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Benefit Booklet - 2024

Colonial Life provides benefits that employees want for the unexpected moments in life Whether planning for retirement growing their families or saving for college they know an injury or illness won t derail their dreams Life is anything but expected That s why we re here Products Hospital Confinement Indemnity Insurance Medical Bridge Provides benefits to help cover the cost of a hospital stay and other medical procedures for a covered accident or sickness regardless of what health insurance pays Accident Insurance From a fall to a car accident this coverage offers a range of benefits to help cover medical or non medical related expenses due to a covered accident Critical Illness Insurance Provides lumpsum benefits for a covered critical illness such as a heart attack or stroke Kitty Mellone 704 907 3944 Kmellone coloniallifenc com

For more information talk with your benefits counselor ColonialLife com Group Hospital Indemnity Insurance Plan 2 Group Medical BridgeSM insurance can help with medical costs associated with a hospital stay that your health insurance may not cover These benefits are available for you your spouse and eligible dependent children Hospital confinement 1500 2000____per day Maximum of one day per covered person per calendar year Waiver of premium Available after 30 continuous days of a covered confinement of the named insured Daily hospital confinement 100 per day Maximum 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 Diagnostic procedure _______ 250___ per day Maximum of one day per covered person per calendar year Outpatient surgical procedure Tier 1 ____750______ per day Tier 2 ____ 1 500____ per day Maximum of ___ 2 250___________ per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedure Diagnostic procedures N A The 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 Hysteroscopy Cervical biopsy Loop electrosurgical Cone biopsy excisional procedure Endometrial biopsy LEEP 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 GMB7000 PLAN 2

ColonialLife com 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 grafting 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 Thyroid Excision of a mass Urologic Lithotripsy Gynecological Hysterectomy Myomectomy Musculoskeletal system A rthroscopic knee surgery with meniscectomy knee cartilage repair Arthroscopic shoulder surgery Clavicle resection D islocations open reduction with internal fixation F racture open reduction with internal fixation Removal or implantation of cartilage Tendon ligament repair KS 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 C olonoscopy 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 THIS POLICY PROVIDES LIMITED BENEFITS EXCLUSIONS We will not pay any benefits for injuries received in accidents or for sicknesses which are caused by contributed to by or occur as a result of the following exclusions and limitations 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 i giving birth within the first nine months after the effective date of the certificate j We will not pay benefits for hospital confinement or daily hospital confinement if included of a newborn child following his birth unless he is injured or sick k The policy may have additional exclusions and limitations which may affect any benefits payable PRE EXISTING CONDITION LIMITATIONS l We will not pay benefits for loss during the first 12 months after the certificate effective 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 effective 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 This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P and certificate form GMB7000 C including state abbreviations where applicable such as policy forms GMB7000 P AU TX and GMB7000 P EE TX and certificate forms GMB7000 C AU TX and GMB7000 C EE TX Coverage may vary by state and may not be available in all states This form is not complete without form 101733 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 8 19 101918 1

Group Hospital Indemnity Insurance Exclusions and Limitations STATE SPECIFIC EXCLUSIONS AK a Replaced by intoxicants and narcotics CA k Additional exclusions include intoxicants and controlled substances CT a Replaced by intoxication or drug addiction d Replaced by felonies f Exclusion does not apply DE a Exclusion does not apply IL a Replaced by alcoholism intoxication or drug addiction f Exclusion does not apply g Exclusion does not apply KS a Replaced by intoxicants and narcotics h Replaced by war or armed conflict i Exclusion does not apply KY a Replaced by intoxicants narcotics and hallucinogenics LA a Replaced by intoxicants and narcotics MI g Exclusion does not apply MO a Replaced by drug addiction d Replaced by illegal activities MS a Replaced by intoxicants and narcotics NC i Exclusion does not apply ND a Exclusion does not apply e Exclusion does not apply NV a Exclusion does not apply OH f Exclusion does not apply i Replaced by 270 days PA 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 conflict SD a Exclusion does not apply TN f Exclusion does not apply TX 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 LIMITATIONS IN SD and WY m applies within the six months before the certificate effective 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 effective 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 effective 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 effective 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 effective date MI l Applies during the first six months after the certificate effective date m applies within the six months before the certificate effective 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 effective 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 effective date If you are 65 or older when this certificate is issued preexisting 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 effective date NV m applies within the six months before the certificate effective 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 effective 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 effective date n Hospital Confinement Admission replaces Hospital Confinement CA Lic if applicable _________________ This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P and certificate form GMB7000 C including state abbreviations where applicable such as policy forms GMB7000 P AU TX and GMB7000 P EE TX and certificate forms GMB7000 C AU TX and GMB7000 C EE TX Coverage may vary by state and may not be available in all states This form is not complete without base form 101917 or 101918 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 GMB7000 EXCLUSIONS AND LIMITATIONS 10 18 101733 3

For more information talk with your benefits counselor Group Hospital Indemnity Insurance Medical Treatment Package The Group Medical BridgeSM medical treatment package can help pay for deductibles co payments and other out of pocket expenses related to the treatment of a covered accident or covered sickness The medical treatment package paired with Plan 1 provides accident only coverage When paired with Plan 2 it provides accident and sickness coverage Medical treatment package Air ambulance 1 000 per day Maximum of one day per covered person per calendar year Ambulance 100 per day Maximum of one day per covered person per calendar year Appliance 100 per day Maximum of one day per covered person per calendar year Doctor s office visit telemedicine 25 per day Maximum of three days per calendar year for named insured coverage or maximum of five days per calendar year for all covered persons combined Emergency room visit 100 per day Maximum of two days per covered person per calendar year X ray 25 per day Maximum of two days per covered person per calendar year ColonialLife com GMB7000 MEDICAL TREATMENT PACKAGE

Hospital Confinement Indemnity Insurance Health Screening Individual Medical BridgeSM insurance s health screening benefit can help pay for health and wellness tests you have each year Health screening 100_____________ Maximum of one health screening test per covered person per calendar year subject to a 30 day waiting period Blood test for triglycerides Bone marrow testing Breast ultrasound CA 15 3 blood test for breast cancer CA 125 blood test for ovarian cancer CEA blood test for colon cancer Carotid Doppler Chest X ray Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy Colonoscopy Echocardiogram ECHO Electrocardiogram EKG ECG Fasting blood glucose test Flexible sigmoidoscopy For more information talk with your benefits counselor Hemoccult stool analysis Mammography Pap smear PSA blood test for prostate cancer Serum cholesterol test for HDL and LDL levels ColonialLife com Waiting period means the first 30 days following any covered person s policy coverage effective date during which no benefits are payable For cost and complete details see your Colonial Life benefits counselor Applicable to policy number IMB7000 including state abbreviations where used for example IMB7000 TX Coverage may vary by state and may not be available in all states This is not an insurance contract and only the actual policy provisions will control 2015 Colonial Life Accident Insurance Company Columbia SC Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand IMB7000 HEALTH SCREENING BENEFIT 2 15 101579

Group Critical Illness Insurance Plan 2 Preparing for a lifelong journey Rebecca was born with Down syndrome Her parents critical illness coverage provided a benefit that can help cover expenses related to Rebecca s care and her changing needs HOW THEIR COVERAGE HELPED The lump sum amount from the family coverage benefit helped pay for A hospital stay and treatment for corrective heart surgery Physical therapy to build muscle strength Special needs daycare For illustrative purposes only When life takes an unexpected turn your focus should be on recovery not finances Colonial Life s group critical illness insurance helps relieve financial worries by providing a lump sum benefit payable directly to you to use as needed Coverage amount ____________________________ Critical illness and cancer benefits COVERED CRITICAL ILLNESS CONDITION PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Benign 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 Occupational infectious HIV or occupational infectious hepatitis B C or D Permanent paralysis due to a covered accident 100 100 100 Stroke 100 Sudden cardiac arrest 100 Coronary artery disease 25 COVERED CANCER CONDITION PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Invasive cancer including all breast cancer 100 Non invasive cancer 25 Skin cancer initial diagnosis 400 per lifetime GCI6000 PLAN 2 CRITICAL ILLNESS AND CANCER

KEY BENEFITS Available coverage for spouse and eligible dependent children at 50 of your coverage amount Cover your eligible dependent children at no additional cost Receive coverage regardless of medical history within specified limits Works alongside your health savings account HSA Benefits payable regardless of other insurance For more information talk with your benefits counselor ColonialLife com Subsequent diagnosis of a different critical illness2 If you receive a benefit 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 illness2 If you receive a benefit 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 benefit 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 children COVERED CONDITION Cerebral palsy Cleft lip or palate Cystic fibrosis Down syndrome Spina bifida PERCENTAGE OF APPLICABLE COVERAGE AMOUNT 100 100 100 100 100 Preparing for the unexpected is simpler than you think With Colonial Life youll have the support you need to face lifes toughest challenges 1 Refer to the certificate for complete definitions 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 infectious HIV or occupational infectious hepatitis B C or D THIS INSURANCE PROVIDES LIMITED BENEFITS Insureds in MA must be covered by comprehensive health insurance before applying for this coverage EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benefit Benefits Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person s alcoholism or drug addiction felonies or illegal occupations intoxicants and narcotics suicide or injuring oneself intentionally whether sane or not war or armed conflict or pre existing condition unless the covered person has satisfied the pre existing condition limitation period shown on the Certificate 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 Benefit Non Invasive Cancer Benefit Benefit Payable Upon Reoccurrence of Invasive Cancer including all Breast Cancer or Skin Cancer Initial Diagnosis Benefit for a covered person s invasive cancer or non invasive cancer that is diagnosed or treated outside the territorial limits of the United States its possessions or the countries of Canada and Mexico is a pre existing condition unless the covered person has satisfied the pre existing condition limitation period shown on the Certificate 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 certificate and who are continuously covered from the date of birth or adoption PRE EXISTING CONDITION LIMITATION We will not pay a benefit for a pre existing condition that occurs during the 12 month period after the coverage effective date Pre existing condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC 2020 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 5 20 387100

Group Critical Illness Insurance Exclusions and Limitations STATE SPECIFIC EXCLUSIONS STATE SPECIFIC PRE EXISTING CONDITION LIMITATIONS AK Alcoholism or Drug Addiction Exclusion does not apply CA Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics replaced with Intoxicants or Controlled Substances CO Suicide exclusion whether sane or not replaced with while sane CT Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Felonies Intoxicants and Narcotics Exclusion does not apply DC Alcoholism or Drug Addiction Exclusion does not apply CA Pre existing Condition means a sickness or physical condition for which a covered person was diagnosed or treated within 12 months before the coverage effective date shown on the Certificate Schedule FL Pre existing is 6 12 Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date shown on the Certificate Schedule Genetic information is not a pre existing condition in the absence of a diagnosis of the condition related to such information DE Alcoholism or Drug Addiction Exclusion does not apply IA Exclusions and Limitations headers renamed to Exclusions and Limitations for Critical Illness Covered Conditions and Critical Illness Cancer Covered Conditions ID War or Armed Conflict Exclusion replaced with War Felonies and Illegal Occupations Exclusion replaced with Felonies Intoxicants and Narcotics Exclusion does not apply Domestic Partner added to Spouse IL Alcoholism or Drug Addiction Exclusion replaced with Alcoholism or Substance Abuse Disorder KS Alcoholism or Drug Addiction Exclusion does not apply KY Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion replaced with Intoxicants Narcotics and Hallucinogenics GA Pre existing Condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis care or treatment or a condition for which medical advice or treatment was recommended by or received within 12 months preceding the coverage effective date ID Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition which caused a covered person to seek medical advice diagnosis care or treatment during the six months immediately preceding the coverage effective date shown on the Certificate Schedule IL Pre existing Condition means a sickness or physical condition for which a covered person was diagnosed treated had medical testing by a legally qualified physician received medical advice produced symptoms or had taken medication within 12 months before the coverage effective date shown on the Schedule of Benefits LA Alcoholism or Drug Addiction Exclusion does not apply Domestic Partner added to Spouse MA Exclusions and Limitations headers renamed to Limitations and Exclusions for critical illness and cancer MD Alcoholism or Drug Addiction Exclusion does not apply Felonies or Illegal Occupations Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Prohibited Practitioner Referral added as an additional exclusion for cancer MI Intoxicants and Narcotics Exclusion does not apply Suicide Exclusion does not apply MN Alcoholism or Drug Addiction Exclusion does not apply Suicide Exclusion does not apply Felonies and Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs Intoxicants and Narcotics Exclusion replaced with Narcotic Addiction MO Alcoholism or Drug Addiction Exclusion replaced with Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Illegal Activities MS Alcoholism or Drug Addiction Exclusion does not apply ND Alcoholism or Drug Addiction Exclusion does not apply NV Intoxicants and Narcotics Exclusion does not apply Domestic Partner added to Spouse PA Alcoholism or Drug Addiction Exclusion does not apply Suicide Exclusion whether sane or not removed SD Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply TX Alcoholism or Drug Addiction Exclusion does not apply Doctor or Physician Relationship added as an additional exclusion UT Alcoholism or Drug Addiction Exclusion replaced with Alcoholism VT Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Suicide Exclusion whether sane or not removed IN Pre existing is 6 months 12 months MA Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing or received medical advice within six months before the coverage effective date shown on the Certificate Schedule MD Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date shown on the Certificate Schedule Pre existing condition does not include a condition revealed on the application unless excluded by a signed waiver rider ME Pre existing is 6 months 6 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing or received medical advice within six months before the coverage effective date shown on the Certificate Schedule MI Pre existing is 6 months 6 months NC Pre existing Condition means those conditions for which medical advice diagnosis care or treatment was received or recommended within the one year period immediately preceding the effective date of a covered person If a covered person is 65 or older when this certificate is issued pre existing conditions for that covered person will include only conditions specifically eliminated NV Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date Pre existing Condition does not include genetic information in the absence of a diagnosis of the condition related to such information PA Pre existing is 90 days 12 months Pre existing Condition means a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage effective date shown on the Certificate Schedule WY Exclusions and Limitations header for Cancer renamed to Limitations for Specified Disease SD Pre existing is 6 months 12 months TX Pre existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage effective date shown on the Certificate Schedule UT Pre existing is 6 months 6 months WY Pre existing is 6 months 12 months This information is not intended to be a complete description of the insurance coverage available The insurance its name or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company This form is not complete without base form 385403 387100 387169 402383 402558 or 387238 and rider form 387307 387381 387452 387523 387594 387665 402605 or 402671 Underwritten by Colonial Life Accident Insurance Company Columbia SC 2021 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GCI6000 EXCLUSIONS AND LIMITATIONS 4 21 388113 4

Group Critical Illness Insurance Progressive Diseases Rider For more information talk with your benefits counselor ColonialLife com The debilitating effects of a progressive disease not only impact you physically but financially as well Changes in lifestyle may require home modification additional medical treatment and other expenses These benefits are for you as well as your covered family members Payable for each covered progressive disease once per covered person per lifetime COVERED PROGRESSIVE DISEASE PERCENTAGE OF APPLICABLE COVERAGE AMOUNT This benefit is payable if the covered person is unable to perform two or more activities of daily living2 and the 90 day elimination period has been met Amyotrophic Lateral Sclerosis ALS 25 Dementia including Alzheimer s disease 25 Huntington s disease 25 Lupus 25 Multiple sclerosis MS 25 Muscular dystrophy 25 Myasthenia gravis MG 25 Parkinson s disease 25 Systemic sclerosis scleroderma 25 1 Refer to the certificate for complete definitions of covered diseases 2 Activities of daily living include bathing continence dressing eating toileting and transferring THIS INSURANCE PROVIDES LIMITED BENEFITS EXCLUSIONS AND LIMITATIONS FOR PROGRESSIVE DISEASES RIDER We will not pay benefits for a covered progressive disease that occurs as a result of a covered person s alcoholism or drug addiction felonies or illegal occupations intoxicants and narcotics suicide or injuring oneself intentionally whether sane or not war or armed conflict or pre existing condition unless the covered person has satisfied the preexisting condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a covered progressive disease PRE EXISTING CONDITION LIMITATION We will not pay a benefit for a pre existing condition that occurs during the 12 month period after the coverage effective date Pre existing condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX and rider form R GCI6000 PD For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC 2020 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GCI6000 PROGRESSIVE DISEASES RIDER 5 20 387594

Group Critical Illness Insurance Exclusions and Limitations STATE SPECIFIC EXCLUSIONS STATE SPECIFIC PRE EXISTING CONDITION LIMITATIONS AK Alcoholism or Drug Addiction Exclusion does not apply CO Suicide exclusion whether sane or not replaced with while sane CT Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Felonies Intoxicants and Narcotics Exclusion does not apply DE Alcoholism or Drug Addiction Exclusion does not apply IA Exclusions and Limitations headers renamed to Exclusions and Limitations for Critical Illness Covered Conditions and Critical Illness Cancer Covered Conditions ID War or Armed Conflict Exclusion replaced with War Felonies and Illegal Occupations Exclusion replaced with Felonies Intoxicants and Narcotics Exclusion does not apply Domestic Partner added to Spouse IL Alcoholism or Drug Addiction Exclusion replaced with Alcoholism or Substance Abuse Disorder KS Alcoholism or Drug Addiction Exclusion does not apply KY Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion replaced with Intoxicants Narcotics and Hallucinogenics LA Alcoholism or Drug Addiction Exclusion does not apply Domestic Partner added to Spouse MA Exclusions and Limitations headers renamed to Limitations and Exclusions for critical illness and cancer MI Intoxicants and Narcotics Exclusion does not apply Suicide Exclusion does not apply MN Alcoholism or Drug Addiction Exclusion does not apply Suicide Exclusion does not apply Felonies and Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs Intoxicants and Narcotics Exclusion replaced with Narcotic Addiction MS Alcoholism or Drug Addiction Exclusion does not apply ND Alcoholism or Drug Addiction Exclusion does not apply NV Intoxicants and Narcotics Exclusion does not apply Domestic Partner added to Spouse PA Alcoholism or Drug Addiction Exclusion does not apply Suicide Exclusion whether sane or not removed SD Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply TX Alcoholism or Drug Addiction Exclusion does not apply Doctor or Physician Relationship added as an additional exclusion UT Alcoholism or Drug Addiction Exclusion replaced with Alcoholism VT Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Suicide Exclusion whether sane or not removed FL Pre existing is 6 12 Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date shown on the Certificate Schedule Genetic information is not a pre existing condition in the absence of a diagnosis of the condition related to such information GA Pre existing Condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis care or treatment or a condition for which medical advice or treatment was recommended by or received within 12 months preceding the coverage effective date ID Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition which caused a covered person to seek medical advice diagnosis care or treatment during the six months immediately preceding the coverage effective date shown on the Certificate Schedule IL Pre existing Condition means a sickness or physical condition for which a covered person was diagnosed treated had medical testing by a legally qualified physician received medical advice produced symptoms or had taken medication within 12 months before the coverage effective date shown on the Schedule of Benefits IN Pre existing is 6 months 12 months MA Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing or received medical advice within six months before the coverage effective date shown on the Certificate Schedule ME Pre existing is 6 months 6 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing or received medical advice within six months before the coverage effective date shown on the Certificate Schedule MI Pre existing is 6 months 6 months NC Pre existing Condition means those conditions for which medical advice diagnosis care or treatment was received or recommended within the one year period immediately preceding the effective date of a covered person If a covered person is 65 or older when this certificate is issued pre existing conditions for that covered person will include only conditions specifically eliminated NV Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date Pre existing Condition does not include genetic information in the absence of a diagnosis of the condition related to such information PA Pre existing is 90 days 12 months Pre existing Condition means a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage effective date shown on the Certificate Schedule SD Pre existing is 6 months 12 months TX Pre existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage effective date shown on the Certificate Schedule UT Pre existing is 6 months 6 months This information is not intended to be a complete description of the insurance coverage available The insurance its name or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company This form is not complete without base form 385403 387100 387169 402383 402558 or 387238 and rider form 387307 387381 387452 387523 387594 387665 402605 or 402671 Underwritten by Colonial Life Accident Insurance Company Columbia SC 2020 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GCI6000 EXCLUSIONS AND LIMITATIONS 8 20 388113 1

Group Critical Illness Insurance Infectious Diseases Rider For more information talk with your benefits counselor ColonialLife com The sudden onset of an infectious or contagious disease can create unexpected circumstances for you or your family The infectious diseases rider provides a lump sum which can be used toward health care expenses or meeting day today needs These benefits are for you as well as your covered family members Payable for each covered infectious disease once per covered person per lifetime COVERED INFECTIOUS DISEASE PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Hospital confinement for seven or more consecutive days for treatment of the disease Antibiotic resistant bacteria including MRSA 50 Cerebrospinal meningitis bacterial 50 Diphtheria 50 Encephalitis 50 Legionnaires disease 50 Lyme disease 50 Malaria 50 Necrotizing fasciitis 50 Osteomyelitis 50 Poliomyelitis 50 Rabies 50 Sepsis 50 Tetanus 50 Tuberculosis 50 Hospital confinement for 14 or more consecutive days for treatment of the disease Coronavirus disease 2019 COVID 19 25 GCI6000 INFECTIOUS DISEASES RIDER

ColonialLife com 1 Refer to the certificate for complete definitions of covered diseases THIS INSURANCE PROVIDES LIMITED BENEFITS EXCLUSIONS AND LIMITATIONS FOR INFECTIOUS DISEASES RIDER We will not pay benefits for a covered infectious disease that occurs as a result of a covered person s alcoholism or drug addiction felonies or illegal occupations intoxicants and narcotics suicide or injuring oneself intentionally whether sane or not war or armed conflict or pre existing condition unless the covered person has satisfied the pre existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a covered infectious disease PRE EXISTING CONDITION LIMITATION We will not pay a benefit for a pre existing condition that occurs during the 12 month period after the coverage effective date Pre existing condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX and rider form R GCI6000 INF For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC 2020 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 5 20 387523

Group Critical Illness Insurance Heart Benefits Rider For more information talk with your benefits counselor Certain types of cardiovascular disease can be treated with a variety of options The heart benefits rider provides a lump sum amount for a covered heart procedure which can be used to help with out of pocket expenses These benefits are for you as well as your covered family members Payable once per covered person per calendar year COVERED HEART PROCEDURE1 Abdominal aortic aneurysm surgery Aortic valve replacement or repair Mitral valve replacement or repair Coronary artery bypass graft surgery Atherectomy Automatic Implantable or internal Cardioverter Defibrillator AICD Balloon angioplasty Heart catheterization Laser angioplasty Pacemaker placement Stent implantation Thrombectomy clot removal using catheters such as AngioJet PERCENTAGE OF APPLICABLE COVERAGE AMOUNT 100 100 100 75 10 10 10 10 10 10 10 10 The rider provides a benefit for a covered heart procedure if it is the result of one of the following acute coronary syndrome atherosclerosis coronary artery disease cardiomyopathy or valvular heart disease If two or more heart procedures occur on the same day we may pay only one heart benefit In addition we may pay the larger of the two heart benefits GCI6000 HEART BENEFITS RIDER

ColonialLife com 1 Refer to the certificate for complete definitions of covered procedures THIS INSURANCE PROVIDES LIMITED BENEFITS EXCLUSIONS AND LIMITATIONS FOR HEART BENEFITS RIDER We will not pay benefits for a covered heart procedure that occurs as a result of a covered person s alcoholism or drug addiction felonies or illegal occupations intoxicants and narcotics suicide or injuring oneself intentionally whether sane or not war or armed conflict or pre existing condition unless the covered person has satisfied the pre existing condition limitation period shown on the Certificate Schedule on the date the covered person undergoes a covered heart procedure PRE EXISTING CONDITION LIMITATION We will not pay a benefit for a pre existing condition that occurs during the 12 month period after the coverage effective date Pre existing condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX and rider form R GCI6000 HB For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC 2020 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 5 20 387452

Group Critical Illness Insurance Exclusions and Limitations STATE SPECIFIC EXCLUSIONS STATE SPECIFIC PRE EXISTING CONDITION LIMITATIONS AK Alcoholism or Drug Addiction Exclusion does not apply CO Suicide exclusion whether sane or not replaced with while sane CT Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Felonies Intoxicants and Narcotics Exclusion does not apply DE Alcoholism or Drug Addiction Exclusion does not apply IA Exclusions and Limitations headers renamed to Exclusions and Limitations for Critical Illness Covered Conditions and Critical Illness Cancer Covered Conditions ID War or Armed Conflict Exclusion replaced with War Felonies and Illegal Occupations Exclusion replaced with Felonies Intoxicants and Narcotics Exclusion does not apply Domestic Partner added to Spouse IL Alcoholism or Drug Addiction Exclusion replaced with Alcoholism or Substance Abuse Disorder KS Alcoholism or Drug Addiction Exclusion does not apply KY Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion replaced with Intoxicants Narcotics and Hallucinogenics LA Alcoholism or Drug Addiction Exclusion does not apply Domestic Partner added to Spouse MA Exclusions and Limitations headers renamed to Limitations and Exclusions for critical illness and cancer MI Intoxicants and Narcotics Exclusion does not apply Suicide Exclusion does not apply MN Alcoholism or Drug Addiction Exclusion does not apply Suicide Exclusion does not apply Felonies and Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs Intoxicants and Narcotics Exclusion replaced with Narcotic Addiction MS Alcoholism or Drug Addiction Exclusion does not apply ND Alcoholism or Drug Addiction Exclusion does not apply NV Intoxicants and Narcotics Exclusion does not apply Domestic Partner added to Spouse PA Alcoholism or Drug Addiction Exclusion does not apply Suicide Exclusion whether sane or not removed SD Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply TX Alcoholism or Drug Addiction Exclusion does not apply Doctor or Physician Relationship added as an additional exclusion UT Alcoholism or Drug Addiction Exclusion replaced with Alcoholism VT Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Suicide Exclusion whether sane or not removed FL Pre existing is 6 12 Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date shown on the Certificate Schedule Genetic information is not a pre existing condition in the absence of a diagnosis of the condition related to such information GA Pre existing Condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis care or treatment or a condition for which medical advice or treatment was recommended by or received within 12 months preceding the coverage effective date ID Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition which caused a covered person to seek medical advice diagnosis care or treatment during the six months immediately preceding the coverage effective date shown on the Certificate Schedule IL Pre existing Condition means a sickness or physical condition for which a covered person was diagnosed treated had medical testing by a legally qualified physician received medical advice produced symptoms or had taken medication within 12 months before the coverage effective date shown on the Schedule of Benefits IN Pre existing is 6 months 12 months MA Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing or received medical advice within six months before the coverage effective date shown on the Certificate Schedule ME Pre existing is 6 months 6 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing or received medical advice within six months before the coverage effective date shown on the Certificate Schedule MI Pre existing is 6 months 6 months NC Pre existing Condition means those conditions for which medical advice diagnosis care or treatment was received or recommended within the one year period immediately preceding the effective date of a covered person If a covered person is 65 or older when this certificate is issued pre existing conditions for that covered person will include only conditions specifically eliminated NV Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date Pre existing Condition does not include genetic information in the absence of a diagnosis of the condition related to such information PA Pre existing is 90 days 12 months Pre existing Condition means a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage effective date shown on the Certificate Schedule SD Pre existing is 6 months 12 months TX Pre existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage effective date shown on the Certificate Schedule UT Pre existing is 6 months 6 months This information is not intended to be a complete description of the insurance coverage available The insurance its name or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company This form is not complete without base form 385403 387100 387169 402383 402558 or 387238 and rider form 387307 387381 387452 387523 387594 387665 402605 or 402671 Underwritten by Colonial Life Accident Insurance Company Columbia SC 2020 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GCI6000 EXCLUSIONS AND LIMITATIONS 8 20 388113 1

Group Critical Illness Insurance Wellbeing Assistance Benefit For more information talk with your benefits counselor The wellbeing assistance benefit can help reduce the risk of serious illness through early detection of disease or risk factors Wellbeing assistance benefit 50 _YR___________ Maximum of one test per covered person per calendar year subject to a 30 day waiting period before the benefit 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 ovarian cancer CA 125 blood test for breast cancer Carotid Doppler CEA blood test for colon cancer Chest x ray Colonoscopy Echocardiogram ECHO Electrocardiogram EKG ECG Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA blood test for prostate cancer Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy ColonialLife com THIS INSURANCE PROVIDES LIMITED BENEFITS 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 form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC 2020 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GCI6000 WELLBEING ASSISTANCE BENEFIT 5 20 387307

Group Accident Insurance Preferred Plan For more information talk with your benefits counselor ColonialLife com Group accident insurance can help with medical or other costs associated with a covered accident or injury that your health insurance may not cover With this coverage you may not need to use your savings or secure a loan to help pay those unexpected out of pocket expenses Coverage options are available for you your spouse and eligible dependent children Benefits are per covered person per covered accident unless stated otherwise Accident emergency treatment 150 One visit per covered person per covered accident and Up to four visits per covered person per calendar year Accident follow up doctor visit 50 Up to four visits per covered person per covered accident and Up to 16 visits per covered person per calendar year Accidental death Accidental death Per covered person Accidental death common carrier Named insured 50 000 200 000 Spouse 50 000 200 000 Dependent child ren 10 000 40 000 Examples of common carriers are mass transit trains buses and planes Accidental dismemberment Loss or loss of use One hand arm foot leg or sight of an eye 9 000 Both hands arms feet legs or the sight of both eyes or any combination 18 000 One finger or one toe 1 050 Two or more fingers two or more toes or any combination 2 100 Air ambulance 1 500 Transportation to or from a hospital or medical facility Ambulance ground 300 Transportation to or from a hospital or medical facility Appliance aid in personal locomotion or mobility 100 Walking boot neck brace back brace leg brace cane crutches walker and wheelchair Blood plasma platelets 400 Required during treatment of a covered accident Burn 2nd degree burns covering at least 36 of the body s surface 1 000 3rd degree burns based on size 2 000 15 000 Burn skin graft 50 of applicable burn benefit As a result of 2nd degree or 3rd degree burns GAC4000 PREFERRED PLAN

Alex was cleaning out the gutters when he fell EMERGENCY ROOM VISIT Alex was taken by ambulance to the nearest emergency room and received immediate care DIAGNOSTIC PROCEDURE The doctor ordered an X ray and discovered Alex had fractured his leg HOSPITAL CONFINEMENT Alex was admitted to the hospital for surgery on his leg He was confined for three days APPLIANCE FOR MOBILITY Alex used crutches PHYSICAL THERAPY Alex had eight sessions of PT to help him regain the strength in his leg DOCTORS OFFICE VISIT Over the next several weeks he had three follow up appointments with his doctor ALEXS OUT OF POCKET EXPENSES When Alex totaled up the bills he had to pay his annual deductible as well as co payments for the ambulance emergency room hospital surgery physical therapy and follow up visits Luckily Alex had accident coverage to help with these expenses ALEX S BENEFITS Ambulance Emergency room visit X ray Hospital admission Hospital confinement Leg fracture surgical Physical therapy Appliance crutches Doctor s follow up office visit 300 150 60 1 000 750 3 600 360 100 150 6 470 For illustrative purposes only Benefit amounts may vary and may not cover all expenses The certificate has exclusions and limitations Catastrophic accident Total and irrecoverable loss or loss of use Both hands arms feet legs or the sight of both eyes or any combination or Loss of hearing in both ears or loss of ability to speak Subject to a 365 day elimination period payable once per lifetime per covered person Named insured 50 000 Spouse 50 000 Dependent child ren 25 000 Coma 10 000 Lasting for 14 or more consecutive days Concussion 375 Dislocation separated joint Non surgical Surgical Hip 3 000 6 000 Knee except patella 1 500 3 000 Ankle bone or bones of the foot other than toes 1 200 2 400 Collarbone sternoclavicular 800 1 600 Collarbone acromioclavicular and separation 200 400 Lower jaw 720 1 440 Shoulder glenohumeral 1 200 2 400 Elbow 450 900 Wrist 600 1 200 Bone s of the hand other than fingers 810 1 620 Finger toe 200 400 Incomplete dislocation or dislocation reduction 25 of the applicable without anesthesia non surgical amount Emergency dental work Dental crown or denture 300 Dental extraction 100 Eye injury 300 With surgical repair or removal of a foreign object Fracture broken bone Non surgical Surgical Skull depressed fracture except face nose 3 750 7 500 Skull simple non depressed fracture except face nose 1 800 3 600 Hip thigh femur 3 150 6 300 Body of vertebrae excluding vertebral processes 2 700 5 400 Pelvis 2 400 4 800 Leg tibia and or fibula 1 800 3 600 Bones of the face or nose except mandible or maxilla 910 1 820 U pper jaw maxilla upper arm between 1 050 elbow and shoulder 2 100 Lower jaw mandible 1 200 2 400 Kneecap ankle foot 1 200 2 400 Shoulder blade collarbone 1 200 2 400 Vertebral processes 630 1 260 Forearm hand wrist 1 200 2 400 Rib 375 750 Coccyx 320 640 Finger toe 200 400 Chip fracture 25 of the applicable non surgical amount

Hospital admission 1 000 Per covered person per covered accident Hospital confinement 250 per day Up to 365 days per covered person per covered accident Hospital intensive care unit admission 1 750 Per covered person per covered accident Hospital intensive care unit confinement 400 per day Up to 15 days per covered person per covered accident Knee cartilage torn 750 Laceration no repair without stitches 50 Laceration repaired by stitches Total of all lacerations is less than two inches long 150 Total of all lacerations is at least two but less than six inches long 300 Total of all lacerations is six inches or longer 600 Lodging companion 200 per day Up to 30 days per covered person per covered accident Medical imaging study CT CAT scan EEG MR or MRI 200 One benefit per covered person per covered accident per calendar year Occupational or physical therapy 45 per day Up to 10 days per covered person per covered accident Pain management for epidural anesthesia 150 Prosthetic device artificial limb One benefit per covered person per covered accident One 1 250 More than one 2 500 Rehabilitation unit confinement 150 per day Immediately after a period of hospital confinement due to a covered accident up to 15 days per covered person per covered accident not to exceed 30 days per covered person per calendar year Ruptured disc with surgical repair 900 Surgery Cranial open abdominal and thoracic 1 500 Hernia with surgical repair 300 Surgery exploratory and arthroscopic 225 Tendon ligament rotator cuff One with surgical repair 900 Two or more with surgical repair 1 800 Transportation for hospital confinement 600 perroundtrip Up to three round trips for more than 50 miles from home per covered person per covered accident X ray 60 For more information talk with your benefits counselor GAC4000 PREFERRED PLAN

ColonialLife com THIS POLICY PROVIDES LIMITED BENEFITS EXCLUSIONS We will not pay any benefits for injuries received in accidents or for sicknesses which are caused by contributed to by or occur as a result of the covered person s Addiction to alcohol or drugs except for drugs taken as prescribed by his physician Treatment for dental care or dental procedures unless treatment is the result of a covered accident However treatment involving any bone or joint of the jaw face or head will be covered so long as the care or procedure is necessary to treat a condition which prevents normal functioning of the particular bone or joint involved and the condition is caused by congenital deformity disease or traumatic injury Undergoing elective procedures or cosmetic surgery This includes procedures or hospital confinement for complications arising from elective or cosmetic surgery This does not include congenital birth defects or anomalies of a child or reconstructive surgery related to a covered sickness or injuries received in a covered accident as long as the procedure is performed within 12 months from the date of the accident and while this coverage is in force This 12 month limitation does not apply to reconstructive surgery on bones or joints of the jaw face or head due to a covered accident Committing or attempting to commit a felony or engaging in an illegal occupation Having a disorder including but not limited to affective disorders neurosis anxiety stress and adjustment reactions Alzheimer s disease and other organic senile dementias are not considered mental or nervous disorders Dependent child s pregnancy including services rendered to her child after birth However complications of pregnancy of a dependent child will be covered to the same extent as any other covered sickness Complications of pregnancy are those conditions requiring treatment whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or caused by pregnancy These include but are not limited to acute nephritis nephrosis cardiac decompensation missed abortion miscarriage non elective Cesarean non elective abortion and similar medical and surgical conditions of comparable severity Complications of pregnancy do not include false labor morning sickness hyperemesis gravadarum and similar conditions associated with the management of a difficult pregnancy Committing or trying to commit suicide or his injuring himself intentionally whether he is sane or not Being exposed to war or any act of war declared or undeclared or serving in the armed forces of any country or authority Losses as a result of acts of terrorism or nuclear release committed by individuals or groups will not be excluded from coverage unless the covered person who suffered the loss committed the act of terrorism or nuclear release This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P NC Coverage may vary by state and may not be available in all states 2016 Colonial Life Accident Insurance Company Columbia SC Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand 7 16 101725 NC

Group Accident Insurance Health Screening Benefit This benefit can help pay for routine preventive tests and services For more information talk with your benefits counselor Health screening _50 00____________ Payable once per covered person per calendar year subject to a 30 day waiting period Blood test for triglycerides Bone marrow testing Breast ultrasound CA 15 3 blood test for breast cancer CA 125 blood test for ovarian cancer Carotid Doppler CEA blood test for colon cancer Chest X ray Colonoscopy Echocardiogram ECHO Electrocardiogram EKG ECG Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA blood test for prostate cancer Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy ColonialLife com HEALTH SAVINGS ACCOUNT HSA COMPATIBLE This 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 The covered person must incur a charge and the certificate must be in force for benefits to be payable This information is not intended to be a complete description of the insurance coverage available For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GACC1 0 P and certificate form GACC1 0 C plus state abbreviations where applicable such as GACC1 0 C TX Coverage may vary by state and may not be available in all states Premium at the effective date will vary according to family coverage type and benefit amount selected Underwritten by Colonial Life Accident Insurance Company Columbia SC 2018 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GAC4000 HEALTH SCREENING 3 18 101865

ColonialLife com HEALTH SAVINGS ACCOUNT HSA COMPATIBLE This 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 CERTIFICATE PROVIDES LIMITED BENEFITS EXCLUSIONS We will not pay benefits for losses that are caused by contributed to by or occur as the result of a covered persons felonies or illegal occupations hazardous avocations racing semi professional or professional sports sickness suicide or injuries which any covered person intentionally does to himself war or armed conflict In addition we will not pay Catastrophic Accident benefits for injuries a child received during birth or for injuries that are the result of being intoxicated or under the influence of any narcotics This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GACC1 0 P and certificate form GACC1 0 C plus state abbreviations where applicable such as GACC1 0 P EE TX and certificate form GACC1 0 C EE TX Coverage may vary by state and may not be available in all states Premium at the effective date will vary according to the family coverage type Underwritten by Colonial Life Accident Insurance Company Columbia SC 2018 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 4 18 101862

Deductions per year 24 Catawba Valley Healthcare Rates per 24 pay periods Group Medical Bridge GMB7000 for NC Composite Applicable to Policy Forms GMB7000 P GMB7000 C l Wellbeing Assistance Standard 100 Outpatient Surgical Procedure Option 2 750 1500 2500 Diagnostic Procedure Option 1 250 Medical Treatment Package Accident Sickness Observation Room Rehabilitation Unit Confinement Daily Hospital Confinement HOSPITAL CONFINEMENT LEVEL ISSUE AGE Level 3 1500 17 99 NAMED INSURED 24 18 EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY 50 92 36 00 62 73 HOSPITAL CONFINEMENT LEVEL ISSUE AGE Level 4 2000 17 99 NAMED INSURED 26 91 EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY 56 80 39 72 69 60 Group Accident for NC l On Off Job Accident Coverage Health Screening Benefit 50 Benefit Preferred ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE 17 99 8 77 14 32 Applicable to policy forms GACC1 0 P GACC1 0 C ONE PARENT FAMILY 15 58 TWO PARENT FAMILY 21 14 Group Critical Illness GCI6000 for NC l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 50 Benefit Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD Non 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 69 70 74 NAMED INSURED 3 45 4 30 5 20 7 20 9 20 12 50 15 75 20 25 27 10 32 90 32 90 NAMED INSURED AND SPOUSE 5 10 6 40 7 70 10 75 13 75 18 85 23 95 30 80 41 20 50 10 50 10 NAMED INSURED AND DEPENDENT CHILD REN 3 45 4 30 5 20 7 20 9 20 12 50 15 75 20 25 27 10 32 90 32 90 NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 5 10 6 40 7 70 10 75 13 75 18 85 23 95 30 80 41 20 50 10 50 10 Page 1 of 2 Underwritten by Colonial Life Accident Insurance Company See page 2 for Important Notice

Continued Group Critical Illness GCI6000 for NC l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 50 Benefit Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD 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 69 70 74 NAMED INSURED 4 65 6 05 7 45 10 65 13 85 19 10 24 30 31 50 42 45 51 75 51 75 NAMED INSURED AND SPOUSE 6 80 8 90 11 00 15 80 20 65 28 80 36 95 47 95 64 60 78 75 78 75 NAMED INSURED AND DEPENDENT CHILD REN 4 65 6 05 7 45 10 65 13 85 19 10 24 30 31 50 42 45 51 75 51 80 NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 6 80 8 90 11 00 15 80 20 65 28 80 36 95 47 95 64 60 78 75 78 80 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 2023 Colonial Life Accident Insurance Company Colonial Life and the Colonial Life logo separately and in combination are service marks of Colonial Life Accident Insurance Company All rights reserved Kitty Mellone Kmellone coloniallifenc com 704 907 3944 Page 2 of 2 Underwritten by Colonial Life Accident Insurance Company See page 2 for Important Notice

Catawba Valley Healthcare Colonial Interest Form Name________________________________________________________ Social Security _________________ Address________________________________ City ___________________St __________Zip_______ Work Phone___________________ Cell Phone________________ Email Address____________________________________________________ Date of Birth DOB ________________ Tobacco______ Non Tobacco_____ Date of Hire____________________ Beneficiary__________________________________DOB___________Relationship____________ Dependent Information Spouse________________________________DOB_______________ Relationship____________ Child_________________________________DOB________________Relationship____________ Child_________________________________DOB________________Relationship____________ Child_________________________________DOB________________Relationship____________ ____ Waive Colonial Coverage I understand that I can only enroll during Annual Enrollment unless I have a qualified event during the year Signature__________________________________________Date____________ Questions or Assistance Contact Kitty Mellone 704 907 3944 D Email Kmellone coloniallifenc com Fax Completed Form with Rate Sheet elected coverage s circled fax to 704 895 9779 FAX

Policyholder Service Guide At Colonial Life our goal is to give you an excellent customer experience that is simple modern and personal Getting started Consider your options The easiest way to manage your business with us is through the My Colonial Life policyholder section of ColonialLife com Whether online or by phone we ll provide the service you need To sign up for the website 1 Visit ColonialLife com 2 Click Register at the top right 3 On the sign up page click Join the Policyholder Website Need ColonialLife com Submit your claim using our eClaims system 3 File health screening wellness and doctor s office visit claims up to 18 months 3 3 Check the status of your claim 3 3 Review print or download a copy of your policy certificate 3 Access claim and service forms 3 3 Access your claim correspondence 3 3 3 Complete a notification for a life claim 3 3 Update your contact information After providing some basic information you ll be ready to go 800 325 4368 Filing claims eClaims With the eClaims feature on ColonialLife com you can file claims online by simply answering a few questions and uploading your supporting documentation You re able to spend less time on paperwork and we re able to process your claim faster With eClaims you can file most claims online including Accident Hospital confinement indemnity Disability Critical illness Cancer Vision You can access eClaims through your computer or mobile device and upload any required supporting documentation Once you re logged in to ColonialLife com visit the Claims Center and select File an Online Claim to get started

Contact us Online ColonialLife com Log in and click on Contact Us to email us Telephone 1 800 325 4368 Contact Center representatives are available Monday through Friday 8 a m to 8 p m ET Information is available 24 7 through our automated phone system Please have your Social Security or policy number ready when you call Hearing impaired customers Customers with a Telecommunications Device for the Deaf TDD should call 803 798 4040 If you do not have a TDD call Voiance Telephone Interpretation Services at 844 495 6105 to reach us Health screening wellness claims The quickest way to receive the applicable benefits for your health screening wellness services is to file online For health screening wellness claims within 18 months of the date you are filing the claim click on File a Wellness Claim Online on the Claims Center page If you do not want to file online you can use the automated customer service center at 1 800 325 4368 For health screening wellness claims over 18 months you ll be directed to print out a paper claim form under the claims and service forms section on the Claims Center page Paper claims If you don t want to file online download the form you need by visiting the Claims Center page on ColonialLife com and clicking on claims and service forms For instructions on how to correctly complete your claim form view the claims videos on the Claims Center page Be sure that you complete all sections of the claim form Also include a diagnosis from your doctor along with copies of any appropriate bills if required Keep a copy of your claim information for your records When we receive information regarding your claim you ll be notified by telephone or email If you select the electronic messaging option you ll receive a call when the claim is processed Claim tips and information When submitting your claim make sure to include all required supporting documentation as this will allow us to process your claim quicker To view correspondence pertaining to your claim visit ColonialLife com Once you log in to your secure account select My Correspondence from the home page Whether you submit your claims online or by paper form you can select optional services that authorize us to Communicate claims information via electronic messaging to your phone number Send claim benefits overnight by deducting a fee from your claim payment Release information to your benefits representative plan administrator or family member You can always check the status of your claim on the My Colonial Life site at ColonialLife com ColonialLife com Applicable to vision rider on the individual dental plan 2016 Colonial Life Accident Insurance Company Columbia SC Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand 4 16 43233 37