2024 -2025 A GUIDE TO YOUR BENEFITS….
Breakthrough ABA is pleased to provide a variety of benefit options to you during this open enrollment period. We strive to be a best-in-class employer and know how valuable each and everyone of you are to our success! Please review NEW benefits available starting July 1!.Before you enroll!Gather any information you may need, such as dependent’s names, dates of birth, ages, Social Security numbers and addresses.BENEFITS ENROLLMENTThursday, June 27 – Friday, June 28Click on the link below or scan the QR Code to learn more about your worksite voluntary benefits.Click Here To View Your Benefit GuideClick the icons below to learn more about your available benefits:Short Term DisabilityCritical Illness InsuranceLife InsuranceAccidentInsuranceThere are changes to some of your benefits this year! Special Underwritingfor this open enrollment onlyAll insurance offerings are Guaranteed Issue NO Pre-Existing health conditions will prevent you from qualifying for coverage!
Breakthrough ABA is pleased to provide a variety of benefit options to you during this open enrollment period. We strive to be a best-in-class employer and know how valuable each and everyone of you are to our success! Please review NEW benefits available starting July 1!.Before you enroll!Gather any information you may need, such as dependent’s names, dates of birth, ages, Social Security numbers and addresses.BENEFITS ENROLLMENTThursday, June 27 – Friday, June 28Click on the link below or scan the QR Code to learn more about your worksite voluntary benefits.Click Here To View Your Benefit GuideClick the icons below to learn more about your available benefits:Short Term DisabilityCritical Illness InsuranceLife InsuranceAccidentInsuranceThere are changes to some of your benefits this year! Special Underwritingfor this open enrollment onlyAll insurance offerings are Guaranteed Issue NO Pre-Existing health conditions will prevent you from qualifying for coverage!
Deductions per year: 26 These rates were prepared on 6/27/2024 and are valid for 90 days.Group Accident (GAC4100) for TXApplicable to policy forms GAC4100-P,GAC4100-ClAdditional Benefits:On/Off-Job Accident CoverageBENEFIT LEVEL AD&D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE ANDSPOUSEEMPLOYEE ANDDEPENDENTCHILD(REN)EMPLOYEE, SPOUSEAND DEPENDENTCHILD(REN)Premier Premier 17-99 $7.27 $11.34 $16.24 $20.40Group Medical Bridge (GMB7000) for TXAge-BandedApplicable to Policy Forms GMB7000–P & GMB7000-ClWithout Wellbeing AssistanceHOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 2: $100017-49 $4.38 $7.89 $6.25 $9.7650-59 $5.68 $11.26 $7.55 $13.1360-64 $7.94 $16.52 $9.81 $18.3965-99 $11.12 $23.12 $12.99 $24.99HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-49 $8.72 $15.69 $12.44 $19.4150-59 $11.31 $22.43 $15.02 $26.1560-64 $15.83 $32.95 $19.55 $36.6765-99 $22.20 $46.15 $25.92 $49.87Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $4.11 $6.03 $4.11 $6.0325-29 $5.29 $7.83 $5.29 $7.8330-34 $6.53 $9.63 $6.53 $9.6335-39 $9.30 $13.85 $9.30 $13.8540-44 $12.07 $18.00 $12.07 $18.0045-49 $16.64 $25.06 $16.64 $25.0650-54 $21.14 $32.13 $21.14 $32.1355-59 $27.37 $41.61 $27.37 $41.6160-64 $36.86 $56.01 $36.86 $56.0165-69 $44.89 $68.33 $44.89 $68.3370-74 $44.89 $68.33 $44.89 $68.33Page 1 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Deductions per year: 26 These rates were prepared on 6/27/2024 and are valid for 90 days.Group Accident (GAC4100) for TXApplicable to policy forms GAC4100-P,GAC4100-ClAdditional Benefits:On/Off-Job Accident CoverageBENEFIT LEVEL AD&D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE ANDSPOUSEEMPLOYEE ANDDEPENDENTCHILD(REN)EMPLOYEE, SPOUSEAND DEPENDENTCHILD(REN)Premier Premier 17-99 $7.27 $11.34 $16.24 $20.40Group Medical Bridge (GMB7000) for TXAge-BandedApplicable to Policy Forms GMB7000–P & GMB7000-ClWithout Wellbeing AssistanceHOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 2: $100017-49 $4.38 $7.89 $6.25 $9.7650-59 $5.68 $11.26 $7.55 $13.1360-64 $7.94 $16.52 $9.81 $18.3965-99 $11.12 $23.12 $12.99 $24.99HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-49 $8.72 $15.69 $12.44 $19.4150-59 $11.31 $22.43 $15.02 $26.1560-64 $15.83 $32.95 $19.55 $36.6765-99 $22.20 $46.15 $25.92 $49.87Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $4.11 $6.03 $4.11 $6.0325-29 $5.29 $7.83 $5.29 $7.8330-34 $6.53 $9.63 $6.53 $9.6335-39 $9.30 $13.85 $9.30 $13.8540-44 $12.07 $18.00 $12.07 $18.0045-49 $16.64 $25.06 $16.64 $25.0650-54 $21.14 $32.13 $21.14 $32.1355-59 $27.37 $41.61 $27.37 $41.6160-64 $36.86 $56.01 $36.86 $56.0165-69 $44.89 $68.33 $44.89 $68.3370-74 $44.89 $68.33 $44.89 $68.33Page 1 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$30,000 17-24 $6.88 $9.97 $6.88 $9.9725-29 $9.23 $13.57 $9.23 $13.5730-34 $11.72 $17.17 $11.72 $17.1735-39 $17.26 $25.62 $17.26 $25.6240-44 $22.80 $33.93 $22.80 $33.9345-49 $31.94 $48.05 $31.94 $48.0550-54 $40.94 $62.17 $40.94 $62.1755-59 $53.40 $81.14 $53.40 $81.1460-64 $72.37 $109.94 $72.37 $109.9465-69 $88.43 $134.59 $88.43 $134.5970-74 $88.43 $134.59 $88.43 $134.59Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $5.77 $8.38 $5.77 $8.3825-29 $7.71 $11.29 $7.71 $11.2930-34 $9.65 $14.20 $9.65 $14.2035-39 $14.08 $20.84 $14.08 $20.8440-44 $18.51 $27.56 $18.51 $27.5645-49 $25.78 $38.84 $25.78 $38.8450-54 $32.98 $50.13 $32.98 $50.1355-59 $42.95 $65.36 $42.95 $65.3660-64 $58.11 $88.41 $58.11 $88.4165-69 $70.99 $108.00 $70.99 $108.0070-74 $70.99 $108.00 $71.06 $108.07$30,000 17-24 $10.20 $14.68 $10.20 $14.6825-29 $14.08 $20.50 $14.08 $20.5030-34 $17.96 $26.31 $17.96 $26.3135-39 $26.82 $39.60 $26.82 $39.6040-44 $35.68 $53.03 $35.68 $53.0345-49 $50.22 $75.60 $50.22 $75.6050-54 $64.62 $98.17 $64.62 $98.1755-59 $84.56 $128.63 $84.56 $128.6360-64 $114.88 $174.74 $114.88 $174.7465-69 $140.63 $213.93 $140.63 $213.9370-74 $140.63 $213.93 $140.77 $214.06(Continued...)Page 2 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$30,000 17-24 $6.88 $9.97 $6.88 $9.9725-29 $9.23 $13.57 $9.23 $13.5730-34 $11.72 $17.17 $11.72 $17.1735-39 $17.26 $25.62 $17.26 $25.6240-44 $22.80 $33.93 $22.80 $33.9345-49 $31.94 $48.05 $31.94 $48.0550-54 $40.94 $62.17 $40.94 $62.1755-59 $53.40 $81.14 $53.40 $81.1460-64 $72.37 $109.94 $72.37 $109.9465-69 $88.43 $134.59 $88.43 $134.5970-74 $88.43 $134.59 $88.43 $134.59Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $5.77 $8.38 $5.77 $8.3825-29 $7.71 $11.29 $7.71 $11.2930-34 $9.65 $14.20 $9.65 $14.2035-39 $14.08 $20.84 $14.08 $20.8440-44 $18.51 $27.56 $18.51 $27.5645-49 $25.78 $38.84 $25.78 $38.8450-54 $32.98 $50.13 $32.98 $50.1355-59 $42.95 $65.36 $42.95 $65.3660-64 $58.11 $88.41 $58.11 $88.4165-69 $70.99 $108.00 $70.99 $108.0070-74 $70.99 $108.00 $71.06 $108.07$30,000 17-24 $10.20 $14.68 $10.20 $14.6825-29 $14.08 $20.50 $14.08 $20.5030-34 $17.96 $26.31 $17.96 $26.3135-39 $26.82 $39.60 $26.82 $39.6040-44 $35.68 $53.03 $35.68 $53.0345-49 $50.22 $75.60 $50.22 $75.6050-54 $64.62 $98.17 $64.62 $98.1755-59 $84.56 $128.63 $84.56 $128.6360-64 $114.88 $174.74 $114.88 $174.7465-69 $140.63 $213.93 $140.63 $213.9370-74 $140.63 $213.93 $140.77 $214.06(Continued...)Page 2 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Group Disability for TX AA Risk ClassApplicable to policy forms GDIS-P & GDIS-ClOff-Job Accident and Off-Job Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $400* $1,000* $2,500* $4,000* $7,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $5.02 $12.55 $31.38 N/A N/A50-64 $5.78 $14.45 $36.12 N/A N/A65-74 $7.00 $17.49 $43.73 N/A N/A14 days Accident/14 days Sickness 17-49 $3.25 $8.12 $20.31 $32.49 $60.9250-64 $3.91 $9.78 $24.46 $39.14 $73.3865-74 $4.98 $12.46 $31.15 $49.85 $93.466 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $400* $1,000* $2,500* $4,000* $7,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $6.31 $15.78 $39.46 N/A N/A50-64 $8.40 $21.00 $52.50 N/A N/A65-74 $10.91 $27.28 $68.19 N/A N/A14 days Accident/14 days Sickness 17-49 $4.47 $11.17 $27.92 $44.68 $83.7750-64 $5.65 $14.12 $35.31 $56.49 $105.9265-74 $7.53 $18.83 $47.08 $75.32 $141.23Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base PlanNon-Tobacco RatesISSUE AGE $10,000 $50,000 $75,000 $100,00025 $3.10 $4.87 $6.38 $7.8935 $3.55 $5.35 $7.10 $8.8545 $4.47 $10.06 $14.17 $18.2755 $8.34 $21.39 $31.16 $40.9265 $18.93 $54.96 $81.52 $108.08Tobacco RatesISSUE AGE $10,000 $50,000 $75,000 $100,00025 $4.84 $8.41 $11.69 $14.9735 $5.41 $9.52 $13.36 $17.2045 $7.34 $20.99 $30.55 $40.1255 $15.66 $48.95 $72.49 $96.0465 $32.38 $93.87 $139.87 $185.8820-Year Spouse Term Life BenefitISSUE AGE $10,00025 $1.0935 $1.3045 $3.03(Continued...)Page 3 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Group Disability for TX AA Risk ClassApplicable to policy forms GDIS-P & GDIS-ClOff-Job Accident and Off-Job Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $400* $1,000* $2,500* $4,000* $7,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $5.02 $12.55 $31.38 N/A N/A50-64 $5.78 $14.45 $36.12 N/A N/A65-74 $7.00 $17.49 $43.73 N/A N/A14 days Accident/14 days Sickness 17-49 $3.25 $8.12 $20.31 $32.49 $60.9250-64 $3.91 $9.78 $24.46 $39.14 $73.3865-74 $4.98 $12.46 $31.15 $49.85 $93.466 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $400* $1,000* $2,500* $4,000* $7,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $6.31 $15.78 $39.46 N/A N/A50-64 $8.40 $21.00 $52.50 N/A N/A65-74 $10.91 $27.28 $68.19 N/A N/A14 days Accident/14 days Sickness 17-49 $4.47 $11.17 $27.92 $44.68 $83.7750-64 $5.65 $14.12 $35.31 $56.49 $105.9265-74 $7.53 $18.83 $47.08 $75.32 $141.23Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base PlanNon-Tobacco RatesISSUE AGE $10,000 $50,000 $75,000 $100,00025 $3.10 $4.87 $6.38 $7.8935 $3.55 $5.35 $7.10 $8.8545 $4.47 $10.06 $14.17 $18.2755 $8.34 $21.39 $31.16 $40.9265 $18.93 $54.96 $81.52 $108.08Tobacco RatesISSUE AGE $10,000 $50,000 $75,000 $100,00025 $4.84 $8.41 $11.69 $14.9735 $5.41 $9.52 $13.36 $17.2045 $7.34 $20.99 $30.55 $40.1255 $15.66 $48.95 $72.49 $96.0465 $32.38 $93.87 $139.87 $185.8820-Year Spouse Term Life BenefitISSUE AGE $10,00025 $1.0935 $1.3045 $3.03(Continued...)Page 3 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base PlanChildren's Term Life BenefitISSUE AGE $10,0000-18 $2.31Whole Life Plus (IWL5000) for TXApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 70Non-Tobacco RatesISSUE AGE $5,000 $10,000 $25,000 $50,00025 $2.28 $4.56 $11.40 $22.7935 $3.45 $6.90 $17.26 $34.5245 $5.90 $11.80 $29.51 $59.02Tobacco RatesISSUE AGE $5,000 $10,000 $25,000 $50,00025 $3.93 $7.86 $19.63 $39.2735 $5.06 $10.12 $25.31 $50.6145 $8.18 $16.36 $40.89 $81.7820-Year Spouse Term Life BenefitISSUE AGE $5,000 $10,000 $20,00025 $0.77 $1.53 $3.0635 $0.97 $1.94 $3.8945 $1.74 $3.49 $6.98Children's Term Life BenefitISSUE AGE $5,0000-18 $1.15Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2024 Colonial Life & Accident Insurance Company"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.Mark | mark@colonialtx.com | (281) 714-8150(Continued...)Page 4 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice