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Voluntary Benefits Booklet
Ballard Industrial is pleased to offer a variety of benefits during your upcoming enrollment. You will have the opportunity to speak with a benefits counselor during open enrollment to find out about all of your benefit options.You also have the opportunity to apply for these Colonial Life voluntary benefits:• Group Hospital Indemnity Insurance provides a benefit for hospital confinement or outpatient surgery to help with deductibles.• Group Accident Insurance can provide a benefit for a range of accidental injuries and treatments. You can use the money however you choose.• Group Critical Illness Insurance provides a benefit to help you manage the financial impacts of a critical illness.• Term life Insurance provides money to your family if you die within a certain time period, or “term.” It can help them with final arrangements, living expenses, tuition and more.
Deductions per year: 26 These rates were prepared on 10/1/2024 and are valid for 90 days.Individual Disability - ISTD3000 for WA AAA Risk ClassApplicable to policy form Individual DisabilitylOff Job Accident & Off Job Sickness12 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,500* $2,000* $2,500* $3,000**monthly benefit amount90 days Accident/90 days Sickness 17-49 $5.82 $8.72 $11.63 $14.54 $17.4550-64 $9.14 $13.71 $18.28 $22.85 $27.4265-74 $13.66 $20.49 $27.32 $34.15 $40.98Group Term Life for WARate Table G7UApplicable to Policy Forms GTL1.0-P & GTL1.0-Clwith Waiver of Premium and AD&DNon-Tobacco RatesISSUE AGE $10,000 $25,000 $50,00016-24 $0.38 $0.96 $1.9225-29 $0.42 $1.05 $2.1030-34 $0.48 $1.21 $2.4235-39 $0.62 $1.56 $3.1240-44 $0.81 $2.02 $4.0445-49 $1.20 $3.01 $6.0250-54 $1.77 $4.42 $8.8455-59 $2.79 $6.98 $13.9660-64 $4.38 $10.94 $21.8865-69 $7.57 $18.92 $37.8570-74 $8.80 $22.01 $44.0175-99 $13.65 $34.12 $68.24Tobacco RatesISSUE AGE $10,000 $25,000 $50,00016-24 $0.50 $1.25 $2.4925-29 $0.56 $1.40 $2.7930-34 $0.66 $1.64 $3.2835-39 $0.92 $2.30 $4.5940-44 $1.31 $3.28 $6.5545-49 $2.00 $5.01 $10.0250-54 $3.27 $8.17 $16.3455-59 $4.55 $11.38 $22.7560-64 $6.73 $16.84 $33.6765-69 $11.15 $27.87 $55.7370-74 $12.67 $31.68 $63.3575-99 $17.58 $43.96 $87.92Important 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.Page 1 of 2Underwritten by Colonial Life & Accident Insurance CompanySee page 1 for Important Notice
Deductions per year: 26 These rates were prepared on 10/1/2024 and are valid for 90 days.Group Accident (GAC4100) for WAApplicable to policy forms GAC4100-P,GAC4100-ClAdditional Benefits: Accident Hospital Benefits PreferredOn/Off-Job Accident CoverageBENEFIT LEVEL AD&D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE ANDSPOUSE/DOMESTICPARTNEREMPLOYEE ANDDEPENDENTCHILD(REN)EMPLOYEE,SPOUSE/DOMESTICPARTNER ANDDEPENDENTCHILD(REN)Preferred Basic 17-99 $4.04 $6.13 $8.82 $10.97Group Medical Bridge (GMB7000) for WACompositeApplicable to Policy Forms GMB7000–P & GMB7000-ClWithout Wellbeing Assistance, Inpatient Mental and NervousHOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 3: $150017-99 $7.28 $15.62 $10.08 $18.41Group Critical Illness (GCI6000) for WAApplicable 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, Without Health Screening BenefitUni-Tobacco RatesATTAINEDAGENAMED INSURED NAMED INSURED ANDSPOUSE/DOMESTIC PARTNERNAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED,SPOUSE/DOMESTIC PARTNERAND DEPENDENT CHILD(REN)$10,000 17-24 $0.42 $0.65 $0.42 $0.6525-29 $0.60 $0.88 $0.60 $0.8830-34 $0.83 $1.25 $0.83 $1.2535-39 $1.66 $2.49 $1.66 $2.4940-44 $2.63 $3.97 $2.63 $3.9745-49 $4.11 $6.18 $4.11 $6.1850-54 $5.86 $8.77 $5.86 $8.7755-59 $8.31 $12.51 $8.31 $12.5160-64 $11.49 $17.22 $11.49 $17.2265-69 $14.63 $21.97 $14.63 $21.9770-74 $18.88 $28.34 $18.88 $28.34Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2024 Colonial Life & Accident Insurance Company"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.Colonial Life | don.brink@colonial-nw.com | (503) 504-8347Page 1 of 1Underwritten by Colonial Life & Accident Insurance CompanySee page 1 for Important Notice
Group Term Life InsuranceVoluntary coverageOur group term life insurance can help increase nancial security for your family if something were to happen to you. You can also apply for coverage for your spouse and eligible dependent children without health questions.1 How much group term coverage do I need?You:$ _____________________• Available in $1,000 increments• Minimum of $10,000 increments to a maximum of ve times your salary to $500,000Your spouse:$ _____________________• Available in $1,000 increments• Minimum of $5,000 to a maximum of $500,000• Spouse coverage cannot exceed your coverage amount2Your dependent children(up to age 26):$ _____________________• Available in $1,000 increments• Minimum of $1,000 to a maximum of $10,000 per dependent child• Each dependent child is covered for the same amount, except children from live birth to six months for whom the death benet is $1,000Why group term life insurance is a good option• Death benet• Lower premiums• Coverage during high-need years• Benet payment typically tax-free VOLUNTARY GROUP TERM LIFE
Additional benets and servicesBuilt-in accelerated death benet provides an advance of up to 75% of the death benet, to a maximum of $150,000, if diagnosed with a terminal illness.3Health Advocate Employee Assistance Program (EAP) provides 24-hour personal support and referral service, including a medical bill saver service. Face-to-face sessions and video counseling with mental health professionals are available.4• Online: ColonialLife.com/EAP • Telephone: 1-888-645-1772Life planning services offer nancial and legal counseling services, as well as grief support and referral for up to 12 months after a claim.4Get the most out of your coveragePortability: You may be able to continue your coverage if you change jobs or retire. Conversion: After the group term period ends, you may be eligible to convert to a whole life policy without health questions. Waiver of premium: Your premium payments may be eligible for waiver if you become disabled. To learn more, talk with your Colonial Life benets counselor.1 Spouse and dependent coverage will not be effective if they are currently totally disabled. Being totally disabled means the inability to perform two or more activities of daily living, being conned to a hospital or similar institution, or being unable to attend school outside the home (for a dependent child age 5 up to age 26). In ID, NH and TX, the denition of total disability does not include Activities of Daily Living (ADL) requirements. The ability to work does not determine disability. You can pay premiums on insurance for your dependents with no health questions asked. Coverage isn’t effective until the earlier of the date they are no longer totally disabled or two years after the date that coverage would have otherwise become effective for the spouse or dependent child. This provision does not apply to newborn children born while dependent insurance is in effect.2 The maximum benet is 50% of your benet in NE.3 Terminal illness means an injury or sickness that results in the covered person having a life expectancy of 12 months or less and from which there is no reasonable prospect of recovery. A life expectancy of 24 months or less in IL, KS, MA, TX and WA. Accelerated death benet payments will reduce the amount the policy pays upon the recipient’s death, may adversely affect the recipient’s eligibility for Medicaid or other government benets or entitlements, and may be taxable. Recipients should consult their tax attorney or advisor before utilizing accelerated benet payments.4 The Employee Assistance Program and Life Planning Services, provided by Health Advocate, are available with Colonial Life & Accident Insurance Company Group Term Life offering. Terms and availability of service are subject to change. The service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. State-mandated limitations for legal services in WA apply. Please contact the company for full details.BENEFIT AGE REDUCTION SCHEDULEWhen a covered person reaches age 70, but not 75, the amount of insurance will be:• 65% of the amount of insurance prior to age 70; or• 65% of the amount of insurance applied for on or after age 70 but before age 75.When a covered person reaches age 75 or more, the amount of insurance will be:• 50% of the amount of insurance prior to the rst reduction; or• 50% of the amount of insurance the employee applied for on or after age 75.Once the benet reduction schedule begins, there will be no further increases in insurance for a covered person. If the proposed insured is age 70, but not age 75 at the time of enrollment, the amount of insurance applied for will be reduced by 65%. If the proposed insured is age 75 or older at the time of enrollment, the amount applied for will be reduced by 50%.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GTL1.0-P and certicate form GTL1.0-C (including state abbreviations where used, for example: GTL1.0-P-TX and GTL1.0-C-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.ColonialLife.comUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 3-24 | 100272-7
Group Term Life InsuranceAccidental Death & Dismemberment Insurance (AD&D)This coverage can provide benets for a covered accidental death or dismemberment. Benets can be used for any purpose, including to help pay costs related to recovery or rehabilitation.What is my AD&D full benet amount? ____________________The AD&D full benet amount is equal to your group term life insurance death benet amount.What is payable under the AD&D benet?If the loss is: % of full amount payableLoss of life 100%Loss or loss of use of both hands or both feet or sight of both eyes100%Loss or loss of use of one hand and one foot 100%Loss or loss of use of one hand and sight of one eye 100%Loss or loss of use of one foot and sight of one eye 100%Loss of speech and hearing 100%Loss or loss of use of one hand or one foot 50%Loss of sight of one eye 50%Loss of speech or hearing 50%Loss or loss of use of thumb and index nger on the same hand25%What other benets are included? Seatbelts and airbags: Pays a benet if the cause of death or dismemberment is a car accident and the covered person was using a seatbelt or airbag.Family coverageAD&D is available to you with your group term life coverage, as well as all your covered family members.To learn more, talk with your Colonial Life benets counselor.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GTL1.0-P and certicate form GTL1.0-C (including state abbreviations where used for example: GTL1.0-P-TX and GTL1.0-C-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.ColonialLife.com GROUP TERM LIFE AD&D BENEFIT FOR EMPLOYEES 1-24 | 100265-3
For more information, talk with your benefits counselor.ColonialLife.comGroup Hospital Indemnity InsurancePlan 1 (HSA-Compliant)THIS INSURANCE PROVIDES LIMITED BENEFITS.EXCLUSIONSWe will not pay benefits for sicknesses which are caused by, contributed to by, or occurs as a result of the covered person’s alcoholism or drug addiction. We will not pay any benefits for injuries received in accidents or for sicknesses which are caused by, contributed to by or occur as a result of the following exclusions and limitations: dental procedures, elective procedures and cosmetic surgery, felonies or illegal occupations, mental or nervous disorders, pregnancy of a dependent child, suicide or injuries which any covered person intentionally does to himself or herself, or war. We will not pay benefits for hospital confinement or daily hospital confinement, if included, due to giving birth within the first nine months aer the certificate eective date or for a newborn who is neither injured nor sick. PRE-EXISTING CONDITION LIMITATIONSWe will not pay benefits for loss during the first 12 months aer the certificate eective 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 eective date.This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GMB7000-P-WA and certificate form GMB7000-C-WA. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.GMB7000 – PLAN 1 | 2-21 | 101731-WAGroup 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 aer 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.Health savings account (HSA) compatibleThis plan is compatible with HSA guidelines and any other HSA plan that a covered family member may participate in. It may also be oered to employees who do not have HSAs.Colonial Life & Accident Insurance Company’s Group Medical Bridge oers an HSA-compatible plan in most states.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.1500
Group Accident InsurancePreferred PlanIf you are in an accident, your focus should be on recovery, not how you’re going to pay your bills. Colonial Life Accident Insurance can pay benets directly to you to use however you like — from medical costs to everyday expenses. Whether you’ve had a fall or a car accident, these benets can offer nancial support when you need it.Our coverage includes:• Benets payable directly to you• No medical questions to qualify for coverage• Coverage for simple and complex injuries• Benets payable regardless of other insurance• Worldwide coverage• Works alongside your Health Savings Account (HSA)BENEFITS STORY Milo was working in his yard when he tripped and injured his hand.With Colonial Life accident benets, Milo was able to pay the annual deductible and co-payments for his health insurance plan without using his savings or taking on debt.MILO’S ACCIDENT BENEFITSMilo went to an urgent care facility and received immediate care.Treatment in a physician’s office or urgent care facility$100The doctor ordered an X-ray and discovered Milo had fractured his hand.• X-ray• Fracture (hand)$60$1,200The doctor also found that Milo had a cut on his hand but did not require stitches. Laceration (no repair) $50Milo was discharged with a splint. Durable medical equipment $50Over the next several weeks, Milo had two follow-up appointments with his doctor. Physician follow-up visits (2 visits)$50 x 2 = $100Total $1,560For illustrative purposes only. Benet amounts may vary and may not cover all expenses. GROUP ACCIDENT (GAC4100) — PREFERRED PLAN 1212757-WA
Give your benets a boostWe know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life. Group Accident includes a Benet Booster* to provide additional nancial support for serious accidents. If you have more than $5,000 in payable benets for a covered accident, we will give you a $500 boost to your benets to help you with whatever expenses you have. *Payable once per insured per covered accidentBENEFITS STORY Olivia was driving to the store when she got into a car accident.Olivia’s benets helped her cover her medical expenses when she was injured in a car accident, helping her to focus on her recovery.OLIVIA’S ACCIDENT BENEFITSOlivia arrived by ambulance at the nearest emergency room and received immediate care.• Ambulance• Emergency department visit• Injury due to auto accident$300$200 $250The doctor ordered an X-ray and discovered Olivia had fractured her thigh (femur). He also ordered a CT scan of her head to check for brain injury.• X-ray• Medical imaging• Fracture (thigh)$60$200 $3,150Olivia required surgery for her leg.• Surgical repair (thigh fracture)• General anesthesia$3,150$250Olivia boarded her pet for two nights after her surgery. Pet boarding (2 days) $20 x 2 = $40Olivia had eight sessions of physical therapy to help regain the strength in her leg and two follow-up appointments with her doctor.• Therapy services (8 sessions)• Physician follow-up visits (2 visits)$45 x 8 = $360$50 x 2 = $100Olivia’s benefits for this accident totaled more than $5,000.Benefit Booster $500Total $8,560For illustrative purposes only. Benet amounts may vary and may not cover all expenses. Benets are per covered person per covered accident unless stated otherwiseInjury benets • Burns (based on size and degree) ............. $500–$15,000• Skin grafts (due to burns) .............................50%(payable as a % of the applicable burn benet)• Skin grafts (not due to burns) ....................$250–$500• Concussion .........................................$375• Connective tissue damage ......................$100–$200• Eye injury .......................................... $300 • Hearing loss injuries ..................................$120(maximum once per lifetime per ear per insured)• Injury due to auto accident1 .......................... $250 • Internal injuries ..................................... $200 • Knee cartilage (meniscus) injury .......................$150 • Lacerations ....................................$50–$600• Loss of a digit — partial .........................$300–$600• Loss of a digit ...............................$750–$2,000• Ruptured or herniated disc ......................$150–$300
Fracture benets• Injury .......................................$200–$3,750 Examples: nger: $200 | wrist: $1,200 | hip: $3,150• Surgical repair of fracture ............................100%(payable as an additional % of the applicable fractures benet)• Chip fracture ........................................25% (payable as a % of the applicable fractures benet)Dislocation benets• Injury .......................................$200–$3,000 Examples: elbow: $450 | ankle: $1,200 | hip: $3,000• Surgical repair of dislocation ..........................100%(payable as an additional % of the applicable dislocations benet)• Incomplete dislocation ................................25%(payable as a % of the applicable dislocations benet)Treatment benets• Air ambulance .....................................$1,500 • Ambulance (ground or water) ......................... $300 • Durable medical equipment ......................$50–$200• Emergency dental repair ........................$100–$300• Emergency department .............................. $200• Family care ................................... $50 per day (maximum of one benet per day for all Insureds combined, up to a maximum of three days per covered accident, regardless of the number of children)• Injections to prevent or limit infection ...................$50 • Lodging .....................................$200 per day (maximum 30 days)• Medical imaging ..................................... $200 • Pain management injections ..........................$100 • Pet boarding .................................. $20 per day (maximum of one benet per day for all insureds combined, up to a maximum of three days per covered accident, regardless of the number of pets that are boarded)• Prosthetic device or articial limb ............$1,250–$2,500• Transfusions ........................................ $400 • Transportation ................................$150 per trip (maximum 6 one-way trips)• Treatment in a physician’s oce or urgent care facility ...$100• X-ray or ultrasound ....................................$60Surgery benets• Anesthesia ....................................$150–$250• Connective tissue surgery ......................$125–$1,600• Eye surgery .........................................$300• General surgery –Abdominal, thoracic, or cranial ....................$1,500 –Exploratory surgery ...............................$225 • Hernia surgery ......................................$300 • Knee cartilage (meniscus) surgery ...............$100–$600• Outpatient surgical facility ............................$300 • Ruptured or herniated disc surgery .............$125–$1,500Recovery care benets• At-home care ................................ $100 per day(maximum 5 days) • Benet Booster .....................................$500• Physician follow-up visits ............................. $50 (maximum 4 days per covered accident)• Rehabilitation or sub-acute rehabilitation unit connement ............................. $150 per day (maximum 15 days per covered accident)• Therapy services (speech, physical therapy, occupational therapy) ..........................$45 per day(maximum 15 days)Options checked below have been chosen by your employer to enhance your Group Accident Coverage. Recovery Plus package• Behavioral health therapy .................. $45 per day (maximum 15 days)• Post-traumatic stress disorder (PTSD) ............ $200 • Prescription drug .................................$25 • Additional therapy services (chiropractic, acupuncture, alternative therapy) ......$45 (existing therapy services benet maximum applies to additional therapy services, maximum 15 days) Gunshot Wound BenetThis benet can help pay your medical expenses if you receive a non-fatal gunshot wound. It offers you a lump sum for a covered injury regardless of any other insurance you may have and includes on/off-job coverage.• Gunshot wound .............................$_________This benet covers a non-fatal gunshot wound from a conventional rearm that requires treatment by a doctor and overnight hospitalization within 24 hours of the injury. If you are shot more than once in a 24-hour period, we can pay benets only for the rst wound.
Contact your Colonial Life insurance producer to learn more.1 Requires transportation by a licensed professional Air Ambulance or Ambulance (Ground or Water).HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate.It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law.EXCLUSIONSWe will not pay benets for claims that are caused by, contributed to by, or resulting from elective procedures, felonies or illegal occupations, hazardous avocations, incarceration, racing, semi-professional or professional sports, sickness, suicide or self-inicted injuries, war, or armed conict. This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GAC4100-P-WA and certicate form GAC4100-C-WA. For cost and complete details of coverage, call or write your Colonial Life insurance producer or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 7-24 | 1212757-WAColonialLife.com1212757-WA
Group Accident InsuranceAccident Hospital benetsThese benets can help with medical costs related to a hospital stay for a covered accident, including costs that your health insurance may not cover, like co-pays and deductibles. Accident Hospital benets are available to you with Group Accident Insurance coverage, as well as all your covered family members. Talk with your Colonial Life insurance producer about the level of accident hospital benets available to you.Benets are per covered person per covered accident unless stated otherwise.Economy Basic Preferred Premier Hospital Admission $500 $750 $1,000 $1,500Hospital Admission – ICU $1,250 $1,500 $1,750 $2,500Hospital Confinement – Daily Stay Max. of 365 days per insured per covered accident$100 $200 $250 $350Hospital ICU Confinement – Daily Stay Max. of 15 days per insured per covered accident$200 $300 $400 $600Hospital Sub-Acute ICU Confinement – Daily Stay Max. of 30 days per insured per covered accident$150 $250 $350 $500Short Stay Min. of 8 hours up to 20 hours$200 $200 $200 $200To learn more, talk with your Colonial Life insurance producer.GROUP ACCIDENT (GAC4100) – ACCIDENT HOSPITAL BENEFITS 1284160-WA
HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law.EXCLUSIONS AND LIMITATIONSWe will not pay benets for claims that are caused by, contributed to by, or resulting from elective procedures, felonies or illegal occupations, hazardous avocations, incarceration, racing, semi-professional or professional sports, sickness, suicide or self-inicted injuries, war, or armed conict.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GAC4100-P-WA and certicate form GAC4100-C-WA. For cost and complete details of coverage, call or write your Colonial Life insurance producer or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 6-24 | 1284160-WAColonialLife.com 1284160-WA
Group Accident InsuranceAccidental Death & Dismemberment BenetsThese benets can help pay for expenses related to an accidental death. They can also help pay costs related to recovery and rehabilitation from an accidental dismemberment, including costs that your medical plan doesn’t cover, like co-pays and deductibles.Accidental Death & Dismemberment (AD&D) benets Accidental Death and Dismemberment benets are available to you with Group Accident Insurance coverage, as well as all your covered family members. Talk with your Colonial Life insurance producer about the level of AD&D benets available to you.Benets are per covered person per covered accident unless stated otherwise.Economy Basic Preferred Premier Accidental death• Named insured $25,000 $25,000 $50,000 $50,000• Spouse $25,000 $25,000 $50,000 $50,000• Children $5,000 $5,000 $10,000 $10,000Accidental death — Common carrier• Named insured $100,000 $100,000 $200,000 $200,000• Spouse $100,000 $100,000 $200,000 $200,000• Children $20,000 $20,000 $40,000 $40,000Accidental dismemberment• Both feet $25,000 $50,000 $75,000 $100,000 • Both hands $25,000 $50,000 $75,000 $100,000 • One foot $6,000 $7,500 $9,000 $15,000• One hand $6,000 $7,500 $9,000 $15,000• Thumb and index nger of the same hand $3,000 $3,750 $4,500 $7,500Coma (7 or more consecutive days) $5,000 $7,500 $10,000 $20,000Home alterations and automobile modifications $500 $1,000 $1,500 $2,000 GROUP ACCIDENT (GAC4100) – AD&D BENEFITS 1284100-WA
Accidental Death & Dismemberment benets (continued)Economy Basic Preferred Premier Loss of use• Hearing (one ear) $6,000 $7,500 $9,000 $15,000• Hearing (both ears) $25,000 $50,000 $75,000 $100,000 • Sight of one eye $6,000 $7,500 $9,000 $15,000• Sight of both eyes $25,000 $50,000 $75,000 $100,000 • Speech $25,000 $50,000 $75,000 $100,000Paralysis• Uniplegia $6,000 $7,500 $9,000 $15,000• Hemiplegia $25,000 $50,000 $75,000 $100,000 • Paraplegia $25,000 $50,000 $75,000 $100,000 • Triplegia $25,000 $50,000 $75,000 $100,000 • Quadriplegia $25,000 $50,000 $75,000 $100,000To learn more, talk with your Colonial Life insurance producer.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law. EXCLUSIONS AND LIMITATIONSWe will not pay benets for claims that are caused by, contributed to by, or resulting from elective procedures, felonies or illegal occupations, hazardous avocations,incarceration, racing, semi-professional or professional sports, sickness, suicide or self-inicted injuries, war, or armed conict.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GAC4100-P-WA and certicate form GAC4100-C-WA. For cost and complete details of coverage, call or write your Colonial Life insurance producer or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 6-24 | 1284100-WAColonialLife.com1284100-WA
Group Critical Illness and Cancer Insurance* Plan 2When life takes an unexpected turn, your focus should be on recovery — not nances. Colonial Life’s group critical illness and cancer insurance helps relieve nancial worries by providing a lump-sum benet payable directly to you to use as needed.Coverage amount: ____________________________Critical illness and cancer benetsCOVERED CONDITION1PERCENTAGE OF APPLICABLE COVERAGE AMOUNTBenign brain tumor 100%Coma 100%End stage renal (kidney) failure 100%Heart attack (myocardial infarction) 100%Loss of hearing 100%Loss of sight 100%Loss of speech 100%Major organ failure requiring transplant 100%Occupational infectious HIV or occupational infectious hepatitis B, C, or D100%Permanent paralysis due to a covered accident2100%Stroke 100%Sudden cardiac arrest 100%Coronary artery disease 25%COVERED CANCER CONDITION¹PERCENTAGE OF APPLICABLE COVERAGE AMOUNTInvasive cancer (including all breast cancer) 100%Non-invasive cancer 25%Skin cancer initial diagnosis ............................$400 per lifetimeBENEFITS STORYPreparing for a lifelong journeyRebecca was born with Down syndrome. Her parents’ critical illness and cancer coverage provided a benet that can help cover expenses related to Rebecca’s care and her changing needs. How their coverage helpedA hospital stay and treatment for corrective heart surgeryPhysical therapy to build muscle strengthSpecial needs daycareFor illustrative purposes only.GCI6000 – PLAN 2 $5,000 to $30,000
Key benets• Available coverage for spouse and eligible dependent children at 50% of your coverage amount • Cover your eligible dependent children at no additional cost • Receive coverage regardless of medical history, within specied limits• Works alongside your health savings account (HSA)• Benets payable regardless of other insuranceSubsequent diagnosis of a different critical illness3If you receive a benet for a critical illness, and are later diagnosed with a different critical illness, 100% of the coverage amount may be payable for that particular critical illness.Subsequent diagnosis of the same critical illness3If you receive a benet for a critical illness, and are later diagnosed with the same critical illness,4 25% of the coverage amount is payable for that critical illness. Reoccurrence of invasive cancer (including all breast cancer)If you receive a benet for invasive cancer and are later diagnosed with a reoccurrence of invasive cancer, 25% of the coverage amount is payable if treatment-free for at least 12 months and in complete remission prior to the date of reoccurrence; excludes non-invasive or skin cancer.Additional covered conditions for dependent childrenCOVERED CONDITION1PERCENTAGE OF APPLICABLE COVERAGE AMOUNTCerebral palsy 100%Cleft lip or palate 100%Cystic fibrosis 100%Down syndrome 100%Spina bifida 100%For more information, talk with your benets counselor.1. Please refer to the certicate for complete denitions of covered conditions. 2. In WA, the covered condition is called Permanent Paralysis.3. Dates of diagnoses of a covered critical illness must be separated by more than 180 days. 4. Critical illnesses that do not qualify include: coronary artery disease, loss of hearing, loss of sight, loss of speech, and occupational infectious HIV or occupational infectious hepatitis B, C, or D.* The led product name in FL and VT is Group Critical Illness and Cancer Limited Benet Insurance.THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benet, Benets Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benet for Dependent Children that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conict; or pre-existing condition, unless the covered person has satised the pre-existing condition limitation period shown on the Certicate Schedule on the date the covered person is diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Invasive Cancer (including all Breast Cancer) Benet, Non-Invasive Cancer Benet, Benet Payable Upon Reoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benet for a covered person’s invasive cancer or non-invasive cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satised the pre-existing condition limitation period shown on the Certicate Schedule on the date the covered person is initially diagnosed as having invasive or non-invasive cancer. No pre-existing condition limitation will be applied for dependent children who are born or adopted while the named insured is covered under the certicate, and who are continuously covered from the date of birth or adoption.PRE-EXISTING CONDITION LIMITATION We will not pay a benet for a pre-existing condition that occurs during the 12-month period after the coverage effective date. Pre-existing condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GCI6000-P and certicate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 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 11-22 | 387100-2ColonialLife.com
Group Critical Illness Insurance*Health Screening BenetThe health screening benet can help reduce the risk of serious illness through early detection of disease or risk factors.Health screening benet...................$_____________Maximum of one test per covered person per calendar year; subject to a 30-day waiting period before the benet is payable. The test must be performed after the waiting period.• Blood test for triglycerides• Bone marrow testing• BRCA1 or BRCA2 testing (genetic test for breast cancer)• Breast ultrasound• CA 15-3 (blood test for breast cancer)• CA 125 (blood test for ovarian cancer)• Carotid Doppler• CEA (blood test for colon cancer)• Chest X-ray• Colonoscopy• Echocardiogram (ECHO)• Electrocardiogram (EKG, ECG)• Fasting blood glucose test• Flexible sigmoidoscopy• Hemoccult stool analysis• Mammography• Pap smear• PSA (blood test for prostate cancer)• Serum cholesterol test for HDL and LDL levels• Serum protein electrophoresis (blood test for myeloma)• Skin cancer biopsy• Stress test on a bicycle or treadmill• Thermography• ThinPrep pap test • Virtual colonoscopyFor more information, talk with your Colonial Life benets counselor.*The led product name is Group Critical Illness and/or Cancer Specied Disease Insurance. Plan 1 includes Critical Illness, Plan 2 includes Critical Illness and Cancer, Plans 3 & 4 only include Cancer.THIS INSURANCE PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy forms GCI6000-P-I-WA and GCI6000-P-A-WA and certicate form GCI6000-C-WA. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.ColonialLife.comGCI6000 – HEALTH SCREENING BENEFIT FOR EMPLOYEES 1-23 | 387307-1-WA50.00
Group Critical Illness Insurance* Exclusions and limitationsState-specic exclusions AK: Alcoholism or Drug Addiction Exclusion does not apply.CA: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics replaced with Intoxicants or Controlled Substances. Insureds must be covered by comprehensive health insurance before applying for insurance.CO: Suicide exclusion: whether sane or not replaced with while sane.CT: Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction; Felonies or Illegal Occupations Exclusion replaced with Felonies; Intoxicants and Narcotics Exclusion does not apply.DC: Alcoholism or Drug Addiction Exclusion does not apply. Insureds must be covered by comprehensive health insurance before applying for insurance.DE: Alcoholism or Drug Addiction Exclusion does not apply.GA: Insureds must be covered by comprehensive health insurance before applying for insurance.IA: Exclusions and Limitations headers renamed to Exclusions and Limitations for Critical Illness Covered Conditions and Critical Illness Cancer Covered Conditions.ID: War or Armed Conict Exclusion replaced with War; Felonies and Illegal Occupations Exclusion replaced with Felonies; Intoxicants and Narcotics Exclusion does not apply; Domestic Partner added to Spouse.IL: Alcoholism or Drug Addiction Exclusion replaced with Alcoholism or Substance Abuse Disorder.KS: Alcoholism or Drug Addiction Exclusion does not apply.KY: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion replaced with Intoxicants, Narcotics and Hallucinogenics. Premium will vary based on the coverage selected and the age of the named insured. For attained age rates, premiums will increase on the account anniversary date once the named insured reaches the next age band. Premium may increase if coverage is ported. Waiting Period If included, the Wellbeing Assistance Benet is subject to a 30-day waiting period. Waiting period means the rst 30 days following each covered person’s effective date during which no benets are payable. Termination of the Named Insured’s Coverage The coverage on a named insured under the policy will terminate on the earliest of the following dates: • the date the policy terminates; • your policyholder cancels the policy and does not offer replacement coverage; • the end of the grace period following the premium due date and we do not receive the required premium for the named insured; • the date the named insured is no longer in an eligible class; • the date the named insured’s class is no longer included for insurance; or • the date the next premium is due after the named insured asks us to end coverage. We will provide coverage for a claim for which we are liable under the terms of this certicate if the loss occurs while you are covered.LA: Alcoholism or Drug Addiction Exclusion does not apply; Domestic Partner added to Spouse.MA: Exclusions and Limitations headers renamed to Limitations and Exclusions for critical illness and cancer. Insureds must be covered by comprehensive health insurance before applying for insurance.MD: Alcoholism or Drug Addiction Exclusion does not apply; Felonies or Illegal Occupations Exclusion does not apply; Intoxicants and Narcotics Exclusion does not apply; Prohibited Practitioner Referral added as an additional exclusion for cancer.MI: Intoxicants and Narcotics Exclusion does not apply; Suicide Exclusion does not apply.MN: Alcoholism or Drug Addiction Exclusion does not apply; Suicide Exclusion does not apply; Felonies and Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs; Intoxicants and Narcotics Exclusion replaced with Narcotic Addiction. Insureds must be covered by comprehensive health insurance before applying for insurance.MO: Alcoholism or Drug Addiction Exclusion replaced with Drug Addiction; Felonies or Illegal Occupations Exclusion replaced with Illegal Activities.MS: Alcoholism or Drug Addiction Exclusion does not apply.ND: Alcoholism or Drug Addiction Exclusion does not apply.NV: Intoxicants and Narcotics Exclusion does not apply; Domestic Partner added to Spouse.PA: Alcoholism or Drug Addiction Exclusion does not apply; Suicide Exclusion: whether sane or not removed.SD: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion does not apply.TX: Alcoholism or Drug Addiction Exclusion does not apply; Doctor or Physician Relationship added as an additional exclusion.UT: Alcoholism or Drug Addiction Exclusion replaced with Alcoholism.VT: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion does not apply; Suicide Exclusion: whether sane or not removed. Insureds must be covered by comprehensive health insurance before applying for insurance.WA: Intoxicants and Narcotics Exclusion does not apply.
State-specic pre-existing condition limitationsCA: Pre-existing Condition means a sickness or physical condition for which a covered person was diagnosed or treated within 12 months before the coverage effective date shown on the Certicate Schedule.FL: Pre-existing is 6/12; Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within six months before the coverage effective date shown on the Certicate Schedule. Genetic information is not a pre-existing condition in the absence of a diagnosis of the condition related to such information.GA: Pre-existing Condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or a condition for which medical advice or treatment was recommended by or received within 12 months preceding the coverage effective date.ID: Pre-existing is 6 months/12 months; Pre-existing Condition means a sickness or physical condition which caused a covered person to seek medical advice,diagnosis, care or treatment during the six months immediately preceding the coverage effective date shown on the Certicate Schedule.IL: Pre-existing Condition means a sickness or physical condition for which a covered person was diagnosed, treated, had medical testing by a legally qualied physician, received medical advice, produced symptoms or had taken medication within 12 months before the coverage effective date shown on the Schedule of Benets.IN: Pre-existing is 6 months/12 months.MA: Pre-existing is 6 months/12 months; Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, or received medical advice within six months before the coverage effective date shown on the Certicate Schedule.MD: Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date shown on the Certicate Schedule. Pre-existing condition does not include a condition revealed on the application unless excluded by a signed waiver rider.ME: Pre-existing is 6 months/6 months; Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, or received medical advice within six months before the coverage effective date shown on the Certicate Schedule.MI: Pre-existing is 6 months/6 months.NC: Pre-existing Condition means those conditions for which medical advice, diagnosis, care, or treatment was received or recommended within the one-year period immediately preceding the effective date of a covered person. If a covered person is 65 or older when this certicate is issued, pre-existing conditions for that covered person will include only conditions specically eliminated.NV: Pre-existing is 6 months/12 months; Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within six months before the coverage effective date. Pre-existing Condition does not include genetic information in the absence of a diagnosis of the condition related to such information.PA: Pre-existing is 90 days/12 months; Pre-existing Condition means a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage effective date shown on the Certicate Schedule.SD: Pre-existing is 6 months/12 months.TX: Pre-existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage effective date shown on the Certicate Schedule.UT: Pre-existing is 6 months/6 months.WY: Pre-existing is 6 months/12 months.*The led product name in IA, PA, and WY is Group Critical Illness Specied Disease Insurance. In FL and VT, the led product name is Group Critical Illness Limited Benet Insurance.THIS INSURANCE PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.This information is not intended to be a complete description of the insurance coverage available. The insurance, its name or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GCI6000-P and certicate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. This form is not complete without base form 385403, 387100, 387169, 402383, 402558 or 387238, and rider form 387307, 387381, 387452, 387523, 387594, 387665, 402605 or 402671.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 12-22 | 388113-6ColonialLife.com
Filing online means never waiting for mail or dealing with fax machines and complex paper forms . Our guided question wizard walks you through the process and checks for missing information that could cause delays. Opting for direct deposit can also get approved payments to you up to a week faster than paper check. NEED TO FILE A CLAIM?Here’s what you can do on Colonial Life for Policyholders:Update yourpersonal info& preferencesFile claimswith a simple,guided form Opt for instant alerts by email or textView claim statusor policy details anytimeCheck your claim status by logging into your account at ColonialLife.com/access. You can also sign up for text or email alerts so you know instantly if status changes or more information is needed. For your convenience, you can login anytime with a mobile device to photograph and upload documents with your camera.AFTER YOU FILE:Find out how simple your claims and benefits experience can be by learning more about the Colonial Life for Policyholders portal. Just visit ColonialLife.com to see what this online account administration platform can do for you.LEARN MOREBECOME A MEMBER TODAY:Go to ColonialLife.com/access to register.Click “create an account”, fill out the required information and click Submit.Enjoy faster service and improved benefits awareness.123THE PORTALOFFERS YOU:Faster service than calling/emailingConfirmation when a claim has been submittedSimplified bill payment and managementAnswers to frequently asked questions and live chat assistance if you don’t see what you are looking for.Colonial Life for Policyholders PortalA faster, simpler way to manage your benefitsColonial Life for Policyholders is an online portal created with you in mind. It’s the most convenient and ecient way to file a claim and manage your benefits. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.43233-41Set up directdeposit forapproved payments