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Benefit Booklet - 2025Barnhill Homes
Colonial Life provides benets that employees want for the unexpected moments in life. Whether planning for retirement, growing their families, or saving for college, they know an injury or illness won’t derail their dreams. 10-22 | NS-1017472Kitty MelloneKmellone@coloniallifenc.com704-907-3944 Life is anything but expected. That’s why we’re here.ProductsDisability InsuranceProvides financial protection to cover income loss from a covered disability.Hospital Confinement Indemnity Insurance (Medical Bridge)Provides benefits to help cover the cost of a hospital stay and other medical procedures for a covered accident or sickness, regardless of what health insurance pays.Accident InsuranceFrom a fall to a car accident, this coverage offers a range of benefits to help cover medical or non-medical related expenses due to a covered accident.Cancer InsuranceProvides benefits for a cancer diagnosis and treatment. Option to add cancer screening benefit.Critical Illness InsuranceProvides lumpsum benefits for a covered critical illness, such as a heart attack or stroke.Term Life InsuranceProvides a predictable way to provide life coverage at more affordable prices during high-need years.Whole Life InsuranceProvides protection for a lifetime. Features guaranteed level premiums and increasing cash values over time. Option to increase coverage on the second, fifth and eighth year of the policy’s anniversary.Dental InsuranceProvides coverage for a wide range of dental services, from routine cleanings to root canals. There are no waiting periods for preventive or basic services, such as fillings and simple extractions. Offers additional savings through a large national network of providers. A Network Access Plan is available.Barnhill Homes
Individual Short-Term Disability Insurance ISTD3000 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 aord 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.Aer calculating your monthly expenses, your benefits counselor can help you complete the benefits worksheet.ColonialLife.comBenefits 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 $6,500.*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?Aer an accident: _______ days Aer a sickness: _______ daysMONTHLY 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) $*Subject to income requirements
EXCLUSIONS AND LIMITATIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of: cosmetic surgery, felonies or illegal occupations, flying, hazardous avocations, intoxicants and narcotics, psychiatric or psychological conditions, racing, semi-professional or professional sports, substance abuse, suicide or injuries which you intentionally do to yourself, war or armed conflict. We will not pay for benefits due to being pregnant before the policy coverage eective date shown in the policy schedule, if medical advice, diagnosis, care or treatment was received or recommended within the one-year period immediately preceding the policy coverage eective date shown on the policy schedule. We will not pay for loss when the disability is a pre-existing condition as described in the policy.Pre-existing condition means those conditions for which medical advice, diagnosis, care, or treatment was received or recommended with the one year period immediately preceding the Policy Coverage Eective Date shown on the Policy Schedule. If you are age 65 or older when this policy is issued, pre-existing conditions will include only conditions specifically eliminated by rider. Aer this policy has been in force for 12 months from the policy coverage eective date shown on the policy schedule, we will pay benefits for any pre-existing condition not excluded by name or specific description if the covered disability began at least 12 months aer the policy coverage eective date and the elimination period has been satisfied.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form ISTD3000-NC and rider form ISTD3000-ADIB-NC. This is not an insurance contract and only the actual policy and rider provisions will control.1-18 | 101629-2-NCProduct information Total disability definitionTotally disabled or total disability means you are: unable to perform the material and substantial duties of your job, not working at any job, and under the regular and appropriate care of a physician.How partial disability worksIf you are able to return to work part-time aer 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 aer 90 consecutive days of a covered disability.Geographical limitationsIf you are disabled while outside of the United States, Canada or Mexico, you may receive benefits for up to 60 days before you have to return to the U.S. in order to continue receiving benefits.Issue ageCoverage is available from ages 17 to 74.Keep your coverage You can keep your coverage to age 75 at no additional cost, even if you change jobs, as long as you pay your premiums when they are due.For more information, talk with your benefits counselor.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
For more information, talk with your benefits counselor.Hospital Confinement Indemnity InsurancePlan 1EXCLUSIONS We will not pay benefits for losses which are caused by: alcoholism or drug addiction, dental procedures, elective procedures and cosmetic surgery, felonies or illegal occupations, pregnancy of a dependent child, psychiatric or psychological conditions, suicide or injuries which any covered person intentionally does to himself or herself, or war. We will not pay benefits for hospital confinement of a newborn who is neither injured nor sick. We will not pay benefits for loss during the first 12 months aer the eective date due to a pre-existing condition. Pre-exisiting conditions are those conditions whether diagnosed or not, for which a covered person received medical advice, diagnosis or care, or treatment was received or recommended within the one-year period immediately preceding the eective date of the policy. If a covered person is 65 or older when the policy is issued, pre-existing conditions will include only conditions specifically eliminated by rider.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number IMB7000-NC. This is not an insurance contract and only the actual policy provisions will control.©2015 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.IMB7000 – PLAN 1 | 7-15 | 101576-NCColonialLife.comOur Individual Medical BridgeSM insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement ........................................................$_2000 / 1000_________________Maximum of one benefit per covered person per calendar yearObservation room .................................................................................. $100 per visitMaximum of two visits per covered person per calendar yearRehabilitation unit confinement .................................................................$100 per dayMaximum of 15 days per confinement with a 30-day maximum per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered hospital confinement of the named insuredHealth savings account (HSA) compatibleThis plan is compatible with HSA guidelines. This plan may also be oered to employees who do not have HSAs.Colonial Life & Accident Insurance Company’s Individual Medical Bridge oers an HSA compatible plan in most states.
Hospital Confinement Indemnity Insurance Health Screening Individual Medical BridgeSM insurance s health screening benefit can help pay for health and wellness tests you have each year Health screening 100_____________ Maximum of one health screening test per covered person per calendar year subject to a 30 day waiting period Blood test for triglycerides Bone marrow testing Breast ultrasound CA 15 3 blood test for breast cancer CA 125 blood test for ovarian cancer CEA blood test for colon cancer Carotid Doppler Chest X ray Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy Colonoscopy Echocardiogram ECHO Electrocardiogram EKG ECG Fasting blood glucose test Flexible sigmoidoscopy For more information talk with your benefits counselor Hemoccult stool analysis Mammography Pap smear PSA blood test for prostate cancer Serum cholesterol test for HDL and LDL levels ColonialLife com Waiting period means the first 30 days following any covered person s policy coverage effective date during which no benefits are payable For cost and complete details see your Colonial Life benefits counselor Applicable to policy number IMB7000 including state abbreviations where used for example IMB7000 TX Coverage may vary by state and may not be available in all states This is not an insurance contract and only the actual policy provisions will control 2015 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 IMB7000 HEALTH SCREENING BENEFIT 2 15 101579
Accident 1.0 -Preferred with Health Screening BenetAccidents happen in places where you and your family spend the most time – at work, in the home and on the playground – and they’re unexpected. How you care for them shouldn’t be. In your lifetime, which of these accidental injuries have happened to you or someone you know?l Sports-related accidental injuryl Broken bonel Burnl Concussionl Lacerationl Back or knee injuriesColonial Life’s Accident Insurance is designed to help you ll some of the gaps caused by increasing deductibles, co-payments and out-of-pocket costs related to an accidental injury. The benet to you is that you may not need to use your savings or secure a loan to pay expenses. Plus you’ll feel better knowing you can have greater nancial security.l Car accidentsl Falls & spillsl Dislocationl Accidental injuries that send youto the Emergency Room, Urgent Careor doctor’s oceWhat additional features are included?l Worldwide coveragel Portablel Compliant with Healthcare SpendingAccount (HSA) guidelinesWill my accident claim payment be reduced if I have other insurance?You’re paid regardless of any other insurance you may have with other insurance companies, and the benets are paid directly to you (unless you specify otherwise).What if I change employers?If you change jobs or leave your employer, you can take your coverage with you at no additional cost. Your coverage is guaranteed renewable as long as you pay your premiums when they are due or within the grace period. Can my premium change?Colonial Life can change your premium only if we change it on all policies of this kind in the state where your policy was issued. How do I le a claim?Visit coloniallife.com or call our Customer Service Department at 1.800.325.4368 for additional information.Accident Insurance
Your Colonial Life policy also provides benets for the following injuries received as a result of a covered accident.l Burn (based on size and degree) ....................................................................................$1,000 to $12,000l Coma .............................................................................................................................................................$10,000l Concussion .......................................................................................................................................................$150l Emergency Dental Work .......................................$75 Extraction, $300 Crown, Implant, or Denturel Lacerations (based on size) ........................................................................................................... $50 to $800Requires Surgeryl Eye Injury ...........................................................................................................................................................$300l Tendon/Ligament/Rotator Cu .......................................................... $500 - one, $1,000 - two or morel Ruptured Disc ..................................................................................................................................................$500l Torn Knee Cartilage .......................................................................................................................................$500Surgical Carel Surgery (cranial, open abdominal or thoracic) ................................................................................$1,500l Surgery (hernia) ..............................................................................................................................................$150l Surgery (arthroscopic or exploratory) ....................................................................................................$250l Blood/Plasma/Platelets ................................................................................................................................$300Benets listed are for each covered person per covered accident unless otherwise specied.Initial Carel Accident Emergency Treatment........... $150 l Ambulance .......................................$400l X-ray Benet ...................................................$50 l Air Ambulance ............................. $2,000Common Accidental InjuriesDislocations (Separated Joint) Non-Surgical SurgicalHip $6,600 $13,200 Knee (except patella) $3,300 $6,600 Ankle – Bone or Bones of the Foot (other than Toes) $2,640 $5,280 Collarbone (Sternoclavicular) $1,650 $3,300 Lower Jaw, Shoulder, Elbow, Wrist $990 $1,980 Bone or Bones of the Hand $990 $1,980 Collarbone (Acromioclavicular and Separation) $330 $660 One Toe or Finger $330 $660 Fractures Non-Surgical Surgical Depressed Skull $5,500 $11,000 Non-Depressed Skull $2,200 $4,400 Hip, Thigh $3,300 $6,600 Body of Vertebrae, Pelvis, Leg $1,650 $3,300 Bones of Face or Nose (except mandible or maxilla) $770 $1,540 Upper Jaw, Maxilla $770 $1,540 Upper Arm between Elbow and Shoulder $770 $1,540 Lower Jaw, Mandible, Kneecap, Ankle, Foot $660 $1,320 Shoulder Blade, Collarbone, Vertebral Process $660 $1,320 Forearm, Wrist, Hand $660 $1,320 Rib $550 $1,100 Coccyx $440 $880 Finger, Toe $220 $440
Transportation/Lodging AssistanceIf injured, covered person must travel more than 50 miles from residence to receive special treatment and connement in a hospital.l Transportation ............................................................................. $500 per round trip up to 3 round tripsl Lodging (family member or companion) ............................................... $125 per night up to 30 days for a hotel/motel lodging costsAccident Hospital Carel Hospital Admission* ........................................................................................................$1,500 per accidentl. Hospital ICU Admission* ................................................................................................$3,000 per accident* We will pay either the Hospital Admission or Hospital Intensive Care Unit (ICU) Admission, but not both.l Hospital Connement .........................................................$250 per day up to 365 days per accidentl Hospital ICU Connement ...................................................$500 per day up to 15 days per accidentAccident Follow-Up Carel Accident Follow-Up Doctor Visit ..........................................................$50 (up to 3 visits per accident)l Medical Imaging Study ......................................................................................................$250 per accident (limit 1 per covered accident and 1 per calendar year)l Occupational or Physical Therapy ..................................................... $35 per treatment up to 10 daysl Appliances ..........................................................................................$125 (such as wheelchair, crutches)l Prosthetic Devices/Articial Limb ....................................................$500 - one, $1,000 - more than 1l Rehabilitation Unit .................................................$100 per day up to 15 days per covered accident, and 30 days per calendar year. Maximum of 30 days per calendar yearAccidental Dismembermentl Loss of Finger/Toe .................................................................................$750 – one, $1,500 – two or morel Loss or Loss of Use of Hand/Foot/Sight of Eye .....................$7,500 – one, $15,000 – two or moreCatastrophic AccidentFor severe injuries that result in the total and irrecoverable:l Loss of one hand and one foot l Loss of the sight of both eyesl Loss of both hands or both feet l Loss of the hearing of both earsl Loss or loss of use of one arm and one leg or l Loss of the ability to speakl Loss or loss of use of both arms or both legsNamed Insured ................ $25,000 Spouse ..............$25,000 Child(ren) ......... $12,500365-day elimination period. Amounts reduced for covered persons age 65 and over.Payable once per lifetime for each covered person.Accidental DeathAccidental Death Common Carrierl Named Insured $25,000 $100,000l Spouse $25,000 $100,000l Child(ren) $5,000 $20,000
EXCLUSIONS We will not pay benets for losses that are caused by or are the result of: hazardous avocations; felonies or illegal occupations; racing; semi-professional or professional sports; sickness; suicide or self-inicted injuries; war or armed conict; in addition to the exclusions listed above, we also will not pay the Catastrophic Accident benet for injuries that are caused by or are the result of: birth; intoxication.For cost and complete details, see your Colonial Life benets counselor. Applicable to policy form Accident 1.0-HS-NC. This is not an insurance contract and only the actual policy provisions will control. Colonial Life 1200 Colonial Life BoulevardColumbia, South Carolina 29210coloniallife.com71740-NC©2014 Colonial Life & Accident Insurance Company | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 6-14Health Screening Benet l $50 per covered person per calendar yearProvides a benet if the covered person has one of the health screening tests performed. This benet is payable once per calendar year per person and is subject to a 30-day waiting period.Tests include:l. Blood test for triglyceridesl. Bone marrow testingl. Breast ultrasoundl. CA 15-3 (blood test for breast cancer)l. CA125 (blood test for ovarian cancer)l. Carotid dopplerl. CEA (blood test for colon cancer)l. Chest x-rayl. Colonoscopyl. Echocardiogram (ECHO)l. Electrocardiogram (EKG, ECG)l. Fasting blood glucose testl. Flexible sigmoidoscopyl. Hemoccult stool analysisl. Mammographyl. Pap smearl. PSA (blood test for prostate cancer)l. Serum cholesterol test to determinelevel of HDL and LDLl. Serum protein electrophoresis(blood test for myeloma)l. Stress test on a bicycle or treadmilll. Skin cancer biopsyl. Thermographyl. ThinPrep pap testl. Virtual colonoscopyAccident 1.0 -Preferred with Health Screening BenetMy Coverage Worksheet (For use with your Colonial Life benets counselor)Who will be covered? (check one) Employee Only Spouse Only One Child Only Employee & Spouse One-Parent Family, with Employee One-Parent Family, with Spouse Two-Parent FamilyWhen are covered accident benets available? (check one) On and O -Job Benets O -Job Only Benets
Cancer Insurance Level 3 Benefits BENEFIT DESCRIPTION Cancer insurance helps provide financial protection through a variety of benefits These benefits are not only for you but also for your covered family members BENEFIT AMOUNT Air ambulance 2 000 per trip Transportation to or from a hospital or medical facility max of two trips per confinement Ambulance 250 per trip Transportation to or from a hospital or medical facility max of two trips per confinement Anesthesia Administered during a surgical procedure for cancer treatment General anesthesia 25 of surgical procedures benefit Local anesthesia 40 per procedure Anti nausea medication 50 per day administered or Doctor prescribed medication for radiation or chemotherapy 200 monthly max per prescription filled Blood plasma platelets immunoglobulins 175 per day A transfusion required during cancer treatment 10 000 calendar year max Bone marrow donor screening 50 Testing in connection with being a potential donor once per lifetime Bone marrow or peripheral stem cell donation 750 Receiving another person s bone marrow or stem cells for a transplant once per lifetime Bone marrow or peripheral stem cell transplant 7 000 per transplant Transplant you receive in connection with cancer treatment max of two bone marrow transplant benefits per lifetime Cancer vaccine 50 An FDA approved vaccine for the prevention of cancer once per lifetime Companion transportation 0 50 per mile Companion travels by plane train or bus to accompany a covered cancer patient more than 50 miles one way for treatment up to 1 200 per round trip Egg s extraction or harvesting sperm collection and storage Extracted harvested or collected before chemotherapy or radiation once per lifetime Egg s extraction or harvesting sperm collection 1 000 Egg s or sperm storage cryopreservation 350 Experimental treatment 300 per day Hospital medical or surgical care for cancer 15 000 lifetime max For more information talk with your benefits counselor Family care 50 per day Inpatient or outpatient treatment for a covered dependent child 2 500 calendar year max Hair external breast voice box prosthesis 350 per calendar year Prosthesis needed as a direct result of cancer Home health care services 100 per day Examples include physical therapy occupational therapy speech therapy and audiology prosthesis and orthopedic appliances rental or purchase of durable medical equipment up to 30 days per calendar year or twice the number of days hospital confined whichever is greater Hospice initial or daily care An initial one time benefit and a daily benefit for treatment 15 000 lifetime max for both Initial hospice care once per lifetime 1 000 Daily hospice care 50 per day CANCER ASSIST LEVEL 3
BENEFIT DESCRIPTION BENEFIT AMOUNT Hospital confinement Hospital stay including intensive care required for cancer treatment 30 days or less 250 per day 31 days or more 500 per day Lodging 75 per day Hotel motel expenses when being treated for cancer more than 50 miles from home 70 day calendar year max Medical imaging studies 175 per study Specific studies for cancer treatment 350 calendar year max Outpatient surgical center 300 per day Surgery at an outpatient center for cancer treatment 900 calendar year max Private full time nursing services 125 per day Services while hospital confined other than those regularly furnished by the hospital Prosthetic device artificial limb 2 000 per device or limb A surgical implant needed because of cancer surgery payable one per site 4 000 lifetime max Radiation chemotherapy Weekly benefit max once per week Injected chemotherapy by medical personnel 750 Radiation delivered by medical personnel 750 Monthly chemotherapy benefit max once per month Self injected 300 Pump 300 Topical 300 Oral hormonal 1 24 months 300 Oral hormonal 25 months 150 Oral non hormonal 300 Reconstructive surgery 60 per surgical unit ColonialLife com A surgery to reconstruct anatomic defects that result from cancer treatment up to 3 000 per procedure including 25 for general anesthesia Second medical opinion 300 A second physician s opinion on cancer surgery or treatment once per lifetime Skilled nursing care facility 100 per day Confinement to a covered facility after hospital release up to the number of days paid for hospital confinement Skin cancer initial diagnosis 400 A skin cancer diagnosis while the policy is in force once per lifetime Supportive or protective care drugs and colony stimulating factors 150 per day Doctor prescribed drugs to enhance or modify radiation chemotherapy treatments 1 200 calendar year max Surgical procedures 60 per surgical unit Inpatient or outpatient surgery for cancer treatment 5 000 max per procedure Transportation 0 50 per mile Travel expenses when being treated for cancer more than 50 miles from home up to 1 200 per round trip Waiver of premium Is available No premiums due if the named insured is disabled longer than 90 consecutive days The policy has limitations and exclusions that may affect benefits payable Most benefits require that a charge be incurred Coverage may vary by state and may not be available in all states For cost and complete details see your benefits counselor This chart highlights the benefits of policy form CanAssist including state abbreviations where used for example CanAssist TX This chart is not complete without form number 101481 2015 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 4 15 101484 1
Cancer Insurance Wellness Benefits To encourage early detection our cancer insurance offers benefits for wellness and health screening tests For more information talk with your benefits counselor Part one Cancer wellness health screening 100 per Yr Provided when one of the tests listed below is performed after the waiting period and while the policy is in force Payable once per calendar year per covered person Cancer wellness tests Health screening tests B one marrow testing B lood test for triglycerides B reast ultrasound C arotid Doppler C A 15 3 blood test for breast cancer E chocardiogram ECHO C A 125 blood test for ovarian cancer E lectrocardiogram EKG ECG C EA blood test for colon cancer F asting blood glucose test C hest X ray C olonoscopy S erum cholesterol test for HDL and LDL levels F lexible sigmoidoscopy S tress test on a bicycle or treadmill H emoccult stool analysis M ammography P ap smear P SA blood test for prostate cancer S erum protein electrophoresis blood test for myeloma S kin biopsy T hermography T hinPrep pap test V irtual colonoscopy Part two Cancer wellness additional invasive diagnostic test or surgical procedure Provided when a doctor performs a diagnostic test or surgical procedure after the waiting period as the result of an abnormal result from one of the covered cancer wellness tests in part one We will pay the benefit regardless of the test results Payable once per calendar year per covered person Waiting period means the first 30 days following the policy s coverage effective date during which no benefits are payable The policy has exclusions and limitations For cost and complete details of the coverage see your Colonial Life benefits counselor Coverage may vary by state and may not be available in all states Applicable to policy form CanAssist and state abbreviations where applicable for example CanAssist TX 2015 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 CANCER ASSIST WELLNESS 3 15 101486 1
For more information, talk with your benefits counselor.ColonialLife.comSubsequent diagnosis of a dierent critical illness3If you receive a benefit for a specified critical illness, and later you are diagnosed with a dierent specified critical illness, the original percentage of the face amount is payable for that particular specified critical illness.Subsequent diagnosis of the same critical illness3If you receive a benefit for a specified critical illness, and later you are diagnosed with the same specified critical illness, 25% of the original face amount is payable. Critical illness conditions that do not qualify are: coronary artery bypass gra surgery/disease2 and occupational infectious HIV or occupational infectious hepatitis B, C or D.Specified Critical Illness InsuranceFor 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%Permanent paralysis due to a covered accident 100%Coma 100%Blindness 100%Occupational infectious HIV or occupational infectious hepatitis B, C or D100%Coronary artery bypass gra surgery/disease225%If you’re diagnosed with a covered critical illness, specified 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.Face amount: $10K, $20K, $30KCritical illness benefitCRITICAL ILLNESS 1.0 WITH SUBSEQUENT DIAGNOSIS The maximum benefit amount for this policy is 3x the face amount for the named insured for all covered persons combined. The policy will terminate when the maximum benefit amount for specified critical illness has been paid.
ColonialLife.com1 Please refer to the policy 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 specified critical illness must be separated by at least 180 days.THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONS AND LIMITATIONS FOR SPECIFIED CRITICAL ILLNESSWe will not pay benefits for a specified critical illness that occurs as a result of a covered person’s: felonies or illegal occupations; intoxicants and narcotics; mental or emotional disorders; pre-existing condition; suicide or self-inflicted injuries; or war or armed conflict.This is not an insurance contract and only the actual policy provisions will control. Applicable to policy form CI-1.0-ID or CI-1.0-SC. Please see your Colonial Life benefits counselor for details.6-17 | 101824-ID-SCUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
For more information, talk with your benefits counselor.ColonialLife.comSubsequent diagnosis of a dierent critical illness3If you receive a benefit for a specified critical illness, and later you are diagnosed with a dierent specified critical illness, the original percentage of the face amount is payable for that particular specified critical illness.Subsequent diagnosis of the same critical illness3If you receive a benefit for a specified critical illness, and later you are diagnosed with the same specified critical illness, 25% of the original face amount is payable. Critical illness conditions that do not qualify are: cancer, coronary artery bypass gra surgery/disease,2 carcinoma in situ, and occupational infectious HIV or occupational infectious hepatitis B, C or D.Specified Critical Illness InsuranceFor the diagnosis of this covered critical illness condition:1This percentage of the face amount is payable:Cancer 100%Heart attack (myocardial infarction) 100%Stroke 100%End-stage renal (kidney) failure 100%Major organ failure 100%Permanent paralysis due to a covered accident 100%Coma 100%Blindness 100%Occupational infectious HIV or occupational infectious hepatitis B, C or D100%Coronary artery bypass gra surgery/disease225%Carcinoma in situ 25%If you’re diagnosed with a covered critical illness or cancer, specified 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.Face amount: $10K, $20K, $30K Critical illness benefitCRITICAL ILLNESS 1.0 WITH CANCER AND SUBSEQUENT DIAGNOSIS The maximum benefit amount for this policy is 3x the face amount for the named insured for all covered persons combined. The policy will terminate when the maximum benefit amount for specified critical illness has been paid.
ColonialLife.com1 Please refer to the policy 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 specified critical illness must be separated by at least 180 days.THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONS AND LIMITATIONS FOR SPECIFIED CRITICAL ILLNESSWe will not pay benefits for a specified critical illness that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; pre-existing condition; psychiatric or psychological condition; suicide or self-inflicted injuries; or war or armed conflict. This is not an insurance contract and only the actual policy provisions will control. Applicable to policy form CI-1.0, CI-1.0-PL7, CI-1.0-PL8 or CI-1.0-PL10 (including state abbreviations where used, for example: CI-1.0-TX). The policy or its provisions may vary or be unavailable in some states. Please see your Colonial Life benefits counselor for details.4-19 | 101825-1Underwritten 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.Cancer vaccine benefit: ................................................................. $50 This benefit is payable if you or your covered family members incur a charge for any FDA-approved cancer vaccine while your policy is inforce.
Critical Illness Insurance Health Screening Benefit The optional health screening benefit can help you reduce the risk of serious illness through early detection Health screening benefit __50 00_____________ Maximum of one screening test per covered person per calendar year Blood test for triglycerides Pap smear Bone marrow testing PSA blood test for prostate cancer Breast ultrasound Serum cholesterol test for HDL and LDL levels 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 For more information talk with your benefits counselor Fasting blood glucose test Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy Flexible sigmoidoscopy Hemoccult stool analysis Mammography ColonialLife com THIS POLICY INSURANCE PROVIDES LIMITED BENEFITS Insureds in GA MA MN and VT must be covered by comprehensive health insurance before applying for critical illness or cancer insurance This information is not intended to be a complete description of the insurance coverage available The policy insurance or its provisions may vary or be unavailable in some states The policy insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form CI 1 0 P and GCC1 0 P and certificate form GCC1 0 C including state abbreviations where used for example CI 1 0 P TX GCC1 0 P TX and GCC1 0 C TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC 2021 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GROUP CRITICAL CARE CRITICAL ILLNESS 1 0 HEALTH SCREENING BENEFIT 5 21 100355 4
Term Life Insurance Peace of mind for you and your loved ones You want what s best for your family and that includes making sure they re prepared for the future With term life insurance from Colonial Life Accident Insurance Company you can provide financial security to help them cover their ongoing living expenses Advantages of term life insurance Lower cost when compared to cash value life insurance Same benefit payout throughout the duration of the policy Several term period options for flexibility during high need years 44 of Americans say their household would face financial hardship within six months should a wage earner die unexpectedly LIMRA 2022 Life Insurance Barometer Study Benefit for the beneficiary that is typically tax free Benefits and features Stand alone spouse policy available whether or not you buy a policy for yourself GA P Guaranteed premiums that do not increase during the selected term Ability to convert all or a portion of the benefit amount into cash value life insurance Flexibility to keep the policy if you change jobs or retire Built in terminal illness accelerated death benefit that provides up to 75 of the policy s death benefit up to 150 000 if you re diagnosed with a terminal illness1 Premium savings for face amounts over 250 000 based on your health 54 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
How 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 year Select any optional riders Spouse term life rider _____________ face amount for ______ year term period Children s term life rider _____________ face amount Accidental death benefit rider Optional riders At an additional cost you can purchase the following riders for even more financial protection Spouse term life rider Your spouse can have up to 50 000 of coverage for a 10 year or 20 year term period Children s term life rider You can purchase up to 20 000 in term life coverage for all of your eligible dependent children and pay one premium The children s term life rider may be added to either your policy or your spouse s policy not both Accidental death benefit rider The beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70 The benefit doubles if the accidental bodily injury occurs while riding as a fare paying passenger using public transportation such as ride sharing services An additional 25 will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt Chronic care accelerated death benefit rider If a licensed health care practitioner certifies that you have a chronic illness you may receive an advance on all or a portion of the death benefit available in a one time lump sum or monthly payments 1 A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living Premiums are waived during the benefit period Critical illness accelerated death benefit rider Chronic care accelerated If you suffer a heart attack myocardial infarction stroke or end stage renal kidney failure a 5 000 benefit is payable 1 A subsequent diagnosis benefit is included Critical illness Waiver of premium benefit rider Waiver of premium Premiums are waived for the policy and riders if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six month elimination period 3 death benefit rider accelerated death benefit rider benefit rider 1 Any payout would reduce the death benefit Benefits may be taxable as income Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits 2 Activities of daily living are bathing continence dressing eating toileting and transferring 3 You must resume premium payments once you are no longer disabled EXCLUSIONS AND LIMITATIONS To learn more talk with your Colonial Life benefits counselor If the insured dies by suicide whether sane or insane within two years one year in ND from the coverage effective date or the date of reinstatement we will not pay the death benefit We will terminate this policy and return the premiums paid without interest minus any loans and loan interest to you This information is not intended to be a complete description of the insurance coverage available The policy or its provisions may vary or be unavailable in some states The policy has exclusions and limitations which may affect any benefits payable Applicable to policy forms ICC18 ITL5000 ITL5000 and rider forms ICC18 R ITL5000 STR R ITL5000 STR ICC18 R ITL5000 CTR RITL5000 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 benefits 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 ColonialLife com FOR EMPLOYEES 6 22 101895 3
Whole Life Insurance You can t predict your family s future but you can be prepared for it You like to think that you ll be there for your family in the years to come But if something happened to you would your family have the income they need In the U S medical spending in the last 12 months of life is nearly 80 000 per person HealthAffairs org End Of Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported July 2017 It s not easy to think about such serious circumstances but it s important to make sure your family is financially protected You can gain peace of mind with whole life insurance from Colonial Life Advantages of whole life insurance Permanent coverage that stays the same throughout the life of the policy Guaranteed level premiums that do not increase because of changes in health or age Access to the policy s cash value through a policy loan for emergencies1 Benefit for the beneficiary that is typically tax free Benefits and features Two plan options to choose what age your premium payments will end Paid Up at Age 70 or Paid Up at Age 100 Stand alone spouse policy available whether or not you buy a policy for yourself Your cost will vary based on the level of coverage you select Talk with your benefits counselor for information about what level of coverage would work best for you Flexibility to keep the policy if you change jobs or retire Built in terminal illness accelerated death benefit that provides up to 75 of the policy s death benefit up to 150 000 if you re diagnosed with a terminal illness2 Immediate 3 000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses Pays cash surrender value at age 100 when the policy endows WHOLE LIFE IWL5000
Benefits worksheet For use with your benefits counselor HOW MUCH COVERAGE DO YOU NEED YOU ___________________ Select the option Paid Up at Age 70 Paid Up at Age 100 SPOUSE _______________ Select the option Paid Up at Age 70 Paid Up at Age 100 DEPENDENT STUDENT ____________ Paid Up at Age 70 Paid Up at Age 100 Select any optional riders S pouse term life rider _____________ face amount for ________ year term period Children s term life rider _____________ face amount Accidental death benefit rider Chronic care accelerated death benefit rider Additional coverage options Spouse term life rider Cover your spouse up to a maximum death benefit of 50 000 10 year and 20 year spouse term riders are available Juvenile whole life policy You can purchase a policy while children are young and premiums are low whether or not you buy a policy on yourself You may also increase the coverage when the child is 18 21 and 24 without providing proof of good health The plan is paid up at age 70 Children s term life rider You may purchase up to 20 000 in term life coverage for all of your eligible dependent children and pay one premium The children s term life rider may be added to either your policy or your spouse s policy not both Accidental death benefit rider The beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70 The benefit doubles if the accidental bodily injury occurs while riding as a fare paying passenger using public transportation such as ride sharing services An additional 25 will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt Chronic care accelerated death benefit rider If a licensed health care practitioner certifies that you have a chronic illness you may receive an advance on all or a portion of the death benefit available in a one time lump sum or monthly payments 2 A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living bathing continence dressing eating toileting and transferring Premiums are waived during the benefit period Critical illness accelerated death benefit rider If you suffer a heart attack myocardial infarction stroke or end stage renal kidney failure a 5 000 benefit is payable 2 A subsequent diagnosis benefit is included Guaranteed purchase option rider If you are age 50 or younger when you purchase the policy you can add the rider which allows you to purchase additional whole life coverage without having to answer health questions at three different points in the future You may purchase up to your initial face amount not to exceed a total combined maximum of 100 000 for all options Critical illness accelerated death benefit rider Waiver of premium benefit rider Premiums are waived for the policy and riders if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six month elimination period Once you are no longer disabled premium payments will resume Guaranteed purchase option rider 1 Loan should be repaid to protect the policy s value Waiver of premium benefit rider 2 Any payout would reduce the death benefit Benefits may be taxable as income Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits EXCLUSIONS AND LIMITATIONS To learn more talk with your benefits counselor ColonialLife com If the insured dies by suicide whether sane or insane within two years one year in ND from the coverage effective date or the date of reinstatement we will not pay the death benefit We will terminate this policy and return the premiums paid without interest minus any loans and loan interest to you Product may vary by state For costs and complete details of the coverage call or write your Colonial Life benefits counselor or the company This brochure is applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD RIWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 RIWL5000 GPO R IWL5000 GPO and applicable state variations Underwritten by Colonial Life Accident Insurance Company Columbia SC 2019 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 6 19 101935
Individual Dental InsuranceFreedom Plan $1,000 | 100% | 80% | 50%This benet summary provides a quick reference for the dental plan benets. Policy detailsPolicy year maximum benefit• Per person (applies to Class A, B and C services)$1,000 Deductible• Per person (applies to Class B and C services only) • Maximum of three per family per policy year$50Freedom Plan dental coverage at a glanceCo-insurance In-network1Out-of-network2 (90th UCR )Class A: Preventive services 100% 100%Class B: Basic services 80% 80%Class C: Major services 50% 50%Carryover benets3Carryover amount Per covered family memberThreshold limit Carryover account max$200 $500 $800 How carryover benefits work Receive a $200 benefit in your carryover account to use in the next benefit year when you meet these conditions:• One cleaning and one routine exam and• Total paid dental claims for Class A, B or C services below $500 (your threshold limit, the maximum amount of benets an insured can receive during a policy year and still be able to receive the carryover benet). Your carryover account can grow up to $800 to help pay for claims if you exceed your policy year maximum benefit.3INDIVIDUAL DENTAL - FREEDOM PLAN
Covered services In-network coverage1Out-of-network coverage2 (90th UCR)Waiting periodClass A: Preventive services• Routine exams and cleanings ‐ Two per 12-month period ‐ One additional cleaning per 12 months if member is in second or third trimester of pregnancy4• X-rays (bitewing x-rays) ‐ Up to four lms, once every 12 months• Full mouth/panoramic x-rays ‐ Once every ve years • Fluoride treatment ‐ Up to age 16, once every 12 months• Sealants ‐ Up to age 16, once every 36 months• Space maintainers ‐ Up to age 16, once every 24 months• Oral cancer screening ‐ For age 40+, once every 12 months100% 100% No waiting periodClass B: Basic services• Fillings• Posterior composite restorations• Simple extractions• Repair of crowns, dentures or bridges• Periodontics (gum treatments)• Endodontics (root canals)• Emergency treatment80% 80% No waiting periodClass C: Major services• Oral surgery (surgical extractions and impacted teeth)• Anesthesia (covered with complex oral surgery)• Inlays and onlays• Crowns, bridges, dentures and endosteal implants• Crown lengthening 50% 50%12-month waiting period5Contact your Colonial Life benets counselor to learn more.1 In-network benets are for covered dental services provided by a participating dentist. Participating dentists have agreed to accept negotiated fees as payment in full, subject to any deductibles, co-insurance and benet maximums, and will le claims for you.2 Out-of-network benets are for covered dental services provided by a non-participating dentist. Benets are based on usual, customary, and reasonable (UCR) charges for the same covered procedure by providers of similar training or experience in the general geographic area. Dentists haven’t agreed to accept the reimbursement as payment in full, and patients are responsible for any remaining charges, deductibles and co-insurance. You may have to le a claim to receive benets. UCR charges are reviewed and updated periodically.3 You must be covered for 12 consecutive months to receive the carryover benet; any break in coverage will eliminate the carryover account balance. The carryover benet may not be used for orthodontic treatment or services.4 Member may have one additional periodontal maintenance in place of an additional cleaning.5 Six-month waiting period in Vermont.Summary of Dental Benets and Coverage Disclosure Matrix (SDBC) is available at ColonialLifeDental.com/California.THIS POLICY PROVIDES LIMITED BENEFITS. A NETWORK ACCESS PLAN IS AVAILABLE.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IDN8100 (including state abbreviations where used, for example: IDN8100-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 4-24 | 1764516ColonialLife.com
Individual Dental InsuranceFreedom Premier Plan $2,000 | 100% | 80% | 50%This benet summary provides a quick reference for the dental plan benets. Policy detailsPolicy year maximum benefit• Per person (applies to Class A, B and C services)$2,000 Deductible• Per person (applies to Class B and C services only)• Maximum of three per family per policy year$50Freedom Premier Plan dental coverage at a glanceCo-insurance In-network1Out-of-network2 (90th UCR)Class A: Preventive services 100% 100%Class B: Basic services 80% 80%Class C: Major services 50% 50%Carryover benets3Carryover amount Per covered family memberThreshold limit Carryover account max$400 $800 $1,600 How carryover benefits work Receive a $400 benefit in your carryover account to use in the next benefit year when you meet these conditions:• One cleaning and one routine exam and• Total paid dental claims for Class A, B or C services below $800 (your threshold limit, the maximum amount of benets an insured can receive during a policy year and still be able to receive the carryover benet).Your carryover account can grow up to $1,600 to help pay for claims if you exceed your policy year maximum benefit.3INDIVIDUAL DENTAL - FREEDOM PREMIER PLAN
Covered services In-network coverage1Out-of-network coverage2 (90th UCR)Waiting periodClass A: Preventive services• Routine exams and cleanings ‐ Two per 12-month period ‐ One additional cleaning per 12 months if member is in second or third trimester of pregnancy4• X-rays (bitewing x-rays) ‐ Up to four lms, once every 12 months• Full mouth/panoramic x-rays ‐ Once every ve years• Fluoride treatment ‐ Up to age 16, once every 12 months• Sealants ‐ Up to age 16, once every 36 months• Space maintainers ‐ Up to age 16, once every 24 months• Oral cancer screening ‐ For age 40+, once every 12 months100% 100% No waiting periodClass B: Basic services• Fillings• Posterior composite restorations• Simple extractions• Emergency treatment80% 80% No waiting periodClass C: Major services• Oral surgery (surgical extractions and impacted teeth)• Anesthesia (covered with complex oral surgery)• Repair of crowns, dentures or bridges• Periodontics (gum treatments)• Endodontics (root canals)• Inlays and onlays• Crowns, bridges, dentures and endosteal implants• Crown lengthening 50% 50%12-month waiting period5Contact your Colonial Life benets counselor to learn more.1 In-network benets are for covered dental services provided by a participating dentist. Participating dentists have agreed to accept negotiated fees as payment in full, subject to any deductibles, co-insurance and benet maximums, and will le claims for you.2 Out-of-network benets are for covered dental services provided by a non-participating dentist. Benets are based on usual, customary, and reasonable (UCR) charges for the same covered procedure by providers of similar training or experience in the general geographic area. Dentists haven’t agreed to accept the reimbursement as payment in full, and patients are responsible for any remaining charges, deductibles and co-insurance. You may have to le a claim to receive benets. UCR charges are reviewed and updated periodically.3 You must be covered for 12 consecutive months to receive the carryover benet. The carryover benet may not be used for orthodontic treatment or services. A break in dental coverage will eliminate the carryover account balance.4 Member may have one additional periodontal maintenance in place of an additional cleaning.5 Six-month waiting period in Vermont. Summary of Dental Benets and Coverage Disclosure Matrix (SDBC) is available at ColonialLifeDental.com/California.THIS POLICY PROVIDES LIMITED BENEFITS. A NETWORK ACCESS PLAN IS AVAILABLE.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IDN8100 (including state abbreviations where used, for example: IDN8100-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 4-24 | 1764443ColonialLife.com
Dental Network More choices greater savings Save more by visiting a network dentist With dental insurance from Colonial Life you ll have access to a nationwide network of more than 323 000 access points1 You can visit any dentist but you ll stretch your benefits by selecting from our DenteMax Plus AlwaysCare network of dental professionals 323 000 dental access points1 How much can you save Dental costs vary from region to region but our dental members everywhere benefit two ways Discounted fees for in network services Insurance coverage of up to 50 80 or even 100 For more information talk with your Colonial Life benefits counselor Our members also receive in network discounts to help offset dental expenses like routine cleanings and X rays as well as major expenses such as implants crowns and oral surgery In network savings2 DENTAL PROCEDURE ColonialLife com AVERAGE COST RANGE MEMBER OUT OF POCKET COST Periodic oral exam3 40 50 0 Adult cleaning3 74 87 0 Four bitewing X rays3 50 62 0 Crown porcelain ceramic 1 000 1 195 425 508 Root canal therapy back tooth 1 015 1 095 432 465 IDN8000 DENTEMAX ALWAYSCARE NETWORK
95 Overall dental and vision member satisfaction4 Using our dental network is easy Our DenteMax Plus AlwaysCare network gives you access to top dental professionals in your area making it easy to locate a dentist who s right for you Refer to the document that came with your Colonial Life dental ID card to see a list of dentists closest to you Click on the dental provider search tool on ColonialLife com Consult the AlwaysAssist mobile app Confirm that your dentist is in network by having the office verify participation in the DenteMax Plus AlwaysCare network prior to your appointment Remember claims forms are not needed for in network dentists Extended customer service hours ET Monday Friday 8 a m 8 p m Saturday 10 a m 4 p m ColonialLife com Online self service is available 24 7 at ColonialLife com We welcome provider referrals Email ReferAProvider ColonialLife com to request that your dentist be added to our network 1 Internal data 2017 Access points are sites where network dentists see patients Some dentists may be available at more than one access point 2 Savings based on in network discounts and covered benefits This is just an illustration Eligibility for entitlement to and amount of actual benefits will be determined according to the terms of your dental policy Based on Colonial Life internal data 2016 and average cost ranges from one ZIP code 70806 After enrollment use the Dental Cost Estimator on AlwaysAssist com for information specific to your ZIP code 3 Dental insurance usually pays 100 for these services Plans and benefits may vary 4 Starmount AlwaysCare Benefits 2017 Customer Satisfaction Survey 2017 2018 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company Dental plans are underwritten by Colonial Life Accident Insurance Company Columbia SC 1 18 101841
Individual Dental PPO Insurance Vision Rider Dental insurance offers an optional vision rider to help pay for eye exams and materials such as glasses and contact lenses This coverage can help you maintain healthy vision and overall wellness as well as provide valuable financial protection for you your spouse and dependent children Vision benefits IN NETWORK OUT OF NETWORK ALLOWANCE CO PAYS Exam once per 12 months 10 Up to 35 Materials 25 See below STANDARD PLASTIC LENSES1 once per 12 months For more information talk with your benefits counselor Single vision Covered by co pay Up to 25 Bifocal Covered by co pay Up to 40 Trifocal Covered by co pay Up to 50 Lenticular 80 allowance Up to 50 Progressive 80 allowance Up to 40 Polycarbonate lenses for children to age 19 Covered by co pay N A FRAMES1 once per 12 months Choose any frame available at provider locations 120 allowance Up to 50 CONTACT LENSES2 once per 12 months Includes fit follow up and materials In lieu of eyeglass lenses and frames Elective Up to 120 allowance Up to 100 allowance Medically necessary Up to 120 allowance Up to 210 allowance Freedom of choice ColonialLife com You ll have access to a national vision network that includes independent optometrists ophthalmologists and retail stores including Walmart Sam s Club Optical Costco 3 Pearle Vision and Target Additional vision benefit advantages Eye exams and materials frames lenses can be purchased from different locations and providers For example you could have an eye exam with your favorite eye care professional and order contacts online Check the network for Value Added and Service Plus providers They can provide special discounts for extra purchases of lenses and coatings frames contact lenses and other products IDN8000 VISION RIDER
Special discounts on material purchases4 Providers identified as Value Added or Service Plus in our online provider directory offer the following additional values for our members on vision material purchases We encourage you to contact your selected provider prior to visiting their location to confirm their continued participation Not all providers such as Walmart Sam s Club and Costco Optical 3 choose to participate in these special discounts Value Added providers DISCOUNTS FOR FIRST PAIR OF GLASSES Lens options add ons for insured purchases UV coating 15 Polarized 75 Standard polycarbonate 40 Solid tinting gradient tinting 15 Transition 75 Standard scratch resistance coating 15 Progressive lenses Standard 110 Premium 170 Ultra member receives a 20 discount High index single vision 1 56 1 60 60 1 66 20 discount Standard anti reflective coating 45 Premium anti reflective coating 70 Ultra anti reflective coating 20 discount High index multi focal 1 56 1 60 75 1 66 20 discount PURCHASE A SECOND PAIR OF GLASSES AND RECEIVE PREFERRED PRICING Lenses Single vision plastic lenses 40 Trifocal lenses 70 Bifocal plastic lenses 60 Progressive lenses standard 110 Progressive lenses premium and ultra 20 discount DISCOUNTS ON FRAMES CONTACT LENSES AND OTHER PRODUCTS Frames Up to 35 discount Contact Lenses 5 15 discount depending on type Other products 20 discount on non prescription sunglasses and other ancillary products solutions5 Service Plus providers RECEIVE UP TO A 20 DISCOUNT FOR THE FOLLOWING ADD ONS TO INSURED PURCHASES UV coating Solid tinting gradient tinting Standard scratch resistance coating Standard anti reflective coating Premium anti reflective coating Transition Standard polycarbonate 1 Eyeglass lenses and frames are paid in lieu of the contact lenses benefit 2 The contact lenses benefit is paid in lieu of eyeglass lenses and frames Contact lenses consist of three components materials exams and fittings Coverage is for materials and the exam up to the contact lenses allowance Fittings may be covered but only up to the amount of any unused contact lenses allowance after materials 3 Optometrists at Costco Optical outlets are independent of Costco and may not be in network To verify that your vision exam will be fully covered after co pay confirm that your doctor is an in network provider Special payment and reimbursement terms apply for material purchases at Costco Additional discounts are not applicable ColonialLife com 4 Not a covered benefit These schedules are subject to change without notice Added value discounts may not be available in all geographical areas and vary by network Many providers are not able to offer discounts on Prestige frames Special lens packages that combine numerous lens enhancements at value price points are not covered by these added value programs Cannot be combined with any other promotions or discounts 5 Some retail chains sell sunglasses in departments outside of their optical shops where discounts do not apply The policy or its provisions may vary or be unavailable in some states The policy had exclusions and limitations which may affect any benefits payable See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability 2018 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company Underwritten by Colonial Life Accident Insurance Company Columbia SC 1 18 101851
Dental PPO Member Guide Dental insurance coverage provides valuable protection for both your smile and your wallet Below is information to help use the plan USING THE DENTAL VISION NETWORKS The name of the dental network is DenteMax Plus AlwaysCare 1 The name of the vision network if applicable to your coverage is First Look Find a network provider by visiting ColonialLifeDental com ID CARDS ID cards are mailed to your home address within 10 business days of enrolling Only the main insured s name will be listed Included with your ID card is a list of the eight nearest network providers based on your home address Vision coverage if purchased includes a separate ID card Below are samples of ID cards and the mailing envelope they are sent in 8485 Goodwood Boulevard Baton Rouge LA 70806 7878 DOWNLOAD THE ALWAYSASSIST MOBILE APP AlwaysAssist makes it simple to access your dental and vision benefits information You can View benefits claim status ID cards and more Find the app in the App Store or Google Play or visit the website ColonialLifeDental com Register using your Social Security number or member ID which can be found on your ID card IMPORTANT Your insurance documents are enclosed CLA OE WIN 9 18 DENTAL ID Card E L P M SA Policyholder Name Member Claims No XXXXXXX Cov Code D Policy No XXXXXX Eff Date 02 01 2022 Plan SCA Network PPO DenteMax Plus AlwaysCare Deductible 50 per benefit year Payor ID STR01 Underwritten by Colonial Life Accident Insurance Company HOW TO USE YOUR DENTAL BENEFITS Scan this code or go directly to ColonialLifeDental com to access AlwaysAssist E L P AM Register and manage your account at AlwaysAssist com Request pre treatment estimates for all services over 300 Member Customer Service 888 400 9304 Provider Services 855 400 9330 Faster claims processing is available for network providers at AlwaysAssist com S Mail claims to Dental Claims Department P O Box 80139 Baton Rouge LA 70898 0139 10 18 NS 15928 1
Deductions per year: 12Barnhill Homes Monthly RatesIndividual Disability - ISTD3000 for NC AAA Risk ClasslOff Job Accident & Off Job Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,200* $1,500* $2,000* $2,500**monthly benefit amount0 days Accident/7 days Sickness 17-49 $26.00 $31.20 $39.00 $52.00 $65.0050-64 $29.70 $35.64 $44.55 $59.40 $74.2565-74 $43.30 $51.96 $64.95 $86.60 $108.256 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,200* $1,500* $2,000* $2,500**monthly benefit amount0 days Accident/7 days Sickness 17-49 $33.00 $39.60 $49.50 $66.00 $82.5050-64 $43.00 $51.60 $64.50 $86.00 $107.5065-74 $67.10 $80.52 $100.65 $134.20 $167.75Individual Medical Bridge for NCl$2000 Hospital Confinement Benefit, $100 Health Screening Benefit. Daily Hospital Confinement benefit, EnhancedIntensive Care Unit Confinement benefitISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENTCHILDRENEMPLOYEE, SPOUSE ANDDEPENDENT CHILDREN17-49 $43.55 $81.40 $58.30 $96.1550-59 $55.60 $104.50 $70.35 $119.2560-64 $74.55 $140.40 $89.30 $155.1565-75 $107.80 $203.25 $124.00 $219.45Individual Medical Bridge for NCl$1000 Hospital Confinement Benefit, $100 Health Screening Benefit. Daily Hospital Confinement benefit, EnhancedIntensive Care Unit Confinement benefitISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENTCHILDRENEMPLOYEE, SPOUSE ANDDEPENDENT CHILDREN17-49 $29.75 $55.30 $38.50 $64.0550-59 $36.70 $68.50 $45.45 $77.2560-64 $48.75 $91.40 $57.50 $100.1565-75 $69.90 $131.45 $79.50 $141.05Accident 1.0 for NClOn/Off-Job Accident CoverageISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYPreferred with health screening 17-80 $21.15 $28.97 $32.67 $40.48Page 1 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
Cancer Assist for NClwith $100 Health Screening Benefit$5,000 Initial Diagnosis BenefitCOVERAGE LEVEL ISSUE AGE NAMED INSURED EMPLOYEE AND SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYLevel 3 17-75 $34.15 $56.90 $35.10 $57.85Critical Illness 1.0 for NClHSA Compliant, with Subsequent Diagnosis Coverage, Health Screening BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $4.55 $6.90 $4.55 $6.9025-29 $5.35 $8.20 $5.35 $8.2030-34 $6.35 $9.80 $6.35 $9.8035-39 $9.25 $14.20 $9.25 $14.2040-44 $10.95 $16.80 $10.95 $16.8045-49 $14.35 $22.10 $14.35 $22.1050-54 $18.95 $29.20 $18.95 $29.2055-59 $23.65 $36.30 $23.65 $36.3060-64 $30.05 $46.20 $30.05 $46.2065-70 $36.35 $55.80 $36.35 $55.80$20,000 17-24 $6.95 $10.50 $6.95 $10.5025-29 $8.55 $13.10 $8.55 $13.1030-34 $10.55 $16.30 $10.55 $16.3035-39 $16.35 $25.10 $16.35 $25.1040-44 $19.75 $30.30 $19.75 $30.3045-49 $26.55 $40.90 $26.55 $40.9050-54 $35.75 $55.10 $35.75 $55.1055-59 $45.15 $69.30 $45.15 $69.3060-64 $57.95 $89.10 $57.95 $89.1065-70 $70.55 $108.30 $70.55 $108.30$30,000 17-24 $9.35 $14.10 $9.35 $14.1025-29 $11.75 $18.00 $11.75 $18.0030-34 $14.75 $22.80 $14.75 $22.8035-39 $23.45 $36.00 $23.45 $36.0040-44 $28.55 $43.80 $28.55 $43.8045-49 $38.75 $59.70 $38.75 $59.7050-54 $52.55 $81.00 $52.55 $81.0055-59 $66.65 $102.30 $66.65 $102.3060-64 $85.85 $132.00 $85.85 $132.0065-70 $104.75 $160.80 $104.75 $160.80(Continued...)Page 2 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
Critical Illness 1.0 for NClHSA Compliant, with Subsequent Diagnosis Coverage, Health Screening Benefit, Cancer BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $6.25 $9.50 $7.85 $11.2025-29 $8.35 $12.80 $9.95 $14.4030-34 $10.65 $16.30 $12.25 $18.0035-39 $14.15 $21.80 $15.85 $23.4040-44 $17.05 $26.20 $18.65 $27.8045-49 $22.45 $34.40 $24.05 $36.1050-54 $31.45 $48.30 $33.15 $50.0055-59 $38.95 $59.90 $40.65 $61.6060-64 $51.95 $79.90 $53.65 $81.5065-70 $61.85 $95.00 $63.55 $96.80$20,000 17-24 $10.35 $15.70 $13.55 $19.1025-29 $14.55 $22.30 $17.75 $25.5030-34 $19.15 $29.30 $22.35 $32.7035-39 $26.15 $40.30 $29.55 $43.5040-44 $31.95 $49.10 $35.15 $52.3045-49 $42.75 $65.50 $45.95 $68.9050-54 $60.75 $93.30 $64.15 $96.7055-59 $75.75 $116.50 $79.15 $119.9060-64 $101.75 $156.50 $105.15 $159.7065-70 $121.55 $186.70 $124.95 $190.30$30,000 17-24 $14.45 $21.90 $19.25 $27.0025-29 $20.75 $31.80 $25.55 $36.6030-34 $27.65 $42.30 $32.45 $47.4035-39 $38.15 $58.80 $43.25 $63.6040-44 $46.85 $72.00 $51.65 $76.8045-49 $63.05 $96.60 $67.85 $101.7050-54 $90.05 $138.30 $95.15 $143.4055-59 $112.55 $173.10 $117.65 $178.2060-64 $151.55 $233.10 $156.65 $237.9065-70 $181.25 $278.40 $186.35 $283.80Term Life (ITL5000) for NCl20-Year Term Base Plan, Waiver of Premium Benefit, Accidental Death Benefit, Chronic Care Accelerated Death BenefitNon-Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $13.71 $16.41 $22.62 $28.8335 $16.46 $18.03 $25.05 $32.0945 $22.38 $30.12 $43.19 $56.2555 $46.77 $61.58 $90.38 $119.1665 $69.02 $134.04 $199.06 $264.08(Continued...)Page 3 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
Term Life (ITL5000) for NCl20-Year Term Base Plan, Waiver of Premium Benefit, Accidental Death Benefit, Chronic Care Accelerated Death BenefitTobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $23.15 $24.08 $34.12 $44.1735 $26.52 $27.07 $38.62 $50.1745 $37.90 $53.79 $78.69 $103.5855 $86.46 $121.29 $179.94 $238.5865 $111.16 $218.33 $325.49 $432.65Whole Life Plus (IWL5000) for NClAdult Base Plan Paid-Up at Age 100, Accelerated Death Benefit for Long-Term Care Services, Accidental Death Benefit,Guaranteed Purchase Option Benefit, Waiver of Premium BenefitNon-Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $26.29 $52.59 $78.88 $105.1735 $35.37 $70.74 $106.12 $141.4945 $56.22 $112.45 $168.68 $224.9155 $93.14 $186.28 $279.43 $372.5765 $154.52 $309.03 $463.55 $618.06Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $43.73 $87.46 $131.19 $174.9235 $53.39 $106.80 $160.18 $213.5745 $80.37 $160.75 $241.11 $321.4855 $134.83 $269.65 $404.49 $539.3265 $220.34 $440.69 $661.04 $881.38Individual Dental 8100 (IDN8100) for NClwith Vision Rider - 0 Month Waiting Period, Applicable to Class C ServicesZip Codes: ALL Zip CodesCOVERAGE LEVEL NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENTCHILD(REN)NAMED INSURED,SPOUSE ANDDEPENDENTCHILD(REN)Freedom (UCR 100/80/50) $1,000 MAX $64.99 $125.12 $155.81 $232.77Freedom Premier (UCR 100/80/50) $2,000 MAX $73.48 $141.43 $176.51 $263.53(Continued...)Page 4 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Important 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.© 2025 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. Kitty Mellone | Kmellone@coloniallifenc.com| (704) 907-3944(Continued...)Page 5 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
Barnhill Homes Colonial Interest Form Name_______________________________ Job Title ______________ Social Security #_________________ Annual Income $________________________ Address________________________________ City ___________________St. __________Zip_______ Work Phone___________________ Cell Phone________________ Email Address____________________________________________________ Date of Birth (DOB) ________________ Tobacco______ Non Tobacco_____ Date of Hire____________________ Drivers License #_______________ State Born__________ Beneficiary__________________________________DOB___________Relationship____________ Dependent Information: Spouse________________________________DOB_______________ Relationship____________ Child_________________________________DOB________________Relationship____________ Child_________________________________DOB________________Relationship____________ Child_________________________________DOB________________Relationship____________ ____ Waive Colonial Coverage. I understand that I can only enroll during Annual Enrollment unless I have a qualified event during the year. ___ Keep my Colonial benefits the same ___ Add Coverage or Change my Colonial Coverages Signature__________________________________________Date____________ Questions or Assistance Contact: Kitty Mellone 704-907-3944 (D) Email: Kmellone@coloniallifenc.com Email Completed Form with Rate Sheet & elected coverage’s circled
Policyholder Service Guide At Colonial Life our goal is to give you an excellent customer experience that is simple modern and personal Getting started Consider your options The easiest way to manage your business with us is through the My Colonial Life policyholder section of ColonialLife com Whether online or by phone we ll provide the service you need To sign up for the website 1 Visit ColonialLife com 2 Click Register at the top right 3 On the sign up page click Join the Policyholder Website Need ColonialLife com Submit your claim using our eClaims system 3 File health screening wellness and doctor s office visit claims up to 18 months 3 3 Check the status of your claim 3 3 Review print or download a copy of your policy certificate 3 Access claim and service forms 3 3 Access your claim correspondence 3 3 3 Complete a notification for a life claim 3 3 Update your contact information After providing some basic information you ll be ready to go 800 325 4368 Filing claims eClaims With the eClaims feature on ColonialLife com you can file claims online by simply answering a few questions and uploading your supporting documentation You re able to spend less time on paperwork and we re able to process your claim faster With eClaims you can file most claims online including Accident Hospital confinement indemnity Disability Critical illness Cancer Vision You can access eClaims through your computer or mobile device and upload any required supporting documentation Once you re logged in to ColonialLife com visit the Claims Center and select File an Online Claim to get started
Contact us Online ColonialLife com Log in and click on Contact Us to email us Telephone 1 800 325 4368 Contact Center representatives are available Monday through Friday 8 a m to 8 p m ET Information is available 24 7 through our automated phone system Please have your Social Security or policy number ready when you call Hearing impaired customers Customers with a Telecommunications Device for the Deaf TDD should call 803 798 4040 If you do not have a TDD call Voiance Telephone Interpretation Services at 844 495 6105 to reach us Health screening wellness claims The quickest way to receive the applicable benefits for your health screening wellness services is to file online For health screening wellness claims within 18 months of the date you are filing the claim click on File a Wellness Claim Online on the Claims Center page If you do not want to file online you can use the automated customer service center at 1 800 325 4368 For health screening wellness claims over 18 months you ll be directed to print out a paper claim form under the claims and service forms section on the Claims Center page Paper claims If you don t want to file online download the form you need by visiting the Claims Center page on ColonialLife com and clicking on claims and service forms For instructions on how to correctly complete your claim form view the claims videos on the Claims Center page Be sure that you complete all sections of the claim form Also include a diagnosis from your doctor along with copies of any appropriate bills if required Keep a copy of your claim information for your records When we receive information regarding your claim you ll be notified by telephone or email If you select the electronic messaging option you ll receive a call when the claim is processed Claim tips and information When submitting your claim make sure to include all required supporting documentation as this will allow us to process your claim quicker To view correspondence pertaining to your claim visit ColonialLife com Once you log in to your secure account select My Correspondence from the home page Whether you submit your claims online or by paper form you can select optional services that authorize us to Communicate claims information via electronic messaging to your phone number Send claim benefits overnight by deducting a fee from your claim payment Release information to your benefits representative plan administrator or family member You can always check the status of your claim on the My Colonial Life site at ColonialLife com ColonialLife com Applicable to vision rider on the individual dental plan 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 4 16 43233 37