the guaranteed issue amount, you may be subject to medical underwriting which may affect your ability to get the larger coverage amount. In order to purchase coverage for your dependents, you must buy coverage for yourself. Coverage amounts cannot exceed 100% of your coverage amounts. Calculate your costs1 2 3 4Employee $______,000 ÷ $10,000 = $________ X $______ = $_______Spouse $______,000 ÷ $5,000 = $________ X $______ = $_______Child $______,000 ÷ $2,000 = $________ X $______ = $_______Total costSpouse weekly ratePer $5,000 of coverageCost$0.231$0.216$0.273$0.381$0.537$0.885$1.355$2.042$2.888$3.710$6.798$22.839Employee weekly rateAgePer $10,000 of coverageCost15-24 $0.06725-29 $0.09530-34 $0.14835-39 $0.24740-44 $0.34845-49 $0.54950-54 $0.82255-59 $1.13160-64 $1.38565-69 $1.83770-74 $3.36075+ $11.296How much coverage can I get?Child weekly rate$0.243 per $2,000 of coverage1. Enter the AD&D coverage amount you want.2. Divide by the amount shown.3. Multiply by the rate. Use the AD&D rate table (at right) to find the rate.4. Enter your cost.AD&D weekly ratesCoverage amount RateEmployee per $10,000 of coverage $0.078Spouse per $5,000 of coverage $0.044Child per $2,000 of coverage $0.042AD&D1 2 3 4Employee $______,000 ÷ $10,000 = $________ X $0.078 = $_______Spouse $______,000 ÷ $5,000 = $________ X $0.044 = $_______Child $______,000 ÷ $2,000 = $________ X $0.042 = $_______Total cost

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Unum | Term Life Insurance EN-1976 FOR EMPLOYEES (6-22) Exclusions and limitationsActively at workEligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.An unmarried handicapped dependent child who becomes handicapped prior to the child’s attainment age of 26 may be eligible for benefits. Please see your plan administrator for details on eligibility.Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.Exclusions and limitationsLife insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits.AD&D specific exclusions and limitations:Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:• Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)• Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane• War, declared or undeclared, or any act of war• Active participation in a riot• Committing or attempting to commit a crime under state or federal law• The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol.• Intoxication – ‘Being intoxicated’ means your or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.Delayed effective date of coverageInsurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.Delayed Effective Date: if your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.Age ReductionCoverage amounts for Life and AD&D Insurance for you and your dependents will reduce to 65% of the original amount when you reach age 70, and will reduce to 50% of the original amount when you reach age 75. Coverage may not be increased after a reduction.Termination of coverageYour coverage and your dependents’ coverage under the policy ends on the earliest of:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverageIn addition, coverage for any one dependent will end on the earliest of:• The date your coverage under a plan ends• The date your dependent ceases to be an eligible dependent• For a spouse, the date of a divorce or annulment• For dependents, the date of your deathUnum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.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. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.Unum complies with state civil union and domestic partner laws when applicable.Underwritten by:Unum Life Insurance Company of America, Portland, Maine© 2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

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Administered By: Benefit Management Administrators, Inc Minimum Essential Coverage Enrollment Guide Minimum Essential Coverage 7KHUH DUH 78 SUHYHQWLYH VHUYLFHV FRYHUHG DW  XQGHU WKH UHTXLUHG JRYHUQPHQW OLVW RI 3UHYHQWLYH DQG :HOOQHVV %HQHILWV ZKHQ \RX YLVLW D QHWZRUN SURYLGHU 6HUYLFHV FRYHUHG LQFOXGH LPPXQL]DWLRQV EORRG SUHVVXUH VFUHHQLQJV GLDEHWHV DQG FKROHVWHURO VFUHHQLQJV SUHQDWDO YLVLWV IRU SUHJQDQW ZRPHQ DQG PRUH $ IXOO OLVW RI WKH FRYHUHG VHUYLFHV LV LQFOXGHG LQ WKLV LQIRUPDWLRQ0LQLPXP (VVHQWLDO &RYHUDJH 0(& SURYLGHV ILUVW GROODUFRYHUDJH ZLWK DFFHVV WR RQH RI WKH ODUJHVW QDWLRQDO SUHIHUUHGSURYLGHU RUJDQL]DWLRQV 332 DYDLODEOH ZLWK JUHDW GLVFRXQWVDYLQJVIRU0(&EHQHILWV7KHQHWZRUNVDYLQJVFDQDOVREHXVHGIRUVHUYLFHVQRWFRYHUHGE\WKH0(&<RXZLOOKDYHDFFHVVWREHVXUH\RXUSURYLGHULVLQWKH3321HWZRUN7KH 0(& FRPHV ZLWK D PHGLFDO ,' &DUG WKDW QHHGV WR EHSUHVHQWHGWR\RXUPHGLFDOSURYLGHUDW\RXUWLPHRIVHUYLFHIf you have questions about how to use your MEC benefits after you have enrolled, BMA has a toll free customer service telephone line dedicated to your service. Plan Designed for Employees of: This employer sponsored Self-Insured 0LQLPXP (VVHQWLDO &RYHUDJHplan FRYHUVRIWKHJRYHUQPHQW¶V OLVWHG 3UHYHQWLYH DQG :HOOQHVV%HQHILWVZKHQ\RXYLVLWDQHWZRUN SURYLGHU AEA Insurance Agency dba Amtex Auto Insurance

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Benefit Management Administrators, Inc. | 11550 IH10 W Suite 220, San Antonio, TX 78230 | (800) 934-6302 | bmatpa.com 2 Minimum Essential Coverage Minimum Essential Coverage What are the Covered Services in Minimum Essential Coverage?There are over 78 preventive services covered 100% (In-Network) under the MEC plan. SHUYLFes include annual well woman exams, men’s physicals, well child care, immunizations, blood pressure screenings, diabetes and cholesterol screenings, prenatal visits for pregnant women and more. Below is a full list of services: Covered Preventive Services for Adults 1. Abdominal Aortic Aneurysm one-time screening2.Alcohol Misuse screening and counseling3.Aspirin use for men and women of certain ages4. Blood Pressure screening5.Cholesterol screening6.Colorectal Cancer screening7.Depression screening8. Type 2 Diabetes screening9. Diet counseling10. Hepatitis B screening for people at high risk11.Hepatitis C screening12.HIV screening13. Immunization vaccines for adults (Hepatitis A, Hepatitis B,Herpes Zoster, Human Papillomavirus, Influenza (Flu Shot),Measles, Mumps, Rubella, Meningococcal, Pneumococcal,Varicella, Tetanus, Diphtheria, Pertussis14. Obesity screening and counseling15. Sexually Transmitted Infection (STI) prevention counseling16. Tobacco Use screening and cessation17. Syphilis screening for adults at high risk18. PrEP (pre-exposure prophylaxis_ HIV prevention medicationfor HIV-negative adults at high risk19. Lung cancer screening for adults at high risk20. Statin prevention medication for adults at high risk21. Tuberculosis screening for certain adults without symptomsat high risk22.Fall Prevention for adults 65 years and over in a communitysettingCovered Preventive Services for Women, Including Pregnant Women 1. Routine prenatal visits for pregnant women2. Bacteriuria urinary tract or other infection screening forpregnant women3.BRCA counseling about genetic testing for women athigher risk4.Breast Cancer Mammography screenings-Every two years for women 50 and over-As recommended by a provider for women 40-49or women at high risk for breast cancer5. Breast Cancer Chemoprevention counseling for womenat higher risk6. Breastfeeding comprehensive support and counselingfrom trained providers, as well as access tobreastfeeding supplies, for pregnant and nursing women7. Cervical Cancer screening (Pap Smear for women age21-65)8. Chlamydia Infection screening9. Contraception: Food and Drug Administration-approvedcontraceptive methods and patient education andcounseling, not including abortifacient drugs10.Domestic and interpersonal violence screening andcounseling for all women11.Folic Acid supplements for women who may becomepregnant13. Gestational diabetes screening14. Gonorrhea screening for all women at higher risk15. Hepatitis B screening for pregnant women16.Human Immunodeficiency Virus (HIV) screening andcounseling17. Human Papillomavirus (HPV) DNA Test: high risk HPV DNAtesting every three years for women with normal cytologyresults who are 30 or older18. Bone density screening for all women over age 65 or womenage 64 and yonger that have gone through menopause19. Rh Incompatibility screening for all pregnant women andfollow-up testing20.Tobacco Use screening and interventions for all women, andexpanded counseling for pregnant tobacco users21. Sexually Transmitted Infections (STI) counseling for sexuallyactive women22. Syphilis screening for all pregnant women or other women atincreased risk23.Well-woman visits to obtain recommended preventiveservice24.Maternal depression screening for mothers at well-baby visits25. Preeclampsia prevention and screening for pregnant womenwith high blood pressure26.Urinary incontinence screening for women yearly27. Diabetes screening for women with a history of gestationaldiabetes12.PrEP (pre-exposure prophylaxis) HIV prevention medication

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Benefit Management Administrators, Inc. | 11550 IH10 W Suite 220, San Antonio, TX 78230 | (800) 934-6302 | bmatpa.com 3 Minimum Essential Coverage Minimum Essential Coverage Covered Preventive Services for Children 1. Alcohol and Drug Use assessments for adolescents2. Autism screening for children at 18 and 24 months3. Behavioral assessments for children limited to 5assessments up to age 174. Blood Pressure screening5. Depression screening for adolescents age 12 and older6. Developmental screening for children under age 3, andsurveillance throughout childhood7. Dyslipidemia screening for children8.Fluoride supplements for children without Fluoride intheir water source9. Gonorrhea preventive medication for the eyes of allnewborns10. Hearing screening for all newborns11. Height, Weight and Body Mass Index measurementsfor children12. Hematocrit or Hemoglobin screening for children13. Hemoglobinopathies or sickle cell screening fornewborns14. HIV screening for adolescents15. Immunization vaccines for children from birth toage 18—doses, recommended ages, andrecommended populations vary (Hepatitis A,Diphtheria, Tetanus, Pertussis, Hepatitis B,Haemophilus influenzae type b, HumanPapillomavirus, Inactivated Poliovirus, Influenza (FluShot), Measles, Mumps, Rubella, Meningococcal,Pneumococcal, Rotavirus, Varicella16.Iron supplements for children ages 6 to 12 months atrisk for anemia17.Lead screening for children at risk of exposure18.Obesity screening and counseling19.Oral Health risk assessment for children up to age 1020.Phenylketonuria (PKU) screening for this geneticdisorder in newborns21.Sexually Transmitted Infection (STI) preventioncounseling and screening for adolescents at higher risk22.Tuberculin testing for children23.Vision screening for all children24. Bilirubin concentration screening for newborns25. Blood screening for newborns26. Hepatitis B screening for adolescents at a higher risk27. Hypothyroidism screening for newborns28.PrEP (pre-exposure prophylaxis) HIV preventionmedication for HIV-negative adolescents at high risk forgetting HIV29. Well-baby and well-child visitsFor more information regarding preventive care recommendations and immunizations, visit the websites for the Centers for Disease Control and Preventions or the United States Department of Human Services: For Adults: x Preventive Services for Adults: http://www.guideline.gov/browse/by-topic.aspx x Immunization Schedule: http://www.cdc.gov/vaccinesFor Women’s Health: x http://www.cdc.gov/womenFor Men’s Health: x http://www.cdc.gov/menFor Children: x Well child check-ups: http://www.cdc.gov/ncbddd/x Immunization schedule: http://www.cdc.gov/vaccines

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Minimum Essential Coverage Frequently Asked QuestionsHOW CAN I PARTICIPATE IN THIS PROGRAM? All employees that work a minimum of 30 hours per week are eligible to enroll. Eligible dependents include spouses and unmarried children or stepchildren, under age 26. Enroll in the plan by completing and returning the enrollment form. CAN I SIGN UP FOR COVERAGE AT ANY TIME? No, you must sign up for coverage within 30 days of completing your waiting period or during annual open enrollment. If you do not elect coverage during your initial offering, you will not be able to enroll until the next open enrollment period unless you experience a qualifying event. WHAT IS A ‘QUALIFYING EVENT’? At other times during the year besides open enrollment you may request a change in your enrollment when you have a “qualifying event”. A qualifying event is a family status change involving any of the following: 1. Marriage or divorce;2. Birth, Adoption, or change in legal custody of a child;3. A child attaining age 26;4. Death of spouse or child;5. Spouse obtaining new employment or insurance through their work; losing their employment or losing their insurance(non-voluntary)Changes, additions or voluntary cancellations cannot be made at any other times during the year, except during the open enrollment period. HOW ARE MY PREMIUMS PAID? Premiums will be taken pre-tax through payroll deductions as part of a Section 125 plan. You will not be able to change these elections until the next annual enrollment period, unless you have a qualifying event. HOW DO I USE MY MEC PLAN? xThe MEC comes with a Medical ID Card that needs to be presented to your medical provider at time of servicexTell your medical provider that you have a preventive-only service planxCommunicating with your medical provider about your MEC ahead of time will help ensure the services provided arecovered at 100%xIf the claim from the medical provider is coded with the correct preventive service indicator (one of the 63), it will be paidat 100% (In-Network) by the MEC planWHEN CAN I EXPECT TO RECEIVE MY ID CARD AND ENROLLMENT INFORMATION? The benefit kit will be mailed directly to you, at the address indicated on the Enrollment Form. Please allow approximately 2-weeks from the time of enrollment for the kit to arrive in your mailbox.WHO DO I CALL IF I HAVE QUESTIONS ABOUT MY MEC PLAN?LOCAL | ADMINISTRATIVE | EXCELLENCE P.O. Box 781709, San Antonio, TX 78278 | bmatpa.com Customer Service Contacts: BMA800934-63020RQGD\±)ULGD\)URP$0±30&67P.O. Box 781709, San Antonio, TX 78278 CustomerService@bmatpa.com www.bmatpa.com PPO Network: )LUVW+HDOWK1HWZRUN 226-5116 ǁǁǁ͘&ŝƌƐƚŚ,ĞĂůƚŚ>W͘ĐŽŵPrescription Network:EHiM(800) 311-3446www.ehimrx.com

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Benefit Management Administrators, Inc. 11550 IH 10 West, Suite 220 San Antonio, Texas 78230 | (800) 934 – 6302 | www.bmatpa.com | customerservice@bmatpa.com Amtex Auto InsuranceOctober 2023 – September 2024MEC Plus Medical Benefit Plan OverviewMEDICAL BENEFIT PLAN Annual & Lifetime Maximum Benefit For the most current information on participating providers, contact the provider network: First Health Network 1 (800) 226-5116 www.FirstHealthLBP.com Unlimited BenefitNetworkNon-NetworkCalendar Year Deductible$0Not Covered Total Annual Out-of-Pocket Maximum Individual Family $6,450 $12,900 Benefit Network Non-Network Preventative Care $0 Co – Pay Not Covered There are 78 preventive services covered at 100% under the required government list of Preventive and Wellness Benefits when you visit a network provider. Examples of Covered Wellness Procedures Include, but are Not Limited to: • Blood Pressure Screenings, Diabetes and Cholesterol Screenings • Laboratory tests • Routine Physical Exam • Gynecological exam, Annual Well Woman Exam, Annual Pap Smear and Other Routine Lab • Prenatal Visits for Pregnant Women • Well Baby Care Exam/Well Child Care Exam • Routine Immunizations, Immunizations and inoculations • Flu Vaccine/Pneumonia Vaccine • Routine Lab, X-Ray, Diagnostic Testing and Other Medical Screenings • Routine Vision Screening (Under Age 19)• Routine Hearing Screening (Newborns) • Smoking/Tobacco Use Cessation (Limited to 2 Office Visits and a 3 Month Supply of Smoking Cessation Aids Covered Through the Rx Program) • FDA Approved Women’s Contraceptive Methods BenefitNetworkNon-NetworkPhysician Services **All Services are limited to a combined 8 visits per plan year. Not Covered Office Visits Primary Care $15 Co-Pay Specialist $25 Co-Pay Injections, Labs and X-rays (Included with an Office Visit Charge) Included Injections, Labs and X-rays (without an Office Visit Charge) $25 Co-Pay Office visit surgery, surgical injection codes, infusion, hospital visits Not Covered Mental Health & Substance Abuse Services Outpatient Office Visit $25 Co-Pay Inpatient or Partial Day Treatments Not Covered Maternity Services Prenatal Office Visit $25 Co-Pay Ultrasound – office or outpatient setting (limited 3 per Pregnancy) $25 Co-Pay Convenience Care Clinic $10 Co-Pay Urgent Care Facility $25 Co-Pay Diagnostic Lab & X-Ray Office Visit (Services must be rendered in an office or outpatient setting) Plan pays 100% (if billed with an office visit) Independent Free-standing Facility $25 Co-Pay MRI, CT, PET scans – One Call Medical (800) 800-7616 Discount Only

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Benefit Management Administrators, Inc. 11550 IH 10 West, Suite 220 San Antonio, Texas 78230 | (800) 934 – 6302 | www.bmatpa.com | customerservice@bmatpa.com Allergy Care* Office Visit and Serum (Testing Not Covered) Primary Care Provider Specialist Attention Deficit Disorder (ADD & ADHD)* Office Visits & Medication Management (Testing Not Covered) Primary Care Provider Specialist Autism Care* Office Visits & Medication Management (Testing Not Covered) Primary Care Provider Specialist $15 Co-Pay $25 Co-Pay $15 Co-Pay $25 Co-Pay $15 Co-Pay $25 Co-Pay Health e360 Membership by BMA* Member Support: 800.800.7616 – www.mybenefitswork.com Additional Non-Insurance Health Benefits Include: Telemedicine MeMD gives you and your family access to medical help via phone or web any time day or night using MeMD’s nationwide telehealth service and national network of US-licensed medical providers Health Advocacy One-on-one support from professional for medical and insurance related issues.Telephonic EAP Provides effective professional counseling and work/life support to help you cope with life’s ups and downs. Medical Bill Saver™ Experts will attempt to negotiate a reduction in out-of-pocket medical expenses MRI & CT Scans Save 40% 75% on usual charges for imaging services.NurseLine™ Highly trained registered nurses are on-call 24/7 to answer questions for non-urgent concerns. Lab Testing Save 10% to 80% off typical costs of routine lab work.Pharmacy Save 10% to 85% on most prescriptions at 60,000 pharmacies nationwide including, CVS, Walgreens, Target and more. Diabetic Supplies Diabetes can be hard to manage-big savings on supplies can make life easier. Chiropractic Care Save 30% to 50% on X-rays, diagnostic services and treatments.Hearing Aids Save 35% off suggested retail prices (MSRP) on hearing aids at retail locations nationwide. Vitamins Find the best prices online for the most trusted brands of vitamins and wellness products.Dental by Aetna Dental Access® Smile brighter with big savings by utilizing the Aetna Dental Access Provider Network. *Part of the Healthe360 Buy-Up PlanVision Save 10% to 60% on eye exams, glasses, contacts & LASIK *Part of the Healthe360 Buy-Up Plan*Health e-360 Membership is NOT insurance, nor intended as a substitute for insurance. Membership materials contain all limitations, terms and conditions.Administrator: New Benefits, Dallas TX. Prescription Drug Benefit Program / EHiM Pharmacy Help Desk 800.311.3446 – www.ehimrx.com Retail Pharmacy 30 Day Supply Only Generic Contraceptive Drugs All Other Generic Drugs Preferred Brand Non-Preferred Brand $0 $10 Not Covered Not Covered This Plan Overview is intended to be a brief summary of your Benefits and is not to be interpreted as the official benefit plan document. This benefit plan may not cover all of your health care expenses. More complete descriptions of Benefits and the terms under which they are provided are contained in the Plan Document. In case of discrepancy, the Employee Benefit Plan Document shall govern.

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QUANTITY LIMITS FOR CERTAIN MEDICATIONSCertain medications under your program may be subject to quantity limits. Medications that are subject to quantity limits are to help ensure these medications are not utilized inappropriately or recommended maximum dosages are not exceeded. EHIM’sQuantity Limitations are based on FDA-approved dosing recommendations, pharmaceutical guidelines and have been reviewed and approved by our licensed, clinical staff. EHIM PHARMACY NETWORKEHIM has over 62,000 participating pharmacies across the country including all of the major chain pharmacies, regional pharmacies, and most independent pharmacies. You may visit our website at www.ehimrx.com for our National PharmacyDirectory and Pharmacy Locator tool.EHIM PHARMACY HELP DESKEHIM’s Pharmacy Help Desk is available for your convenience 24 hours a day, 7 days per week, 365 days per year. Our toll freenumber is (800) 311-3446 and will be printed on the back of your ID card and on all of our communication pieces. If you haveany questions regarding your benefits or just need help finding a participating pharmacy, please contact our Pharmacy Help Desk. You may also contact our help desk through our website at www.ehimrx.com.Copayment on any Covered Generic Medication that is part of the Generic Plus FormularyEHIM has a national pharmacy network, therefore, youcan receive your medications through any local retail pharmacyof your choosing. If you ever encounter a pharmacy not in our network, please call the EHIM Pharmacy Help Desk and we will enroll the pharmacy into the network. You will be receiving an EHIM ID Card to use at the pharmacy. The ID card will have the employee’s name on every card. All of the ID cards are interchangeable between family members.All members who are 18 or older will receive a card. If an additional ID card is required, please notify your HR Directoror call the EHIM Pharmacy Help Desk at 800-311-3446 to request additional cards.Customer Service 800-311-3446 • 24/7/365EHIM’s main mission is to provide our members with the best customer service possible. If you are experiencing a problem filling a retail or mail orderprescription please contact EHIM’s Pharmacy HelpDesk. For your convenience, our help desk has a representative available 24 hours a day, 7 days a week, 365 days a year. Our toll free number is 1-800-311-3446 and will be printed on the back ofyour ID card for easy reference.Welcome...to EHIM’s Prescription Beneﬁt Program!We are excited to serve you and would like to introduceyou to our program before your beneﬁts begin.Your BenefitsRXEHIM26711 Northwestern Highway, Suite 400 :: Southfield, MI 48033-2154 800-311-3446 :: 248-948-9900 :: www.ehimrx.com26711 Northwestern Highway, Suite 400 :: Southfield, MI 48033-2154 800-311-3446 :: 248-948-9900 :: www.ehimrx.com 00.01$AEA Insurance Agency dba Amtex Auto Insurance Policy Period: September 1st through August 31st 8102/52/5

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Deductions per year: 52 These rates were prepared on 9/24/2023 and are valid for 90 days.Group Disability for TX AAA Risk ClassApplicable to policy forms GDIS-P & GDIS-ClOff-Job Accident and Off-Job Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $400* $1,000* $2,500* $4,000* $7,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $2.24 $5.61 $14.02 N/A N/A50-64 $2.58 $6.46 $16.15 N/A N/A65-74 $3.13 $7.82 $19.56 N/A N/A14 days Accident/14 days Sickness 17-49 $1.45 $3.62 $9.06 $14.49 $27.1750-64 $1.70 $4.25 $10.62 $16.98 $31.8565-74 $2.18 $5.45 $13.62 $21.78 $40.856 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $400* $1,000* $2,500* $4,000* $7,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $2.83 $7.08 $17.71 N/A N/A50-64 $3.74 $9.35 $23.37 N/A N/A65-74 $4.86 $12.16 $30.40 N/A N/A14 days Accident/14 days Sickness 17-49 $1.98 $4.94 $12.35 $19.75 $37.0450-64 $2.49 $6.23 $15.58 $24.92 $46.7365-74 $3.32 $8.31 $20.77 $33.23 $62.31Group Accident for TXApplicable to policy forms GACC1.0-P & GACC1.0-ClOn/Off-Job Accident CoveragePreferredISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY17-99 $3.45 $5.69 $6.59 $8.83Group Medical Bridge (GMB7000) for TXAge-BandedApplicable to Policy Forms GMB7000–P & GMB7000-ClWithout Wellbeing AssistanceHOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 2: $100017-49 $2.19 $3.95 $3.13 $4.8850-59 $2.84 $5.63 $3.77 $6.5760-64 $3.97 $8.26 $4.90 $9.2065-99 $5.56 $11.56 $6.50 $12.50HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-49 $4.36 $7.85 $6.22 $9.7050-59 $5.65 $11.22 $7.51 $13.0760-64 $7.92 $16.48 $9.77 $18.3365-99 $11.10 $23.08 $12.96 $24.93Page 1 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $2.05 $3.01 $2.05 $3.0125-29 $2.64 $3.91 $2.64 $3.9130-34 $3.27 $4.81 $3.27 $4.8135-39 $4.65 $6.92 $4.65 $6.9240-44 $6.04 $9.00 $6.04 $9.0045-49 $8.32 $12.53 $8.32 $12.5350-54 $10.57 $16.06 $10.57 $16.0655-59 $13.69 $20.81 $13.69 $20.8160-64 $18.43 $28.01 $18.43 $28.0165-69 $22.44 $34.17 $22.44 $34.1770-74 $22.44 $34.17 $22.44 $34.17$30,000 17-24 $3.44 $4.99 $3.44 $4.9925-29 $4.62 $6.79 $4.62 $6.7930-34 $5.86 $8.59 $5.86 $8.5935-39 $8.63 $12.81 $8.63 $12.8140-44 $11.40 $16.96 $11.40 $16.9645-49 $15.97 $24.02 $15.97 $24.0250-54 $20.47 $31.09 $20.47 $31.0955-59 $26.70 $40.57 $26.70 $40.5760-64 $36.19 $54.97 $36.19 $54.9765-69 $44.22 $67.29 $44.22 $67.2970-74 $44.22 $67.29 $44.22 $67.29Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $2.89 $4.19 $2.89 $4.1925-29 $3.85 $5.64 $3.85 $5.6430-34 $4.82 $7.10 $4.82 $7.1035-39 $7.04 $10.42 $7.04 $10.4240-44 $9.25 $13.78 $9.25 $13.7845-49 $12.89 $19.42 $12.89 $19.4250-54 $16.49 $25.06 $16.49 $25.0655-59 $21.47 $32.68 $21.47 $32.6860-64 $29.05 $44.21 $29.05 $44.2165-69 $35.49 $54.00 $35.49 $54.0070-74 $35.49 $54.00 $35.53 $54.04(Continued...)Page 2 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitTobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$30,000 17-24 $5.10 $7.34 $5.10 $7.3425-29 $7.04 $10.25 $7.04 $10.2530-34 $8.98 $13.16 $8.98 $13.1635-39 $13.41 $19.80 $13.41 $19.8040-44 $17.84 $26.52 $17.84 $26.5245-49 $25.11 $37.80 $25.11 $37.8050-54 $32.31 $49.09 $32.31 $49.0955-59 $42.28 $64.32 $42.28 $64.3260-64 $57.44 $87.37 $57.44 $87.3765-69 $70.32 $106.96 $70.32 $106.9670-74 $70.32 $106.96 $70.39 $107.03Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base PlanNon-Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00025 $1.55 $2.48 $2.43 $3.18 $3.9435 $1.77 $3.05 $2.67 $3.54 $4.4245 $2.23 $4.20 $5.03 $7.08 $9.1355 $4.16 $9.03 $10.69 $15.57 $20.4665 $9.46 $14.20 $27.48 $40.76 $54.03Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00025 $2.42 $4.66 $4.20 $5.84 $7.4835 $2.70 $5.37 $4.76 $6.68 $8.5945 $3.66 $7.78 $10.49 $15.27 $20.0555 $7.83 $18.19 $24.47 $36.24 $48.0265 $16.18 $23.92 $46.93 $69.93 $92.9320-Year Spouse Term Life BenefitISSUE AGE $10,000 $20,000 $30,000 $40,000 $50,00025 $0.54 $1.09 $1.63 $2.18 $2.7235 $0.65 $1.30 $1.94 $2.59 $3.2445 $1.51 $3.03 $4.54 $6.05 $7.57Children's Term Life BenefitISSUE AGE $10,000 $20,0000-18 $1.15 $2.31(Continued...)Page 3 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Whole Life Plus (IWL5000) for TXApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-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,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100Non-Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00025 $2.12 $5.31 $10.62 $15.92 $21.2335 $2.89 $7.22 $14.44 $21.66 $28.8845 $4.59 $11.47 $22.94 $34.41 $45.8855 $7.49 $18.72 $37.44 $56.16 $74.8865 $13.33 $33.32 $66.63 $99.95 $133.26Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00025 $3.71 $9.27 $18.54 $27.81 $37.0835 $4.51 $11.28 $22.56 $33.84 $45.1145 $6.72 $16.79 $33.59 $50.38 $67.1755 $11.32 $28.31 $56.61 $84.92 $113.2365 $19.36 $48.41 $96.82 $145.23 $193.6520-Year Spouse Term Life BenefitISSUE AGE $10,000 $20,000 $30,000 $40,000 $50,00025 $0.77 $1.53 $2.30 $3.06 $3.8335 $0.97 $1.94 $2.91 $3.88 $4.8645 $1.75 $3.49 $5.24 $6.99 $8.73Children's Term Life BenefitISSUE AGE $10,000 $20,0000-18 $1.15 $2.31Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2023 Colonial Life & Accident Insurance Company"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.(Continued...)Page 4 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Group Disability InsuranceGROUP DISABILITY BASEYou never know when a disability could impact your way of life. Fortunately, there’s a way to help protect your income. If a covered accident or sickness prevents you from earning a paycheck, disability insurance can provide a monthly benefit to help you cover your ongoing expenses.Can you aord to not protect your income? You don’t have the same lifestyle expenses as the next person. That’s why you need disability coverage that can be customized to fit your specific needs.Aer calculating your monthly expenses, your benefits counselor can help you complete the benefits worksheet.ColonialLife.comMONTHLY EXPENSESRound to the nearest hundred.1 Rent or mortgage $2 Transportation $3 Utilities (phone, internet, electricity/gas, water, etc.) $4 Food and necessities $5 Other expenses $ Total monthly expenses (add lines 1-5 together) $Benefits worksheetHow much coverage do I need?Monthly benefit amount for o-job accident and o-job sickness: ______________Choose a monthly benefit amount between $400 and $7,500.*If your plan includes on-job accident/sickness benefits, the benefit is 50% of the o-job amount.What is the benefit period?Benefit period: _______ monthsThe partial disability benefit period is three months.When may my total disability benefits start?Aer an accident: _______ days Aer a sickness: _______ days*Subject to income requirements

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EXCLUSIONS AND LIMITATIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of: alcoholism or drug addiction, felonies or illegal occupations, flying, 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 conflict. We will not pay for losses due to you giving birth within the first nine months aer the coverage eective date of the certificate. We will not pay for loss when the disability is a pre-existing condition as described in the certificate.Pre-Existing Condition means a sickness or physical condition, whether diagnosed or not, for which you were treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage eective date.We will not pay for loss when the disability is a pre-existing condition as defined in this certificate, unless you have satisfied the pre-existing condition limitation period (typically 12 months) shown on the Certificate Schedule on the date you suer a loss due to a covered accident or covered sickness.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form GDIS-P-EE-TX and certificate form GDIS-C-EE-TX. This is not an insurance contract and only the actual policy and certificate provisions will control.Product information and features Total disabilityTotally 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.Partial disabilityIf you are able to return to work part time aer at least 14 days of being paid for a total disability, you may be able to still receive 50% of your total disability benefit.Waiver of premiumWe will waive your premium payments aer 90 consecutive days of a covered disability.Geographical limitationsIf you are disabled while outside of the United States, Mexico or Canada, you may receive benefits for up to 60 days before you have to return to the U.S. Issue ageCoverage is available from ages 17 to 74.PortabilityYou may be able to keep your coverage even if you change jobs.For more information, talk with your benefits counselor.10-19 | 101296-3Underwritten 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.

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For more information, talk with your benefits counselor.Group Hospital Indemnity InsurancePlan 2ColonialLife.comGroup 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 dayMaximum of one day per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered confinement of the named insured£ Daily hospital confinement ................................................................... $100 per dayMaximum 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.£ Diagnostic procedure .................................................................. $_______________ per dayMaximum of one day per covered person per calendar year£ Outpatient surgical procedure¾ Tier 1 .................................................................................... $_______________ per day¾ Tier 2 .................................................................................... $_______________ per dayMaximum of $________________ per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedureGMB7000 – PLAN 2Diagnostic proceduresThe following is a list of common diagnostic procedures that may be covered if the diagnostic procedure benefit is selected.  Breast– Biopsy (incisional, needle, stereotactic)  Cardiac– Angiogram– Arteriogram– Thallium stress test– Transesophageal echocardiogram (TEE)  Diagnostic radiology– Computerized tomography scan (CT scan)– Electroencephalogram (EEG)– Magnetic resonance imaging (MRI)– Myelogram– Nuclear medicine test– Positron emission tomography scan (PET scan)  Digestive– Barium enema/lower GI series– Barium swallow/upper GI series– Esophagogastroduodenoscopy (EGD)  Ear, nose, throat, mouth– Laryngoscopy  Gynecological– Amniocentesis– Cervical biopsy– Cone biopsy– Endometrial biopsy  Liver– Biopsy  Lymphatic– Biopsy  Miscellaneous– Bone marrow aspiration/biopsy  Renal– Biopsy  Respiratory– Biopsy– Bronchoscopy– Pulmonary function test (PFT)  Skin– Biopsy– Excision of lesion  Thyroid– Biopsy  Urologic– Cystoscopy– Hysteroscopy– Loop electrosurgical excisional procedure (LEEP)

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ColonialLife.com©2016 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 6-16 | 101732* Colonoscopy must result in polyp removal or be recommended by a physician for the purposes of treating or diagnosing a sickness.If a covered family member has a qualified high deductible health plan (HDHP) and actively contributes to a health savings account (HSA), their HSA can be disqualified with this coverage. THIS POLICY PROVIDES LIMITED BENEFITS.PRE-EXISTING CONDITION LIMITATION We will not pay benefits for loss during the first 12 months aer the certificate eective date due to a pre-existing condition. 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 eective date.This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy forms GMB7000-P and GMB7000-P-TX. Coverage may vary by state and may not be available in all states.  Breast– Breast reconstruction– Breast reduction  Cardiac– Angioplasty– Cardiac catheterization  Digestive– Exploratory laparoscopy– Laparoscopic appendectomy– Laparoscopic cholecystectomy  Ear, nose, throat, mouth– Ethmoidectomy– Mastoidectomy– Septoplasty– Stapedectomy– Tympanoplasty  Eye– Cataract surgery– Corneal surgery (penetrating keratoplasty)– Glaucoma surgery (trabeculectomy)– Vitrectomy Tier 2 outpatient surgical procedures  Gynecological– Hysterectomy– Myomectomy  Musculoskeletal system– Arthroscopic knee surgery with meniscectomy (knee cartilage repair)– Arthroscopic shoulder surgery– Clavicle resection– Dislocations (open reduction with internal fixation)– Fracture (open reduction with internal fixation)– Removal or implantation of cartilage– Tendon/ligament repair  Thyroid– Excision of a mass  Urologic– LithotripsyThe procedures listed below are only a sampling of the procedures that may be covered if the outpatient surgical procedure benefit is selected. Procedures must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, refer to your certificate.Tier 1 outpatient surgical procedures  Breast– Axillary node dissection– Breast capsulotomy– Lumpectomy  Cardiac– Pacemaker insertion  Digestive– Colonoscopy* – Fistulotomy– Hemorrhoidectomy– Lysis of adhesions  Ear, nose, throat, mouth– Adenoidectomy– Removal of oral lesions– Myringotomy– Tonsillectomy– Tracheostomy– Tympanotomy  Gynecological– Dilation and curettage (D&C)– Endometrial ablation– Lysis of adhesions  Liver– Paracentesis  Musculoskeletal system– Carpal/cubital repair or release– Foot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair)– Removal of orthopedic hardware– Removal of tendon lesion  Skin– Laparoscopic hernia repair– Skin graing

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ColonialLife.comGroup Hospital Indemnity InsuranceExclusions and LimitationsGMB7000 – EXCLUSIONS AND LIMITATIONSGeneral 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 covered person’s:  Addiction to alcohol or drugs, except for drugs taken as prescribed by his physician.  Treatment for dental care or dental procedures, unless treatment is the result of a covered accident.  Undergoing elective procedures or cosmetic surgery. This includes procedures or hospital confinement for complications arising from elective or cosmetic surgery. This does not include congenital birth defects or anomalies of a child, or reconstructive surgery related to a covered sickness or injuries received in a covered accident.  Committing or attempting to commit a felony, or engaging in an illegal occupation.  Having a disorder including but not limited to aective disorders, neurosis, anxiety, stress and adjustment reactions. Alzheimer’s disease and other organic senile dementias are not considered mental or nervous disorders. This exclusion does not apply to inpatient mental and nervous benefit, if included.  Dependent child’s pregnancy, including services rendered to her child aer birth.  Committing or trying to commit suicide or his injuring himself intentionally, whether he is sane or not.  Being exposed to war or any act of war, declared or undeclared, or serving in the armed forces of any country or authority. Losses as a result of acts of terrorism or nuclear release committed by individuals or groups will not be excluded from coverage unless the covered person who suered the loss committed the act of terrorism or nuclear release.Hospital confinement limitationsWe will not pay benefits for hospital confinement or daily hospital confinement, if included, due to any covered person giving birth within the first nine (9) months aer the coverage eective date of the certificate as a result of a normal pregnancy, including cesarean. Complications of pregnancy will be covered to the same extent as any other covered sickness.KS – no birth limitation. TN – adds that complications of pregnancy are those conditions, requiring treatment, whose diagnoses are distinct from pregnancy but are adversely aected by pregnancy or caused by pregnancy. These include, but are not limited to, acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity. This does not include false labor, morning sickness, hyperemesis gravaidarum, and similar conditions associated with the management of a diicult pregnancy.VA – adds that pregnancy resulting from the act of 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. 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.AR – no well baby care limitation.CA – well baby care limitation has special wording that diers from language above. MD – no well baby care limitation.

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12-16 | 101733-1©2016 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy forms GMB7000-P (including state abbreviations, where used, for example: GMB7000-P-TX). Coverage may vary by state and may not be available in all states.Additional state-specific exclusions and limitationsIn the following states, we will not pay any benefits for injuries or sicknesses which are caused by, contributed to by or occur as a result of the covered person’s:AK, LA, MS and TX – being intoxicated or under the influence of any narcotic unless administered on the advice of his doctor/physician. This replaces the alcoholism or drug addiction exclusion above.AR – having a disorder including neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder of any kind. Alzheimer’s disease and other organic senile dementias are not considered mental or nervous disorders. This exclusion does not apply to inpatient mental and nervous benefit, if included. CA – We will not pay any benefits for injuries or sicknesses which are caused by, contributed to by or occurs as a result of the covered person’s: having a treatment for dental care or dental procedures, unless treatment is the result of a covered injury. Intoxicants and Controlled Substances exclusion has been added and means any covered person being intoxicated or under the influence of any controlled substance unless administered on the advice of a physician. Suicide exclusion has special language. DE – no alcoholism or drug addiction exclusion. KS – being intoxicated or under the influence of any narcotic unless administered on the advice of his physician. This replaces the alcoholism or drug addiction exclusion above. The war or armed conflict exclusion is defined as: being exposed to war or any act of war, declared or undeclared, or serving in the armed forces of any country or authority. KY – being intoxicated or under the influence of any narcotic or any hallucinogenic unless administered on the advice of his physician. This replaces the alcoholism or drug addiction exclusion above.MD – no alcoholism or drug addiction exclusion; no felonies or illegal occupations exclusions; no birth limitation. MD’s elective procedures and cosmetic surgery adds the treating provider, acting inde-pendently from us, shall determine whether a procedure is elective or cosmetic. Pregnancy or a depen-dent child adds: However, complications of pregnancy of a dependent child will be covered to the same extent as any other covered sickness. Prohibited Practitioner Referral means the policy will not provide payment of any claim, bill, or other demand or request for payment for health care service provided as a result of a referral prohibited by the Health Occupation Article. MD’s suicide exclusion is defined as com-mitting or trying to commit suicide or his injuring himself intentionally, while sane or insane. The war or armed conflict exclusion is defined as: being exposed to war or any act of war, declared or undeclared, or serving in the armed forces of any country or authority.MO – addiction to drugs, except for drugs taken as prescribed by his physician; and participating or attempting to participate in illegal activities. This replaces the alcoholism and drug addiction, and felonies or illegal occupations exclusions above. MO’s pregnancy of a dependent child exclusion adds that complications of pregnancy will be covered to the same extent as any other covered sickness. MO’s suicide exclusion is defined as committing or trying to commit suicide or his injuring himself intentionally, while sane.NE – commission of or attempting to commit a felony or to which a contributing cause was the covered person engaging in an illegal occupation. This replaces the felonies or illegal occupations exclusion aboveOH – no pregnancy of a dependent child exclusion. The birth limitation is the first 270 days aer the chronic energy deficiency (CED), rather than the first nine months.OK – being exposed to war or any act of war, declared or undeclared, while serving in the military or an auxiliary unit attached to the military or working in an area of war whether voluntarily or as required by an employer. This replaces the war exclusion above. OK’s pregnancy of a dependent child exclusion adds complications of pregnancy, including cesarean births, will be covered to the same extent as any other sickness. SD – committing a felony, or engaging in an illegal occupation. In SD, there’s no alcoholism or drug addiction exclusion. This replaces the felonies or illegal occupations exclusion above.TN – treatment for dental care or dental procedures, unless treatment is the result of a covered accident, except for covered expenses for procedures performed on a minor, eight years or younger, that cannot be safely performed in a dental oice setting. There’s no pregnancy of a dependent child exclusion. UT – being addicted to alcohol or drugs that contribute to, cause the loss, or are over the legal limit, unless you are addicted to a narcotic taken on the advice of a physician; voluntarily participating in, committing or attempting to commit a felony, or engaging in an illegal occupation; having a neurosis, psychoneurosis, psychopathy, psychosis, or any other mental or emotional disease or disorder which does not have a demonstrable organic cause. This exclusion does not apply to inpatient mental and nervous benefit, if included.

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For more information, talk with your benefits counselor.Group Critical Illness InsurancePlan 2 FullIf you’re diagnosed with a covered critical illness or cancer, group critical illness insurance* from Colonial Life can help with your expenses, so you can concentrate on what’s most important – your treatment, care and recovery.*The policy name is Critical Illness and Cancer Group Specified Disease Insurance.For the diagnosis of this covered critical illness condition:1This percentage of the face amount is payable:Heart attack (myocardial infarction) 100%Stroke 100%End-stage renal (kidney) failure 100%Major organ failure 100%Coma 100%Permanent paralysis due to a covered accident 100%Blindness 100%Occupational infectious HIV or occupational infectious hepatitis B, C or D 100%Coronary artery bypass gra surgery/disease225%GROUP CRITICAL CARE PLAN 2 FULLFace amount: $_______________ Critical illness benefitSubsequent diagnosis of a dierent critical illness3If you receive a benefit for a critical illness, and later you are diagnosed with a dierent critical illness, the original percentage of the face amount is payable for that particular critical illness.Subsequent diagnosis of the same critical illness3If you receive a benefit for a critical illness, and later you are diagnosed with the same critical illness, 25% of the original face amount is payable. Critical illness conditions that do not qualify are: coronary artery bypass gra surgery/coronary artery disease2 and occupational infectious HIV or occupational infectious hepatitis B, C or D.ColonialLife.com

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ColonialLife.comCovered cancer benefitsFor this condition:1The amount payable is:Diagnosis of cancer (internal or invasive) 100% of the face amountDiagnosis of carcinoma in situ 25% of the face amountSkin cancer $500Diagnosis of cancer benefitCancer vaccine benefit: ................................................................................$50This benefit is payable if you or your covered family members incur a charge for any FDA-approved cancer vaccine while your certificate is inforce.1 Please refer to the certificate for complete definitions of covered conditions. 2 Benefit for coronary artery disease applicable in lieu of benefit for coronary artery bypass gra surgery when health savings account (HSA) compliant plan is selected.3 Dates of diagnoses of a covered critical illness must be separated by at least 180 days.THIS POLICY PROVIDES LIMITED BENEFITS.Insureds in MA must be covered by comprehensive health insurance before applying for this coverage. EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESSWe will not pay the Critical Illness Benefit or Benefit Payable Upon Subsequent Diagnosis of a Critical Illness that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; psychiatric or psychological conditions; suicide or injuries which any covered person intentionally does to himself; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Diagnosis of Cancer Benefit, Diagnosis of Carcinoma in Situ Benefit, the Cancer Treatment and Care Benefit or the Skin Cancer Benefit for a covered person’s cancer (internal or invasive), carcinoma in situ or skin cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having cancer (internal or invasive), carcinoma in situ or skin cancer. No pre-existing condition limitation will be applied for dependent children who are born or adopted while you are covered under the policy, and who are continuously covered from the date of birth or adoption. This is not an insurance contract and only the actual certificate provisions will control. Applicable to certificate form GCC1.0-C (including state abbreviations where used, for example: GCC1.0-C-TX). The certificate or its provisions may vary or be unavailable in some states. Please see your Colonial Life benefits counselor for details.10-19 | 100361-2Underwritten 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.

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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 benet payout throughout the duration of the policy Several term period options for exibility during high-need years Benet for the beneciary that is typically tax freeBenets 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 benet amount into cash value life insurance• Flexibility to keep the policy if you change jobs or retire• Built-in terminal illness accelerated death benet that provides up to 75% of the policy’s death benet (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)

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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 benet riderThe beneciary may receive an additional benet if the covered person dies as a result of an accident before age 70. The benet 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 benet riderIf a licensed health care practitioner certies that you have a chronic illness, you may receive an advance on all or a portion of the death benet, 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 benet period. Critical illness accelerated death benet riderIf you suffer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benet is payable.1 A subsequent diagnosis benet is included.Waiver of premium benet 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 benet rider Chronic care accelerated death benet rider Critical illness accelerated death benet rider Waiver of premium benet riderTo learn more, talk with your Colonial Life benets counselor.1. Any payout would reduce the death benet. Benets may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benets. 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 benet. 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 benets 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 benets 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

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Whole Life Plus InsuranceOur individual whole life plan offers dependable lifetime coverage and guaranteed cash value to help employees during challenging times.Whether employees want the nancial security of a predictable death benet or access to the plan’s cash value through a policy loan for emergency situations, Whole Life Plus insurance has the exibility to provide both.1Product guarantees(as long as premiums are paid and no loans are taken)Competitive features• Death benet stays the same2• Choice of two plan designs based on length of time premiums are paid (Paid-Up at Age 70 and Paid-Up • Accumulates cash value based on a nonforfeiture at Age 100)interest rate of 3.75%1 • Coverage for broad issue age ranges, up to 79 on • Premiums remain the samePaid-Up at Age 100 plan• Tobacco-distinct, unisex ratesAttractive underwriting• Accelerated death benet due to terminal illness2• Face amounts up to $500,000• $3,000 advance claim payment from the death benet2• Guaranteed issue available• Policy loans available ($250 minimum)1• Nonmedical underwriting (no blood proles or examinations) available for certain age bands and face amounts• Spouse signature not required for spouse term rider or spouse whole life plus policy with face • Policy pays cash surrender value at age 100 (when the policy endows)• Portability that enables employees to take coverage with them if they change jobs or retireamounts up to $50,000, except in states that require applicant to signOptional riders• Accidental death benet riderFamily coverage options• Chronic care accelerated death benet rider• Stand-alone spouse and juvenile policies available with no employee policy required• Spouse term rider (10- and 20-year) available on • Critical illness accelerated death benet rider• Guaranteed purchase option rider• Waiver of premium benet rideremployee policy • Children’s term rider available on employee or spouse policyWHOLE LIFE PLUS (IWL5000)

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Why choose Colonial Life?Life is full of unexpected moments. Colonial Life offers an unexpected approach to benets. Service at every step: We make account setup, enrollment, billing and claims easy. And we have a team ready to help when you need it.Personalized benets counseling: Our benets counselors can meet with employees individually to create a personalized benets solution that ts their needs now and in the future. A trusted partnership: As business and employees’ needs change, we ensure that the support we provide changes and adapts, too. One in four employers indicated life insurance is now more important and they are considering changes to their plans, such as adding supplemental life.3Contact your Colonial Life representative to learn more about Whole Life Plus.ColonialLife.com1. Accessing the accumulated cash value reduces the death benet by the amount accessed, unless the loan is repaid. Cash value will be reduced by any outstanding loans against the policy.2. Any accelerated benet payout would reduce the death benet. Benets may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benets.3. LIMRA, 2021 Insurance Barometer Study. https://www.limra.com/en/research/research-abstracts-public/2021/2021-insurance-barometer-study. Accessed July 2021.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 benet. 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 benets payable. 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/R-IWL5000-ACCD, ICC19-R-IWL5000-CI/R-IWL5000-CI, ICC19-R-IWL5000-CC/R-IWL5000-CC, ICC19-R-IWL5000-GPO/R-IWL5000-GPO. For cost and complete details of the coverage, call or write your Colonial Life benets 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. FOR BROKERS AND EMPLOYERS 7-21 | 642200

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Life insurance: Term or Whole?LIFE INSURANCEIf you’re wondering which life insurance to offer your employees — term or whole life? The answer is: They need both options. Term and Whole Life work hand in hand Term and Whole Life insurance work together to provide nancial protection for your employees and their loved ones at all phases of life — whether they’re just starting out, raising a family or planning for retirement. Term Life offers nancial protection and peace of mind for employees and their families during their working years.Whole Life provides coverage employees can keep into retirement — at competitive rates when they buy it early. Life insurance for all phases of your employees’ livesWhole life Term life Childhood Young professional Mid-career RetirementBy offering these benets at work with premiums paid by payroll deduction, you provide valuable coverage options for employees without added costs to your bottom line. Coverage for spouse and children also provides critical protection for your employees’ family.When employees purchase both types of life insurance, they have valuable nancial protection that can last a lifetime.

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This information is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benets payable. Applicable to policy forms GTL1.0-P and certicate number GTL1.0-C, ICC18-ITL5000/ITL5000, ICC19- IWL5000-70/IWL5000-70, ICC19-IWL5000-100/IWL5000-100, and ICC19-IWL5000J/IWL5000J and applicable state variations. For cost and complete details of the coverage, call or write your Colonial Life benets 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. FOR BROKERS AND EMPLOYERS 7-21 | 6911501. Any payout would reduce the death benet. Benets may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benets.2. Accessing the accumulated cash value reduces the death benet by the amount accessed. Cash value will be reduced by any outstanding loans against the policy.Term LifeWHAT IS TERM LIFE?• Offers nancial protection for loved ones during an employee’s working years • Offers highest amount of life insurance coverage for the lowest premiums KEY BENEFITS• Income replacement if the insured passes away• Can help pay ongoing expenses for the family, such as: ‐ Mortgage or rent ‐ Education ‐ Saving for retirementHOW IT WORKS Group Term Life • Employer-owned • Limited portability options• Flexible coverage that normally ends at retirement• Benet typically decreases after age 70• Guaranteed issue — coverage with no health questions or examsIndividual Term Life • Employee can continue their coverage if they change jobs or retire• The insured chooses a term period of 10, 15, 20, or 30 years• Guaranteed level premiums that do not increase during the selected term period • After the term period, the insured can end or renew coverage, or convert to a whole life policyWhole Life WHAT IS WHOLE LIFE? • Provides nancial protection for loved ones through their retirementKEY BENEFITS • Can help with nal expenses• Can provide a living benet to help pay for expenses associated with a terminal illness, chronic illness or critical illness1• Accumulates cash value at a guaranteed interest rate; employees can borrow against this value during times of need2HOW IT WORKS • Guaranteed issue — coverage with no health questions or exams• Permanent coverage for life with level premiums that can be paid-up at age 70 or 100• Death benet stays the same, as long as the employee makes payments How they work togetherTerm Life and Whole Life provide comprehensive life insurance with nancial protection during working years and benets that carry into retirement. Together, Term Life and Whole Life can help your employees and their loved ones give each other stronger nancial security and, perhaps, some peace of mind after they’re gone. ColonialLife.comTo learn more, talk with your Colonial Life benets representative.