Return to flip book view

Canine Carousel Benefit Booklet 2024

Accident Insurance Accidents 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 injury l Broken bone l Burn l Concussion l Laceration l Back or knee injuries l Car accidents l Falls spills l Dislocation l Accidental injuries that send you to the Emergency Room Urgent Care or doctor s office Colonial Life s Accident Insurance is designed to help you fill some of the gaps caused by increasing deductibles co payments and out of pocket costs related to an accidental injury The benefit 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 financial security What additional features are included l Worldwide coverage l Portable l Compliant with Healthcare Spending Account HSA guidelines Will 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 benefits 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 file a claim Visit coloniallife com or call our Customer Service Department at 1 800 325 4368 for additional information Accident 1 0 Premier with Health Screening Benefit

Benefits listed are for each covered person per covered accident unless otherwise specified Initial Care l Accident Emergency Treatment 200 l X ray Benefit 60 l Ambulance 600 l Air Ambulance 2 000 Common Accidental Injuries Dislocations Separated Joint Hip Knee except patella Ankle Bone or Bones of the Foot other than Toes Collarbone Sternoclavicular Lower Jaw Shoulder Elbow Wrist Bone or Bones of the Hand Collarbone Acromioclavicular and Separation One Toe or Finger Non Surgical 9 600 4 800 3 840 2 400 1 440 1 440 480 480 Surgical 19 200 9 600 7 680 4 800 2 880 2 880 960 960 Fractures Depressed Skull Non Depressed Skull Hip Thigh Body of Vertebrae Pelvis Leg Bones of Face or Nose except mandible or maxilla Upper Jaw Maxilla Upper Arm between Elbow and Shoulder Lower Jaw Mandible Kneecap Ankle Foot Shoulder Blade Collarbone Vertebral Process Forearm Wrist Hand Rib Coccyx Finger Toe Non Surgical 9 000 3 600 5 400 2 700 1 260 1 260 1 260 1 080 1 080 1 080 900 720 360 Surgical 18 000 7 200 10 800 5 400 2 520 2 520 2 520 2 160 2 160 2 160 1 800 1 440 720 Your Colonial Life policy also provides benefits for the following injuries received as a result of a covered accident l Burn based on size and degree 1 000 to 12 000 l Coma 12 500 l Concussion 150 l Emergency Dental Work 100 Extraction 400 Crown Implant or Denture l Lacerations based on size 50 to 800 Requires Surgery l Eye Injury 300 l Tendon Ligament Rotator Cuff 750 one 1 500 two or more l Ruptured Disc 750 l Torn Knee Cartilage 750 Surgical Care l Surgery cranial open abdominal or thoracic 1 500 l Surgery hernia 150 l Surgery arthroscopic or exploratory 300 l Blood Plasma Platelets 300

Transportation Lodging Assistance If injured covered person must travel more than 50 miles from residence to receive special treatment and confinement in a hospital l Transportation 600 per round trip up to 3 round trips l Lodging family member or companion 150 per night up to 30 days for a hotel motel lodging costs Accident Hospital Care l Hospital Admission 2 000 per accident l Hospital ICU Admission 4 000 per accident We will pay either the Hospital Admission or Hospital Intensive Care Unit ICU Admission but not both l Hospital Confinement 300 per day up to 365 days per accident l Hospital ICU Confinement 600 per day up to 15 days per accident Accident Follow Up Care l Accident Follow Up Doctor Visit 50 up to 4 visits per accident l Medical Imaging Study 300 per accident limit 1 per covered accident and 1 per calendar year l Occupational or Physical Therapy 35 per treatment up to 10 days l Appliances 125 such as wheelchair crutches l Prosthetic Devices Artificial Limb 750 one 1 500 more than 1 l Rehabilitation Unit 150 per day up to 15 days per covered accident and 30 days per calendar year Maximum of 30 days per calendar year Accidental Dismemberment l Loss of Finger Toe 1 250 one 2 400 two or more l Loss or Loss of Use of Hand Foot Sight of Eye 12 000 one 24 000 two or more Catastrophic Accident For severe injuries that result in the total and irrecoverable l Loss of one hand and one foot l Loss of both hands or both feet l Loss or loss of use of one arm and one leg or l Loss or loss of use of both arms or both legs l Loss of the sight of both eyes l Loss of the hearing of both ears l Loss of the ability to speak Named Insured 25 000 Spouse 25 000 Child ren 12 500 365 day elimination period Amounts reduced for covered persons age 65 and over Payable once per lifetime for each covered person Accidental Death l Named Insured l Spouse l Child ren Accidental Death 50 000 50 000 10 000 Common Carrier 200 000 200 000 40 000

Health Screening Benefit l 50 per covered person per calendar year Provides a benefit if the covered person has one of the health screening tests performed This benefit is payable once per calendar year per person and is subject to a 30 day waiting period Tests include l Blood test for triglycerides l Bone marrow testing l Breast ultrasound l CA 15 3 blood test for breast cancer l CA125 blood test for ovarian cancer l Carotid doppler l CEA blood test for colon cancer l Chest x ray l Colonoscopy l Echocardiogram ECHO l Electrocardiogram EKG ECG l Fasting blood glucose test l Flexible sigmoidoscopy l Hemoccult stool analysis l Mammography l Pap smear l PSA blood test for prostate cancer l Serum cholesterol test to determine level of HDL and LDL l Serum protein electrophoresis blood test for myeloma l Stress test on a bicycle or treadmill l Skin cancer biopsy l Thermography l ThinPrep pap test l Virtual colonoscopy My Coverage Worksheet For use with your Colonial Life benefits 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 Family When are covered accident benefits available check one On and Off Job Benefits Off Job Only Benefits EXCLUSIONS We will not pay benefits 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 inflicted injuries war or armed conflict in addition to the exclusions listed above we also will not pay the Catastrophic Accident benefit for injuries that are caused by or are the result of birth intoxication For cost and complete details see your Colonial Life benefits counselor Applicable to policy form Accident 1 0 HS NC This is not an insurance contract and only the actual policy provisions will control Accident 1 0 Premier with Health Screening Benefit Colonial Life 1200 Colonial Life Boulevard Columbia South Carolina 29210 coloniallife com 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 14 71741 NC

Disability Insurance How you can protect your income If you become disabled you could be out of work for a while Without your income how would you pay for your everyday living expenses Fortunately Colonial Life offers financial protection options that can help you What can cause a disability Many accidents or sicknesses can lead to short term disability claims including pregnancy and childbirth injuries from a major accident including dislocations sprains and fractures back problems side effects from medicines or medical procedures and some mental illnesses Regardless of your age or health a disabling sickness or accidental injuries could keep you out of work for weeks or even months How reliable is your safety net While many people with disabilities look to workers compensation or Social Security Disability Insurance SSDI for help these resources aren t always reliable In fact 68 of workers who apply for SSDI are denied 1 Even if these resources can help they might not be enough to meet your financial obligations How to help yourself You can be better prepared to preserve your way of life with short term disability insurance Disability insurance features Benefits payable directly to you in regular payments if you can t work because of a covered accident or sickness injury or illness Disability benefits may be available if you return to work part time In most cases you can keep your coverage even if you change jobs as long as you pay your premiums when due Your Colonial Life benefits counselor can help you determine the amount of coverage that s right for you Nearly 70 of Americans worry about having enough emergency savings to cover a month s worth of living expenses 2 25 of 20 year olds can expect to be out of work for at least a year for a disabling condition before they retire 3 DISABILITY INSURANCE

Disability Insurance Worksheet You can tailor disability coverage to fit your specific needs Talk with your benefits counselor about your expenses and other paid leave benefits such as state paid medical leave to help determine the coverage that s right for you 4 MONTHLY EXPENSES Rent or mortgage insurance minor home repairs Transportation car note bus fare insurance gas maintenance Utilities cell phone Wi Fi electricity gas water Food and household necessities toiletries cleaning supplies Childcare daycare after school care Health medical needs and prescription drugs Other gym fitness streaming cable extracurricular Total monthly expenses add lines 1 7 together ROUND TO THE NEAREST HUNDRED Your state s paid medical leave approximate benefits if any Monthly benefit _____________ Benefit period up to _____________ Talk with your Colonial Life benefits counselor to learn more about disability insurance ColonialLife com 1 Social Security Administration SSI Annual Statistical Report 2021 2 Bankrate Bankrate s 2023 annual emergency savings report 2023 3 Social Security Administration Disability and Death Probability Tables for Insured Workers 2022 4 State paid medical leave PML benefits fall under state specific program names For example in New Jersey it may be referred to as Temporary Disability Insurance TDI Not available in all states 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 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 benefits payable Applicable to policy forms ISTD3000 and rider form ISTD3000 ADIB including state abbreviations where used for example ISTD3000 TX and ISTD3000 ADIB TX policy form DIS1000 including state abbreviations where used for example DIS1000 TX policy form ED DIS 1 0 including state abbreviations where used for example ED DIS 1 0 TX policy form ICC21 DIP3000 and rider form ICC21 DIP3000 R DIS policy form GDIS P and certificate form GDIS C including state abbreviations where used for example GDIS P EE TX and GDIS C EE TX and policy form VSTDMP and certificate form VSTDC including state abbreviations where used for example VSTDMP TX and VSTDC TX Not applicable in Oregon for policy form ICC21 DIP3000 and rider form ICC21 DIP3000 R DIS For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company An insurance producer may contact you 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 6 23 101165 10

Individual Dental Insurance Standard Plan 1 000 100 80 50 This benefit summary provides a quick reference for the dental plan benefits Policy details Policy year maximum benefit Per person applies to Class A B and C services Deductible Per person applies to Class B and C services only Maximum of three per family per policy year 1 000 50 Standard Plan dental coverage at a glance Co insurance Class A Preventive services Class B Basic services Class C Major services In network1 100 80 50 Out of network2 MAC 100 80 50 Carryover benefits3 Carryover amount Per covered family member Threshold 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 benefits an insured can receive during a policy year and still be able to receive the carryover benefit Your carryover account can grow up to 800 to help pay for claims if you exceed your policy year maximum benefit 3 INDIVIDUAL DENTAL STANDARD PLAN

Covered services Class 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 films 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 months Class B Basic services Full mouth panoramic x rays Once every five years Fillings Posterior composite restorations Simple extractions Emergency treatment Class 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 In network coverage1 100 80 50 Out of network coverage2 MAC Waiting period 100 No waiting period 80 No waiting period 50 12 month waiting period5 Contact your Colonial Life benefits counselor to learn more 1 In network benefits 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 coinsurance and benefit maximums and will file claims for you 2 Out of network benefits are for covered dental services provided by a non participating dentist Benefits are provided at the lesser of the dentist s actual fee or the Maximum Allowable Charge MAC a scheduled amount determined by Colonial Life In Alaska only benefits are based on usual customary and reasonable charges 80th UCR for the same covered procedure by providers of similar training or experience in the general geographic area reviewed and updated periodically Benefits are subject to any deductibles co insurance and maximums Dentists haven t agreed to accept reimbursement as payment in full Additional out of pocket costs may apply You may have to file a claim to receive benefits 3 You must be covered for 12 consecutive months to receive the carryover benefit any break in coverage will eliminate the carryover account balance The carryover benefit 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 Benefits 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 benefits 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 benefits counselor or the company ColonialLife com 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 1763264

Individual Dental Insurance Freedom Plan 1 000 100 80 50 This benefit summary provides a quick reference for the dental plan benefits Policy details Policy year maximum benefit Per person applies to Class A B and C services Deductible Per person applies to Class B and C services only Maximum of three per family per policy year 1 000 50 Freedom Plan dental coverage at a glance Co insurance Class A Preventive services Class B Basic services Class C Major services In network1 100 80 50 Out of network2 90th UCR 100 80 50 Carryover benefits3 Carryover amount Per covered family member Threshold 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 benefits an insured can receive during a policy year and still be able to receive the carryover benefit Your carryover account can grow up to 800 to help pay for claims if you exceed your policy year maximum benefit 3 INDIVIDUAL DENTAL FREEDOM PLAN

Covered services Class 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 films once every 12 months Full mouth panoramic x rays Once every five 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 months Class B Basic services Fillings Posterior composite restorations Simple extractions Emergency treatment Class 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 In network coverage1 100 80 50 Out of network coverage2 90th UCR 100 80 50 Waiting period No waiting period No waiting period 12 month waiting period5 Contact your Colonial Life benefits counselor to learn more 1 In network benefits 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 coinsurance and benefit maximums and will file claims for you 2 Out of network benefits are for covered dental services provided by a non participating dentist Benefits 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 file a claim to receive benefits UCR charges are reviewed and updated periodically 3 You must be covered for 12 consecutive months to receive the carryover benefit The carryover benefit 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 Benefits 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 benefits 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 benefits counselor or the company ColonialLife com 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 1764443

Individual Dental Insurance Vision 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 benefit summary provides a quick reference to the rider s benefits Co pays per insured 1 Benefits once per 12 months Vision exam Contact lenses fitting Materials In network 10 25 25 Out of network N A N A N A Benefits and allowances1 Benefits after co pay In network Vision exam Covered in full Contact lenses fitting after co pay Standard2 Up to 60 allowance Specialty3 Up to 100 allowance Materials Eyeglass lenses and frames after co pay4 Single vision Covered in full Bifocals Covered in full Trifocals Covered in full Lenticular Up to 120 allowance Progressives Up to 70 allowance Polycarbonate lenses Covered in full for children to age 19 only Frames Up to 170 allowance Materials Contact lenses after co pay5 Elective Up to 170 allowance Non elective Up to 210 allowance Out of network 35 allowance Up to 45 allowance Up to 75 allowance Up to 25 allowance Up to 40 allowance Up to 50 allowance Up to 50 allowance Up to 40 allowance Up to 30 allowance Up to 50 allowance Up to 100 allowance Up to 210 allowance MAXIMIZE YOUR BENEFITS Maximize your vision benefits with any provider in our large nationwide network including independent eye doctors and retail stores such as Walmart and Sam s Club Optical Target Optical Pearle Vision Visionworks You 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 Digital ID cards are available on the policyholders portal when your coverage starts Only the primary insured s name will be listed INDIVIDUAL DENTAL VISION RIDER

Special savings on material purchases6 Some 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 PROVIDERS Special 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 antireflective coating 45 Premium antireflective coating 70 Ultra antireflective 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 discount Discount 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 solutions 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 resistant coating Standard antireflective coating Premium antireflective coating Transition lenses Standard polycarbonate lenses Note Not a covered benefit Prices shown reflect member payment Discounts reflect 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 fitting 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 fitting exam fee applies to a new or existing contact lens user who wears toric gas permeable mono fit or multi focal lens This includes follow ups 4 Eyeglass lenses and frames are paid in lieu of the contact lenses benefit 5 The contact lenses benefit 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 benefits payable Applicable to policy forms IDN8100 AR and IDN8100 NC and rider forms R VSN8100 AR and R VSN8100 NC For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company ColonialLife com 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 5 24 1820767 AR NC

Specified Critical Illness Insurance For more information talk with your benefits counselor ColonialLife com 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 _______________ Critical illness benefit For the diagnosis of this covered critical illness condition 1 Cancer Heart attack myocardial infarction Stroke End stage renal kidney failure Major organ failure Permanent paralysis due to a covered accident Coma Blindness Occupational infectious HIV or occupational infectious hepatitis B C or D Coronary artery bypass graft surgery disease2 Carcinoma in situ This percentage of the face amount is payable 100 100 100 100 100 100 100 100 100 25 25 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 Subsequent diagnosis of a different critical illness3 If you receive a benefit for a specified critical illness and later you are diagnosed with a different specified critical illness the original percentage of the face amount is payable for that particular specified critical illness Subsequent diagnosis of the same critical illness3 If 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 graft surgery disease 2 carcinoma in situ and occupational infectious HIV or occupational infectious hepatitis B C or D CRITICAL ILLNESS 1 0 WITH CANCER AND SUBSEQUENT DIAGNOSIS $10K - $75K

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 ColonialLife com 1 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 graft 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 ILLNESS We 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 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 4 19 101825 1

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 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 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 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 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

Deductions per year 26 Accident 1 0 for NC l On Off Job Accident Coverage Premier with health screening These rates were prepared on 10 15 2024 and are valid for 90 days Applicable to policy forms ACCIDENT 1 0 HS and ACCIDENT 1 0 NS ISSUE AGE 17 80 NAMED INSURED 12 24 EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY 16 76 18 32 22 85 Individual Disability ISTD3000 for NC A Risk Class l Off Job Accident Off Job Sickness 3 Month Benefit Period ELIMINATION PERIOD ISSUE AGE 1 000 0 days Accident 7 days Sickness monthly benefit amount 17 49 50 64 65 74 14 72 18 00 26 12 1 500 22 08 27 00 39 18 Applicable to policy form Individual Disability 2 000 29 45 36 00 52 25 Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Cancer Benefit Non Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE 10 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 1 89 2 82 3 78 5 22 6 46 8 72 12 46 15 55 20 91 25 02 2 86 4 29 5 77 7 98 9 88 13 43 19 15 23 91 32 12 38 45 20 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 3 78 5 63 7 57 10 43 12 92 17 45 24 92 31 11 41 82 50 03 5 72 8 58 11 54 15 97 19 75 26 86 38 31 47 82 64 25 76 89 ONE PARENT FAMILY 2 63 3 55 4 52 5 95 7 20 9 51 13 20 16 34 21 69 25 85 5 26 7 11 9 05 11 91 14 40 19 02 26 40 32 68 43 38 51 69 Applicable to policy form CI 1 0 TWO PARENT FAMILY 3 65 5 08 6 55 8 77 10 66 14 17 19 89 24 69 32 91 39 28 7 29 10 15 13 11 17 54 21 32 28 34 39 78 49 38 65 82 78 55 Page 1 of 4 Underwritten by Colonial Life Accident Insurance Company See page 4 for Important Notice

Continued Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Cancer Benefit Non Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE 30 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 5 68 8 45 11 35 15 65 19 38 26 17 37 38 46 66 62 72 75 05 8 58 12 88 17 31 23 95 29 63 40 29 57 46 71 72 96 37 115 34 Tobacco Rates ISSUE AGE 10 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 20 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 NAMED INSURED 2 68 4 20 6 09 8 35 10 71 14 03 19 43 24 97 32 12 38 72 5 35 8 40 12 18 16 71 21 42 28 06 38 86 49 94 64 25 77 45 EMPLOYEE SPOUSE 4 11 6 46 9 37 12 83 16 48 21 60 29 86 38 35 49 34 59 49 8 22 12 92 18 74 25 66 32 95 43 20 59 72 76 71 98 68 118 98 ONE PARENT FAMILY 7 89 10 66 13 57 17 86 21 60 28 52 39 60 49 02 65 08 77 54 ONE PARENT FAMILY 3 46 4 98 6 88 9 14 11 49 14 82 20 22 25 71 32 91 39 55 6 92 9 97 13 75 18 28 22 98 29 63 40 43 51 42 65 82 79 11 Applicable to policy form CI 1 0 TWO PARENT FAMILY 10 94 15 23 19 66 26 31 31 98 42 51 59 68 74 08 98 72 117 83 TWO PARENT FAMILY 4 89 7 20 10 15 13 62 17 26 22 34 30 65 39 09 50 12 60 32 9 78 14 40 20 31 27 23 34 52 44 68 61 29 78 18 100 25 120 65 Page 2 of 4 Underwritten by Colonial Life Accident Insurance Company See page 4 for Important Notice

Continued Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Cancer Benefit Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE 30 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 8 03 12 60 18 28 25 06 32 12 42 09 58 29 74 91 96 37 116 17 12 32 19 38 28 11 38 49 49 43 64 80 89 58 115 06 148 02 178 48 ONE PARENT FAMILY 10 38 14 95 20 63 27 42 34 48 44 45 60 65 77 12 98 72 118 66 Applicable to policy form CI 1 0 TWO PARENT FAMILY 14 68 21 60 30 46 40 85 51 78 67 02 91 94 117 28 150 37 180 97 Individual Dental 8100 IDN8100 for NC l with Vision Rider 12 Month Waiting Period Applicable to policy form Individual Dental 8100 IDN8100 Zip Codes ALL Zip Codes COVERAGE LEVEL Standard MAC 100 80 50 1 000 MAX Freedom UCR 100 80 50 1 000 MAX NAMED INSURED 19 98 28 85 NAMED INSURED AND NAMED INSURED AND SPOUSE DEPENDENT CHILD REN 38 00 55 56 46 76 69 14 NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 69 74 103 31 Term Life ITL5000 for NC l 20 Year Term Base Plan Non Tobacco Rates ISSUE AGE 10 000 25 3 10 35 3 55 45 4 47 55 8 34 65 18 93 Tobacco Rates ISSUE AGE 25 35 45 55 65 10 000 4 84 5 41 7 34 15 66 32 38 20 000 4 35 5 26 7 10 14 83 23 09 20 000 7 84 8 97 12 83 29 48 38 66 30 000 5 60 6 96 9 72 13 57 33 72 30 000 10 83 12 53 18 31 30 11 57 06 Applicable to policy form ITL5000 Page 3 of 4 Underwritten by Colonial Life Accident Insurance Company See page 4 for Important Notice

Continued Whole Life Plus IWL5000 for NC l Adult Base Plan Paid Up at Age 100 Non Tobacco Rates ISSUE AGE 10 000 25 4 25 35 5 78 45 9 18 55 14 98 65 26 65 Tobacco Rates ISSUE AGE 25 35 45 55 65 10 000 7 42 9 02 13 44 22 64 38 73 20 000 8 49 11 55 18 36 29 95 53 31 20 000 14 83 18 05 26 87 45 29 77 46 30 000 12 74 17 33 27 53 44 93 79 96 30 000 22 25 27 07 40 30 67 93 116 19 Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC Important Notice Insurance coverage has exclusions and limitations that may affect benefits payable For a complete description of benefits limitations and exclusions please refer to an outline of coverage sample policy certificate proposal description or see your Colonial Life benefits counselor Coverage type benefits and rates vary by state Coverage may not 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 Lisa Jones 980 622 3718 Page 4 of 4 Underwritten by Colonial Life Accident Insurance Company See page 4 for Important Notice

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 to File a Claim for Colonial Life Benefits FOR FASTEST RESULTS FILE ONLINE 1 Go to ColonialLife com access to login or register 2 Fill out the required information and click Submit 3 Enjoy streamlined claims management and faster service online DIGITALLY FILE ALL TYPES OF CLAIMS Disability Insurance Accident Hospital Insurance Life Insurance Critical Illness Cancer Insurance Wellness benefits for screening tests Not sure which type of claim to file No problem Just answer a few questions on the portal and we ll help you figure everything out BEFORE YOU FILE Review the appropriate claims checklist at ColonialLife com and have this information handy to make the process go smoothly Proper documentation must be submitted when filing your claim AFTER YOU FILE Check your claim status and manage your claim by logging into your account at ColonialLife com access Live chat is also available 9 a m 5 p m EST OTHER WAYS TO FILE A CLAIM Fax 1 800 880 9325 Mail P O Box 100195 Columbia SC 29202 Colonial Life is committed to providing you our valued customer a market leading claims experience We look forward to serving you on ColonialLife com On the policyholder portal you can View benefit details Here you ll find a copy of your policy to see what s covered and benefit amounts Track your claim Log in anytime to view status or opt in to receive status alerts by email or text so you know instantly if we require additional information Sign up for direct deposit to get approved payments up to a week faster than paper check Colonial Life 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 ADR 1312251

Thank you Colonial Life Voluntary Benefits Please contact Lisa Jones Benefits Specialist 980 622 3718 Lisa Jones ColonialLifeSales com