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Message Bobcat of Portland2025 Voluntary Benefits BookletNS-15576 (9-17)Bobcat of Portland
Welcome to Your Voluntary Benefits At Bobcat of Portland, our greatest asset is people like you. We value your hard work and like to do what we can to reward your efforts. That’s why we are pleased to offer you these valuable employee benefits. Please review the information in this booklet to learn about the plans being offered and determine what coverage is right for you.The information contained in this booklet is only a summary of coverage and is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. If there are differences between the information in the booklet and the contract, the contract will govern.
Individual Dental InsuranceStandard Plan - No waiting period $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$50Standard Plan dental coverage at a glanceCo-insurance In-network1Out-of-network2 (MAC)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.31794373-ORINDIVIDUAL DENTAL - STANDARD PLAN - NO WAITS
Covered services In-network coverage1Out-of-network coverage2 (MAC)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• 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• Full mouth/panoramic x-rays ‐ Once every ve years• 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% No waiting periodContact 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 provided at the lesser of the dentist’s actual fee or the Maximum Allowable Charge (MAC), a scheduled amount determined by Colonial Life, subject to any deductibles, co-insurance and benet maximums. Dentists haven’t agreed to accept the charges as payment in full, and additional out-of-pocket costs may apply. You may have to le a claim to receive benets.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.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-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 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 | 1794373-ORColonialLife.com1794373-OR
Individual Dental InsuranceEnhanced Plan — No waiting period $3,000 | 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)$3,000 Deductible• Per person (up to maximum of three per policy year)$50Enhanced Plan dental coverage at a glanceCo-insurance In-network1Out-of-network2 (MAC)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 limit$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 yearly maximum benefits.31797034-OR INDIVIDUAL DENTAL – ENHANCED PLAN – NO WAITS
Covered services In-network coverage1Out-of-network coverage2 (MAC)Waiting periodClass A: Preventive services• Routine exams and cleanings ‐ Twice every 12 months ‐ 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 (extractions and impacted teeth)• Anesthesia (covered with complex oral surgery)• Inlays and onlays• Crowns, bridges, dentures and endosteal implants• Crown lengthening 50% 50% No waiting periodContact your Colonial Life benets representative 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 provided at the lesser of the dentist’s actual fee or the Maximum Allowable Charge (MAC), a scheduled amount determined by Colonial Life, subject to any deductibles, co-insurance and benet maximums. Dentists haven’t agreed to accept the charges as payment in full, and additional out-of-pocket costs (balance billing) may apply. You may have to le a claim to receive benets.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.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-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 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 | 1797034-ORColonialLife.com1797034-OR
Individual Dental InsuranceVision Rider Our vision coverage helps you and your family maintain your vision wellness, with coverage for eye exams and optical materials, such as eyeglasses or contact lenses. This benet summary provides a quick reference to the rider’s benets.Co-pays (per insured)1Benefits (once per 12 months) In-network Out-of-networkVision exam $10 N/AContact lenses fitting $25 N/AMaterials $25 N/ABenets and allowances1Benets In-network Out-of-networkVision exam Covered in full after co-pay $35 allowanceContact lenses fittingStandard2Up to $60 allowance after co-payN/ASpecialty3Up to $100 allowance after co-payN/AMaterials: Eyeglass lenses and frames4Single vision Covered in full after co-pay Up to $25 allowanceBifocals Covered in full after co-pay Up to $40 allowanceTrifocals Covered in full after co-pay Up to $50 allowanceLenticular Up to $120 allowance Up to $50 allowanceProgressives Up to $70 allowance Up to $40 allowancePolycarbonate lenses (for children to age 19 only)Covered in full after co-pay N/AFrames Up to $170 allowance Up to $50 allowanceMaterials: Contact lenses5Elective Up to $170 allowance Up to $100 allowanceNon-elective Up to $210 allowance Up to $210 allowanceMAXIMIZE YOUR BENEFITS Maximize your vision benets with any provider in our large, nationwide network, including independent optometrists, ophthalmologists, and retail stores such as: • Walmart and Sam’s ClubOptical• Target Optical• Pearle Vision• VisionworksYou can choose different providers for eye exams, eyeglasses and contact lenses.ID CARDS• Vision ID cards are mailed to your home address within 10 business days of enrolling, separate from dental ID cards.• Only the primary insured’sname will be listed.1820767-OR INDIVIDUAL DENTAL - VISION RIDER
Special savings on material purchases6Some network providers offer special pricing and discounts for certain vision materials, including lens add-ons and a second pair of glasses. See the chart below for details. Participating providers are designated as “Value Added” or “Service Plus” in the provider directory at ColonialLifeDental.com.VALUE ADDED PROVIDERSSpecial pricing and discounts on lens options for first pair of glasses (add-ons for insured purchases)• UV Coating ...................................$15• Solid tinting/gradient tinting ........ $15• Standard scratch-resistant coating ........................................$15• Standard antireective coating ....................................... $45• Premium antireective coating ....................................... $70• Ultra-antireective coating ........................20% discount • Polarized lenses ...........................$75• Transition lenses .........................$75• Progressive lenses: ‐ Standard .................................$110 ‐ Premium ................................ $170 ‐ Ultra ......................... 20% discount • Standard polycarbonate lenses ......................................... $40• High index (single vision) ‐ 1.56–1.60 .................................. $60 ‐ 1.66+ .........................20% discount • High index (multifocal) ‐ 1.56–1.60 ...................................$75 ‐ 1.66+ .........................20% discount Special pricing and discounts on purchase of second pair of glasses• Single vision plastic lenses ......... $40• Bifocal plastic lenses ...................$60• Trifocal lenses..............................$70• Progressive lenses (standard) ...................................$110• Progressive lenses (premium and ultra) ..................... 20% discountDiscount on frames, contact lenses and other products• Frames ................................................ Up to 35% discount• Contact lenses ..........5 to 15% discount, depending on type• Other products ...............20% discount on nonprescription sunglasses and other products/solutionsSERVICE PLUS PROVIDERSReceive up to a 20% discount for the following add-ons to insured purchases• UV Coating• Solid tinting/gradient tinting• Standard scratch-resistant coating• Standard antireective coating• Premium antireective coating• Transition lenses• Standard polycarbonate lensesNote: Not a covered benet. Prices shown reect member payment. Discounts reect percentage off the regular price.1 You are responsible for paying the provider directly for any co-pays, amounts over your allowance, and for any services or materials that are not covered under this rider.2 The standard contact lenses tting exam fee applies to a new or existing contact lens user who wears spherical disposable, daily wear, or extended wear lenses only. This includes follow-ups. 3 The specialty contact lenses tting exam fee applies to a new or existing contact lens user who wears toric, gas permeable, mono-t or multi-focal lens. This includes follow-ups. 4 Eyeglass lenses and frames are paid in lieu of the contact lenses benet.5 The contact lenses benet is paid in lieu of eyeglass lenses and frames.6 These schedules are subject to change without notice. Added value discounts may not be available in all geographical areas and may vary by network. Not all providers, such as Walmart, Sam’s Club and Costco Optical, choose to participate in these programs. Some frames and lens items may have manufacturer restrictions and cannot be discounted. Special lens packages that combine multiple lens enhancements at value price points are not covered by these added value programs. Programs may not be combined with any other promotions or discounts.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-OR and rider form R-VSN8100-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Insurance products are 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 | 1820767-ORColonialLife.com1820767-OR
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. 1212757-ORGROUP ACCIDENT (GAC4100) — PREFERRED PLAN
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• 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 accident ........................... $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(Maximum 4 per year) • 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• Skin grafts (due to burns) .............................50%(Payable as a % of the applicable burn benet)• Skin grafts (not due to burns) ....................$250–$500• Transfusions ........................................ $400 • Transportation ................................$150 per trip (Maximum 6 one-way trips)• Treatment in a physician’s oce or urgent care facility ...$100(Maximum 4 per year) • 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 and 16 days per calendar year)• Rehabilitation or sub-acute rehabilitation unit connement ............................. $150 per day (Maximum 15 days per covered accident and 30 days per calendar year)• 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)• Injury due to felonious act of violence or sexual assault ................................ $250(Maximum once per insured per calendar year, with an accompanying police report) Gunshot wound benetThis benet can help pay your medical expenses if you receive a non-fatal gunshot wound. It offers you a lump sum for a covered injury regardless of any other insurance you may have and includes on/off-job coverage.• Gunshot wound .............................$_________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 benets counselor to learn more.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. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance. 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 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-OR and certicate form GAC4100-C-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 3-23 | 1212757-ORColonialLife.com1212757-OR
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. Economy Basic Preferred PremierXHospital 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$150 $250 $350 $500Hospital Sub-Acute ICU Confinement – Daily Stay Max. of 30 days per insured per covered accident$200 $300 $400 $600Short Stay Min. of 8 hours up to 20 hours$200 $200 $200 $200To learn more, talk with your Colonial Life benets counselor.GROUP ACCIDENT (GAC4100) – ACCIDENT HOSPITAL BENEFITSAccident hospital benets are available to you with group accident coverage, as well as all your covered family members Talk with your benets counselor about the level of accident hospital benets available to you.Benets are per covered person per covered accident unless stated otherwise.1284160-OR
ColonialLife.com 1284160-ORHEALTH 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. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.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, semiprofessional 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-OR and certicate form GAC4100-C-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 3-23 | 1284160-OR
Group Accident InsuranceAccidental Death & Dismemberment eneťts}ìese Åeneťts can ìeăp pař åor eŘpenses reăated to an accidentaă deatìȘ }ìeř can aăso ìeăp pař costs reăated to recoŒerř and reìaÅiăitation åroĉ an accidentaă disĉeĉÅerĉentș incăudinæ costs tìat řour ĉedicaă păan doesnȸt coŒerș ăiāe coȭpařs and deductiÅăesȘÆÆðÌÐĊĴăÌÐĴìɪÌðĮĉÐĉÅÐīĉÐĊĴȧ#ɪ#ȨÅÐĊÐťĴĮAccidentaă deatì and disĉeĉÅerĉent Åeneťts are aŒaiăaÅăe to řou œitì æroup accident coŒeraæeș as œeăă as aăă řour coŒered åaĉiăř ĉeĉÅersȘ }aăā œitì řour Åeneťts counseăor aÅout tìe ăeŒeă oå A#ɪ# Åeneťts aŒaiăaÅăe to řouȘeneťts are per coŒered person per coŒered accident unăess stated otìerœiseȘEconomy Basic Preferred PremierXAccidental death• Uaĉed insured ɄǡǤșǟǟǟ ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǤǟșǟǟǟ• Spouse ɄǡǤșǟǟǟ ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǤǟșǟǟǟ• ìiădren ɄǤșǟǟǟ ɄǤșǟǟǟ ɄǠǟșǟǟǟ ɄǠǟșǟǟǟAccidental death – Common carrier• Uaĉed insured ɄǠǟǟșǟǟǟ ɄǠǟǟșǟǟǟ Ʉǡǟǟșǟǟǟ Ʉǡǟǟșǟǟǟ• Spouse ɄǠǟǟșǟǟǟ ɄǠǟǟșǟǟǟ Ʉǡǟǟșǟǟǟ Ʉǡǟǟșǟǟǟ• ìiădren Ʉǡǟșǟǟǟ Ʉǡǟșǟǟǟ Ʉǣǟșǟǟǟ ɄǣǟșǟǟǟAccidental dismemberment• otì åeet ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟ • Both hands ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟ • Zne åoot Ʉǥșǟǟǟ ɄǦșǤǟǟ ɄǨșǟǟǟ ɄǠǤșǟǟǟ• One hand Ʉǥșǟǟǟ ɄǦșǤǟǟ ɄǨșǟǟǟ ɄǠǤșǟǟǟ• }huĉÅ and indeŘ ťnæer oå the saĉe hand ɄǢșǟǟǟ ɄǢșǦǤǟ ɄǣșǤǟǟ ɄǦșǤǟǟoĉa ȧǦ or ĉore consecutiŒe dařsȨ ɄǤșǟǟǟ ɄǦșǤǟǟ ɄǠǟșǟǟǟ Ʉǡǟșǟǟǟ>oĉe aăterations and autoĉoÅiăe ĉodiåications ɄǤǟǟ ɄǠșǟǟǟ ɄǠșǤǟǟ Ʉǡșǟǟǟ ǠǡǧǣǠǟǟȭOtGtOq AI#'U} ȧGAǣǠǟǟȨ ȯ A#ɪ# B'U'9I}S
ÆÆðÌÐĊĴăÌÐĴìɪÌðĮĉÐĉÅÐīĉÐĊĴÅÐĊÐťĴĮȧÆďĊĴðĊķÐÌȨEconomy Basic Preferred PremierLoss of use• >earinæ ȧone earȨ Ʉǥșǟǟǟ ɄǦșǤǟǟ ɄǨșǟǟǟ ɄǠǤșǟǟǟ• >earinæ ȧÅoth earsȨ ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟ • Siæht oå one eře Ʉǥșǟǟǟ ɄǦșǤǟǟ ɄǨșǟǟǟ ɄǠǤșǟǟǟ• Siæht oå Åoth eřes ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟ • Speech ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟParalysis• nipăeæia Ʉǥșǟǟǟ ɄǦșǤǟǟ ɄǨșǟǟǟ ɄǠǤșǟǟǟ• >eĉipăeæia ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟ • qarapăeæia ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟ • }ripăeæia ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟ • suadripăeæia ɄǡǤșǟǟǟ ɄǤǟșǟǟǟ ɄǦǤșǟǟǟ ɄǠǟǟșǟǟǟ}o learn moreș talā œith your Colonial Life beneťts counselorȘColonialLifeȘcomǠǡǧǣǠǟǟȭOtHEALTH SAVINGS ACCOUNT (HSA) COMPATIBLE}his păan is coĉpatiÅăe œith >SA æuideăines and anř other >SA păan in œhich a coŒered åaĉiăř ĉeĉÅer ĉař participateȘ It ĉař aăso Åe oååered to eĉpăořees œho do not haŒe >SAsȘTHIS INSUtANCE PtOVIDES LIMITED BENE9ITSȘ}his coŒeraæe is a suppăeĉent to heaăth insuranceȘ It is not a suÅstitute åor essentiaă heaăth Åeneťts or ĉiniĉuĉ essentiaă coŒeraæe as deťned in åederaă ăaœȘ Insureds in soĉe states ĉust Åe coŒered Åř coĉprehensiŒe heaăth insurance Åeåore appăřinæ åor this insuranceȘEXCLUSIONS AND LIMITATIONSe œiăă not pař Åeneťts åor căaiĉs that are caused Åřș contriÅuted to Åřș or resuătinæ åroĉ eăectiŒe proceduresș åeăonies or iăăeæaă occupationsș hašardous aŒocationsș incarcerationș racinæș seĉiȭproåessionaă or proåessionaă sportsș sicānessș suicide or seăåȭinŦicted inþuriesș œarș or arĉed conŦictȘ}his inåorĉation is not intended to Åe a coĉpăete description oå the insurance coŒeraæe aŒaiăaÅăeȘ }he insurance or its proŒisions ĉař Œarř or Åe unaŒaiăaÅăe in soĉe statesȘ }he insurance has eŘcăusions and ăiĉitations œhich ĉař aååect anř Åeneťts pařaÅăeȘ AppăicaÅăe to poăicř åorĉ GAǣǠǟǟȭqȭOt and certiťcate åorĉ GAǣǠǟǟȭȭOtȘ 9or cost and coĉpăete detaiăs oå coŒeraæeș caăă or œrite řour oăoniaă Oiåe Åeneťts counseăor or the coĉpanřȘnderœritten Åř oăoniaă Oiåe ɪ Accident Insurance oĉpanřș oăuĉÅiaș SȘ ɭ ǡǟǡǢ oăoniaă Oiåe ɪ Accident Insurance oĉpanřȘ Aăă riæhts reserŒedȘ oăoniaă Oiåe is a reæistered tradeĉarā and ĉarāetinæ Årand oå oăoniaă Oiåe ɪ Accident Insurance oĉpanřȘ9Ot 'TqOO''S ǢȭǡǢ ɳ ǠǡǧǣǠǟǟȭOt
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 accident 100%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 387100-1-OR
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 • No medical underwriting to qualify for coverage• Works alongside your health savings account (HSA)• Benets payable regardless of other insuranceSubsequent diagnosis of a different critical illness2If 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 illness2If you receive a benet for a critical illness, and are later diagnosed with the same critical illness,3 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. Dates of diagnoses of a covered critical illness must be separated by more than 180 days. 3. Critical illnesses that do not qualify include: coronary artery disease, loss of hearing, loss of sight, loss of speech, and occupational infectiousHIV or occupational infectious hepatitis B, C, or D.* The led product name is Group Critical Illness and Cancer Specied Disease 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; • 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, or• 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, by a doctor, received advice from a doctor or had taken medication prescribed by a doctor within a six-month period immediately preceding the coverage effective date shown on the Certicate Schedule. 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-OR and certicate form GCI6000-C-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 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 | 387100-1-ORColonialLife.com387100-1-OR
Group Critical Illness Insurance*Wellbeing Assistance BenetThe wellbeing assistance benet can help reduce the risk of serious illness through early detection of disease or risk factors.Wellbeing assistance benefit...................$ $50 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 prostatecancer)• Serum cholesterol test for HDLand 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 form GCI6000-P-OR and certicate form GCI6000-C-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.ColonialLife.comGCI6000 – WELLBEING ASSISTANCE BENEFIT FOR EMPLOYEES 1-23 | 387307-1-OR387307-1-OR
For more information, talk with your benefits counselor.Group Hospital Indemnity InsurancePlan 2ColonialLife.comGroup Medical Bridge 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 ................................................................ $$1,000 or $2,000 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 X 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.X Diagnostic procedure ................................................................... $ 250 per dayMaximum of one day per covered person per calendar yearX Outpatient surgical procedure¾ Tier 1 ............ ................................................. ................. ....... $ 500 per day¾ Tier 2 ............ ................................................. ................. ....... $ 1,000 per dayMaximum of $ 1,500 per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedureDiagnostic proceduresThe following is a list of common diagnostic procedures that may be covered if the diagnostic procedure benefit is selected. Breast– Biopsy (incisional, needle, stereotactic) Cardiac– Angiogram– Arteriogram– Thallium stress test– Transesophageal echocardiogram (TEE) Diagnostic radiology– Computerized tomography scan (CT scan)– Electroencephalogram (EEG)– Magnetic resonance imaging (MRI)– Myelogram– Nuclear medicine test– Positron emission tomography scan (PET scan) Digestive– Barium enema/lower GI series– Barium swallow/upper GI series– Esophagogastroduodenoscopy (EGD) Ear, nose, throat, mouth– Laryngoscopy Gynecological– Amniocentesis– Cervical biopsy– Cone biopsy– Endometrial biopsy Liver– Biopsy Lymphatic– Biopsy Miscellaneous– Bone marrow aspiration/biopsy Renal– Biopsy Respiratory– Biopsy– Bronchoscopy– Pulmonary function test (PFT) Skin– Biopsy– Excision of lesion Thyroid– Biopsy Urologic– Cystoscopy– Hysteroscopy– Loop electrosurgical excisional procedure(LEEP)
ColonialLife.com1-24 | 101918-3THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this coverage.EXCLUSIONS AND LIMITATIONSWe will not pay any benefits for injuries received in accidents or for sicknesses which are caused by, contributed to or occur as a result of the following exclusions and limitations. (a) alcoholism or drug addiction; (b) dental procedures; (c) elective procedures and cosmetic surgery; (d) felonies or illegal occupations; (e) mental or nervous disorders; (f) pregnancy of a dependent child; (g) suicide or injuries which any covered person intentionally does to himself or herself; (h) war or armed forces service. We will not pay benefits for hospital confinement (i) due to giving birth within the first nine months aer the eective date of the policy or (j) for a newborn who is neither injured nor sick.(k) The policy may have additional exclusions and limitations which may aect any benefits payable. PRE-EXISTING CONDITION LIMITATIONS(l) We will not pay benefits for loss during the first 12 months aer the certificate eective date due to a pre-existing condition.(m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the certificate eective date. (n) This limitation applies to the following benefits, if applicable: Hospital Confinement, Daily Hospital Confinement, Inpatient Mental and Nervous, Rehabilitation Unit Confinement, Specified Critical Illness, Diagnostic Procedure,and Outpatient Surgical Procedure.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 aect any benefits payable. Applicable to policy form GMB7000-P and certificate form GMB7000-C (including state abbreviations where used, for example: (including state abbreviations where used, for example GMB7000-P-TX and GMB7000-C-TX.) For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.The procedures listed below are only a sampling of the procedures that may be covered if the outpatient surgical procedure benefit is selected. Procedures must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, refer to your certificate.Tier 1 outpatient surgical procedures Breast– Axillary node dissection– Breast capsulotomy– Lumpectomy Cardiac– Pacemaker insertion Digestive– Colonoscopy* – Fistulotomy– Hemorrhoidectomy– Lysis of adhesions Ear, nose, throat, mouth– Adenoidectomy– Removal of oral lesions– Myringotomy– Tonsillectomy– Tracheostomy– Tympanotomy Gynecological– Dilation and curettage (D&C)– Endometrial ablation– Lysis of adhesions Liver– Paracentesis Musculoskeletal system– Carpal/cubital repair or release– Foot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair)– Removal of orthopedic hardware– Removal of tendon lesion Skin– Laparoscopic hernia repair– Skin graingKS: "Surgical Procedure" benefit replaces "Outpatient Surgical Procedure." Diagnostic Procedures must be performed in a hospital or an ambulatory surgical center.PA: "Hospital Confinement Admission" benefit replaces the "Hospital Confinement" benefit* Colonoscopy must result in polyp removal or be recommended by a physician for the purposes of treating or diagnosing a sickness.If a covered family member has a qualified high deductible health plan (HDHP) and actively contributes to a health savings account (HSA), their HSA can be disqualified with this coverage.Tier 2 outpatient surgical procedures Breast– Breast reconstruction– Breast reduction Cardiac– Angioplasty– Cardiac catheterization Digestive– Exploratory laparoscopy– Laparoscopic appendectomy– Laparoscopic cholecystectomy Ear, nose, throat, mouth– Ethmoidectomy– Mastoidectomy– Septoplasty– Stapedectomy– Tympanoplasty Eye– Cataract surgery– Corneal surgery (penetrating keratoplasty)– Glaucoma surgery (trabeculectomy)– Vitrectomy Gynecological– Hysterectomy– Myomectomy Musculoskeletal system– Arthroscopic knee surgery with meniscectomy (knee cartilage repair)– Arthroscopic shoulder surgery– Clavicle resection– Dislocations (open reduction with internal fixation)– Fracture (open reduction with internal fixation)– Removal or implantation of cartilage– Tendon/ligament repair Thyroid– Excision of a mass Urologic– LithotripsyUnderwritten 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.
Group Hospital Indemnity InsuranceExclusions and LimitationsTHIS INSURANCE PROVIDES LIMITED BENEFITS. For policies issued or delivered in the Commonwealth of Virginia, THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this coverage.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 aect any benefits payable. Applicable to policy form GMB7000-P and certificate form GMB7000-C (including state abbreviations where used, for example: GMB7000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. This form is not complete without base form 101917 or 101918.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.GMB7000 – EXCLUSIONS AND LIMITATIONS | 12-23 | 101733-6STATE-SPECIFIC DISCLOSURES KY: Premium will vary based on the coverage selected and the age of the named insured.Eligibility for benefitsThe provisions of this policy insure a covered person against losses due to injuries received in a covered accident or losses due to a covered sickness. Covered Accident means an unintended or unforeseen bodily injury sustained by a covered person, wholly independent of disease, bodily infirmity, illness, infection, or any other abnormal physical condition and which: occurs on or aer the Coverage Eective Date; occurs while policy is in force; and is not excluded by name or specific description in this policy. Covered Sickness means an illness, infection, disease, or any other abnormal physical condition, not caused by an accident, which: occurs on or aer the policy coverage eective date; occurs while this policy is in force; and is not excluded by name or specific description in this policy.End of Coverage for the Named InsuredThis policy is guaranteed renewable for life as long as you pay the premiums when they are due or within the grace period. STATE-SPECIFIC EXCLUSIONSAK: (a) Replaced by intoxicants and narcotics CA: (k) Additional exclusions include intoxicants and controlled substancesCT: (a) Replaced by intoxication or drug addiction; (d) Replaced by felonies; (f) Exclusion does not applyDE: (a) Exclusion does not apply IL: (a) Replaced by alcoholism, intoxication, or drug addiction; (f) Exclusion does not apply; (g) Exclusion does not applyKS: (a) Replaced by intoxicants and narcotics; (h) Replaced by war or armed conflict; (i) Exclusion does not applyKY: (a) Replaced by intoxicants, narcotics and hallucinogenics LA: (a) Replaced by intoxicants and narcotics MI: (g) Exclusion does not applyMO: (a) Replaced by drug addiction; (d) Replaced by illegal activitiesMS: (a) Replaced by intoxicants and narcoticsNC: (i) Exclusion does not applyND: (a) Exclusion does not apply; (e) Exclusion does not applyNV: (a) Exclusion does not apply OH: (f) Exclusion does not apply; (i) Replaced by 270 daysPA: (a) Replaced by intoxicants and narcotics; (c) Replaced by cosmetic surgery; (e) Replaced by mental, nervous or emotional disorders; (h) Replaced by war or armed conflictSD: (a) Exclusion does not apply TN: (f) Exclusion does not applyTX: (a) Replaced by intoxicants and narcotics VA: (i) Pregnancy resulting from the rape of any covered person, which was reported to the police within seven days following its occurrence, will be covered to the same extent as any other covered accident. The seven-day requirement will be extended to 180 days in the case of an act of rape or incest of a female under 13 years of age.STATE-SPECIFIC PRE-EXISTING CONDITION LIMITATIONSIN, SD, and WY: (m) Applies within the six months before the certificate eective date.CA: (m) A pre-existing condition is a sickness or physical condition for which a covered person was diagnosed or treated within 12 months before the coverage eective date.FL: (m) A pre-existing condition is a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within six months before the coverage eective date. Genetic information is not a pre-existing condition in the absence of a diagnosis of the condition related to such information. IL: (m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing by a legally qualified physician or, received medical advice, produced symptoms or had taken medication within 12 months before the coverage eective date.KS: (n) Surgical Procedure replaces Outpatient Surgical Procedure ME: (m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, or received medical advice within 12 months before the coverage eective date.MI: (l) Applies during the first six months aer the certificate eective date; (m) applies within the six months before the certificate eective date.MO: (m) A pre-existing condition means having a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage eective date of this certificate.NC: (m) A pre-existing condition is those conditions, whether diagnosed or not, for which a covered person received medical advice, diagnosis, care or treatment that was received or recommended within the one-year period immediately preceding the coverage eective date. If you are 65 or older when this certificate is issued, pre-existing conditions will include only conditions specifically eliminated by a rider.ND: (m) A pre-existing condition is a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage eective date.NV: (m) Applies within the six months before the certificate eective date. Additionally, pre-existing condition does not include genetic information in the absence of a diagnosis of the condition related to such information.OR: (m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated by a doctor, received advice from a physician or had taken medication prescribed by a doctor within the 12 months period immediately preceding the coverage eective date.PA: (m) A pre-existing condition is a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage eective date. (n) Hospital Confinement Admission replaces Hospital Confinement.
Voluntary BenefitsYou never know when an unexpected illness or injury could leave you and your family with financial difficulties. Health insurance can help, but you can still have deductibles, co-payments and other out-of-pocket expenses.That’s where voluntary benefits come in. Sometimes called supplemental insurance, voluntary benefits are designed to complement your health insurance and help provide extra financial protection. This year, your employer is helping you protect your way of life by giving you the opportunity to purchase the following voluntary benefits from Colonial Life:To learn more, talk to your Colonial Life benefits counselor.
The information contained in this booklet is only a summary of coverage and is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. If there are differences between the information in the booklet and the contract, the contract will govern.NS-15576 (9-17)9-17 | NS-15576ColonialLife.comUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.