Return to flip book view

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 For more information Shelley Hartsell 704 883 4838 Shelley Hartsell ColonialLifeSales com Life is anything but expected That s why we re here Plan options Accident insurance Helps offset unexpected medical expenses such as emergency room fees deductibles and copayments that can result from a fracture dislocation or other covered accidental injury Hospital insurance Provides a lump sum benefit for a covered hospital confinement or outpatient surgery to help with co payments and deductibles that are not covered by most major medical plans Critical illness Cancer Supplements your major medical coverage by providing a lump sum benefit you can use to pay the direct and indirect costs related to a covered critical illness and cancer Disability Provides financial protection to cover income loss from a covered disability Dental Vision Annual cleanings x rays basic and comprehensive services Life insurance Enables you to tailor coverage for your individual needs and helps provide financial security for your family members

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

For more information, talk with your benefits counselor.Hospital Confinement Indemnity InsurancePlan 1THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONS We will not pay benefits for injuries received in accidents or for sicknesses which are caused by: (a) alcoholism or drug addiction, (b) dental procedures, (c) elective procedures and cosmetic surgery, (d) felonies or illegal occupations, (e) pregnancy of a dependent child, (f) psychiatric or psychological conditions, (g) suicide or injuries which any covered person intentionally does to himself or herself, or (h) war. We will not pay benefits for hospital confinement (i) due to giving birth within the first nine months aer the eective date of the policy or (j) for a newborn who is neither injured nor sick. (k) The policy may have additional exclusions and limitations which may aect any benefits payable.PRE-EXISTING CONDITION LIMITATION(l) We will not pay benefits for loss during the first 12 months aer the eective date due to a pre-existing condition. (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 the 12 months before the eective date of the policy. (n) This limitation applies to the following benefits, if applicable: Hospital Confinement, Daily Hospital Confinement, Enhanced Intensive Care Unit Confinement and Rehabilitation Unit Confinement.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 policy has exclusions and limitations which may aect any benefits payable. Applicable to policy form IMB7000 (including state abbreviations where used, for example: IMB7000-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 form #562973.IMB7000 – PLAN 1 | 1-21 | 562880ColonialLife.comOur Individual Medical BridgeSM insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement ..................................................................... $__________________Maximum of one benefit per covered person per calendar yearObservation room .................................................................................. $100 per visitMaximum of two visits per covered person per calendar yearRehabilitation unit confinement .................................................................$100 per dayMaximum of 15 days per confinement with a 30-day maximum per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered hospital confinement of the named insuredHealth savings account (HSA) compatibleThis plan is compatible with HSA guidelines. This plan may also be oered to employees who do not have HSAs.Colonial Life & Accident Insurance Company’s Individual Medical Bridge oers an HSA-compatible plan in most states.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.1500ICU.....................................................................................................$500 per day

Hospital Confinement Indemnity InsuranceExclusions and LimitationsSTATE-SPECIFIC EXCLUSIONSAK: (a) Replaced by intoxicants and narcotics CA: (a) Replaced by intoxicants or controlled substances; (c) Replaced by cosmetic surgeryCT: (a) Replaced by intoxication or drug addiction; (d) Replaced by felonies; (e) Exclusion does not applyDE: (a) Exclusion does not applyIL: (a) Replaced by alcoholism, intoxication, or drug addiction; (e) Exclusion does not apply; (g) Exclusion does not applyKS: (a) Replaced by intoxicants and narcotics; (f) Exclusion does not apply; (h) Replaced by war or armed conflict; (i) Exclusion does not apply; (j) or requires necessary care and treatment of medically diagnosed congenital defects, birth abnormalities or routine and necessary immunizationsKY: (a) Replaced by intoxicants, narcotics and hallucinogenics LA: (a) Replaced by intoxicants and narcoticsMI: (g) Exclusion does not applyMN: (a) Replaced by narcotic addiction; (e) Exclusion does not apply; (g) Exclusion does not applyMO: (a) Replaced by drug addictionNC: (i) Exclusion does not applyOR: (a) Exclusion does not apply; (d) Replaced by felony; (i) Replace “nine months” with “six months”SC: (f) Replaced by mental or emotional disordersSD: (a) Exclusion does not applyTN: (a) Replaced by intoxicants and narcotics; (e) Exclusion does not applyTX: (a) Replaced by intoxicants and narcotics WA: (a) Only sicknesses caused by alcoholism or drug addiction are excluded, not accidentsSTATE-SPECIFIC PRE-EXISTING CONDITION LIMITATIONSNV, WY: (m) applies within the six months before the policy eective date.CT: (m) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, received medical advice or had taken medication within 12 months before the eective date of this policy.FL: (m) Pre-existing Condition means any covered person having a sickness or physical condition that during the 12 months immediately preceding the eective date of this policy had manifested itself in such a manner as would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment or for which medical advice, diagnosis, care, or treatment was recommended or received.Routine follow-up care during the 12 months immediately preceding the eective date of this policy to determine whether a breast cancer has recurred in a covered person who has been previously determined to be free of breast cancer does not constitute medical advice, diagnosis, care, or treatment for purposes of determining pre-existing conditions, unless evidence of breast cancer is found during or as a result of the follow-up care.GA: (m) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken prescription medication within 12 months before the e ective date of this policy.IL: (m) Pre-existing Condition means having a sickness or physical condition for which any covered person was diagnosed, treated, had medical testing by a legally qualified physician, or received medical advice or had taken medication within 12 months prior to the e ective date of this policy.ME: (m) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, or received medical advice within 12 months before the eective date of this policy.NC: (m) Pre-existing Condition means having those conditions whether diagnosed or not, for which any covered person received medical advice, diagnosis, care or treatment was received or recommended within one-year period immediately preceding the eective date of this policy.If you are 65 or older when this policy is issued, pre-existing conditions will include only conditions specifically eliminated by rider.OR: Pre-existing Condition means having a sickness or physical condition for which any covered person was diagnosed, received treatment, care or medical advice within the 6-month period immediately preceding the eective date of this policy.Insureds in California, Oregon, and South Dakota must be covered by comprehensive health insurance before applying for hospital indemnity insurance.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form IMB7000 (including state abbreviations where used, for example: IMB7000-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 562880, 562911, or 562942.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.IMB7000 – EXCLUSIONS AND LIMITATIONS | 3-22 | 562973-1

For more information, talk with your benefits counselor.Dental InsurancePlan 4 – $2,000, 100% | 80% | 50% IDN8000 – PLAN 4Dental insurance from Colonial Life can help preserve your smile with easy-to-use coverage that promotes overall wellness. Benefits can help with a variety of dental costs, from routine cleanings to more advanced procedures. Coverage is available for you, your spouse and dependent children.Plan detailsThe benefit year maximum for this plan is $2,000 per person.Class A, B and C services apply toward the benefit year maximum.This plan has a deductible of $50 per person. Families only pay the deductible for a maximum of three people. Applies only to class B and C services.The co-insurance for this plan is:ColonialLife.comCLASS TYPE OF SERVICE INSURANCE PAYSClass A Preventive services 100%Class B Basic services 80%Class C Major services 50%See reverse for covered procedures and waiting periods.NetworkOur national dental network oers more than 323,000 access points.1 Members may choose any dentist but may receive additional savings by choosing an in-network dentist. Plus, services not covered by this plan may also still be eligible for in-network savings.2 Out-of-network benefits are paid at the network negotiated rate.3To locate a participating dentist, access the provider search at ColonialLifeDental.com.

Covered procedures and waiting periodsColonialLife.comPreventive services (Class A): No waiting period  Routine exams and cleanings (twice every 12 months) – One additional cleaning per 12 months if member is in second or third trimester of pregnancy4  X-rays – Bitewing x-rays (up to four films; once every 12 months) – Full mouth/panoramic x-rays (once every five years)  Children’s services (up to age 14) – Fluoride treatment (once every 12 months) – Sealants (once every 36 months) – Space maintainers (up to age 14; once every 24 months)  Adjunctive pre-diagnostic oral cancer screening (for age 40 or older; once every 12 months)Basic services (Class B): No waiting period  Simple restorative services (fillings)  Simple extractions  Emergency treatment  Repair of crown, denture or bridgeMajor services (Class C): 12-month waiting period  Oral surgery (extractions and impacted teeth)  Anesthesia (subject to review; covered with complex oral surgery)  Periodontics (gum treatments)  Endodontics (root canals)  Inlays and onlays  Crowns  Bridges  Dentures  Endosteal implants (in lieu of an approved three-unit bridge)1 Internal data (2017). Access points are sites where network dentists see patients. Some dentists may be available at more than one access point.2 Not an insured benefit. 3 If you visit an out-of-network dentist, you may be billed for remaining amounts over the benefit amount paid, up to the billed charge. 4 Member may have one additional periodontal maintenance in lieu of an additional cleaning. Periodontal maintenance is a major service and subject to a 12-month waiting period.The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may aect any benefits payable. See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability.11-18 | 101839-2Dental plans are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC, and administered by Starmount Life Insurance Company. ©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

Dental PPO InsurancePlan 5 – $1,500 | 100% | 80% | 50%Life is full of unexpected smiles, and good oral health helps maintain them. Colonial Life dental insurance helps you pay for routine and costly dental care for you and your family, so you can focus on what’s important. Policy detailsThe policy year maximum benet for this policy is $1,500 per person. Class A, B and C services apply toward the maximum.This policy has a deductible of $50 per person, per policy year for class B and C services. Each covered family member pays a deductible up to a maximum of three members each policy year.The coinsurance for this policy is:CLASS TYPE OF SERVICE INSURANCE PAYSClass A Preventive services 100% Class B Basic services 80%Class C Major services 50%Large national network• Save more with 120,000+ unique providers¹• Claims led for members by providers• Easy provider search on ColonialLifeDental.com• In-house recruiting team dedicated to expanding the networkHow does this policy pay benets for network and out-of-network care?Network benetsNetwork providers have agreed to charge discounted rates for covered services. You receive the benet of discounted services, and pay only your coinsurance portion and any applicable deductible. Plus, network providers will le your claim for you, so you don’t have to deal with the paperwork. Out-of-network benetsOut-of-network providers haven’t agreed to discounted rates, and their fees may vary signicantly. Your policy’s coinsurance is applied to the lesser of the provider’s charge or a percentage of the customary charge in your area (90th percentile), and may not cover the total costs of dental care. You are responsible for your coinsurance portion, deductible and any remaining balance. IDN8000 — Plan 5

Covered procedures and waiting periodsPreventive services (Class A): no waiting period• Routine exams and cleanings (twice every 12 months) ‐ One additional cleaning per 12 months if member is in second or third trimester of pregnancy2• X-rays ‐ Bitewing X-rays (up to four lms, once every 12 months)• Children’s services (up to age 14) ‐ Fluoride treatment (once every 12 months) ‐ Sealants (once every 36 months) ‐ Space maintainers (up to age 14, once every 24 months)• Oral cancer screening (for age 40+, once every 12 months)• Virtual dental visits through TeleDentistry.com3Basic services (Class B): no waiting period• Full mouth/panoramic X-rays (once every ve years)• Fillings• Simple extractions• Emergency treatmentMajor services (Class C): 12-month waiting period4,5• Oral surgery (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• Endosteal implants (in place of a three-unit bridge)Missing Tooth Exclusion: No benets will be paid for replacement of teeth missing prior to the effective date of coverage.Virtual Dental Visits through TeleDentistry.com24/7 dental care for dental emergencies when an in-person visit is not an option.A virtual dental visit can:• Evaluate the patient’s symptoms (jaw pain, chipped or broken tooth, sensitivity)• Identify needs and determine if emergency treatment is required• Write prescriptions for antibiotics or pain relief if appropriate6Visit ColonialLifeDental.com and click Virtual Dental Visits or call (866) 256-2261 to get started.For more information about this dental policy, talk with your benets counselor.1. Network360, December 2021.2. Member may have one additional periodontal maintenance in place of an additional cleaning.3. Terms and availability of service from TeleDentistry.com are subject to change. Services are not valid after policy terminates.4. Waiting periods may be waived if takeover applies. 5. No waiting period in Maine. Six-month waiting period in Vermont.6. TeleDentistry.com dentists do not prescribe controlled substances or prescribe outside of the United States.THIS POLICY PROVIDES LIMITED BENEFITS. A NETWORK ACCESS PLAN IS AVAILABLE.This policy is not available in ZIP codes beginning with 025. For California: Summary of Dental Benets and Coverage Disclosure (SDBC) is available at www.ColonialLifeDental.com.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 benets payable. Applicable to policy form IDN8000 (including state abbreviations where used, for example: IDN8000-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 10-22 | 101840-6ColonialLifeDental.com

Dental PPO InsuranceVision RiderLife is full of unexpected moments, and healthy vision can help you see them all. 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.VISION BENEFITS IN-NETWORK OUT-OF-NETWORKCO-PAYSExam (once per 12 months) $10 co-pay $35 allowanceMaterials $25 co-pay See belowSTANDARD PLASTIC LENSES (once per 12 months)Single vision Covered by co-pay $25 allowanceBifocal Covered by co-pay $40 allowanceTrifocal Covered by co-pay $50 allowanceLenticular $80 allowance $50 allowanceProgressive $70 allowance $40 allowancePolycarbonate lenses (for dependents to age 19) Covered by co-pay N/AFRAMES (once per 12 months)Choose any frame available at provider locations$120 allowance $50 allowanceCONTACT LENSES (once per 12 months; in lieu of eyeglass lenses and frames)Benet includes materials, t and follow-up. Provider may charge t separately, leaving entire allowance for materials.Elective $120 allowance $100 allowanceMedically necessary $210 allowance $210 allowanceVISION NETWORK — MAXIMIZE YOUR BENEFITSYou can maximize your vision benets with any provider in our large, nationwide network. Our network includes independent optometrists and ophthalmologists, as well as retail stores such as:• Walmart and Sam’s Club Optical • Target Optical • Pearle Vision • Visionworks • Costco1 You can choose different providers to use your benets for eye exams and eyeglasses or contact lenses. IDN8000 - VISION RIDER FIND A PROVIDER OR REFER A PROVIDERFind a network provider near you on our Vision Provider Directory at ColonialLifeVision.com. If your preferred provider isn’t in our network, you can send their contact information to referaprovider@ColonialLife.com, and one of our network recruiters will reach out to them.

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 benets payable. Applicable to policy forms IDN8000-AK-17 and IDN8000-NC and rider forms R-VSN8000-AK-17 and R-VSN8000-NC. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 11-21 | 101851-2-AK-NC1. Optometrists at Costco Optical outlets are independent of Costco and may not be in network. Special payment and reimbursement terms apply for material purchases at Costco. Additional discounts are not applicable. 2. 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 numerous 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.ColonialLifeVision.comSPECIAL SAVINGS ON MATERIAL PURCHASES2Some 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 ColonialLifeVision.com. VALUE-ADDED PROVIDERSSPECIAL PRICING AND DISCOUNTS ON LENS OPTIONS FOR FIRST PAIR OF GLASSES (ADD-ONS FOR INSURED PURCHASES)SPECIAL PRICING AND DISCOUNTS ON PURCHASE OF SECOND PAIR OF GLASSES DISCOUNTS ON FRAMES, CONTACT LENSES AND OTHER PRODUCTSSERVICE PLUS PROVIDERSRECEIVE UP TO A 20% DISCOUNT FOR THE FOLLOWING ADD-ONS TO INSURED PURCHASES• UV Coating .............................. $15• Solid tinting/gradient tinting ... $15• Standard scratch-resistant coating ................................... $15• Standard antireective coating ...................................$45• Premium antireective coating ...................................$70• Ultra-antireective 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 • Single vision plastic lenses .....$40• Bifocal plastic lenses .............. $60• Trifocal lenses ........................ $70• Progressive lenses (standard) .............................. $110• Progressive lenses (premium and ultra) ................. 20% discount • 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• UV Coating• Solid tinting/gradient tinting• Standard scratch-resistant coating• Standard antireective coating• Premium antireective coating• Transition lenses• Standard polycarbonate lensesNote: Not a covered benet. Prices shown reect member payment. Discounts reect percentage off the regular price.For more information about our vision coverage, talk with your benets counselor.

Specified Critical Illness Insurance 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 ___1_0_k_ _2_0_k_ _3_0_k__ Critical illness benefit FOR THE DIAGNOSIS OF THIS COVERED CRITICAL ILLNESS CONDITION THIS PERCENTAGE OF THE FACE AMOUNT IS PAYABLE Cancer 100 Heart attack myocardial infarction 100 Stroke2 100 End stage renal kidney failure 100 Major organ failure 100 Permanent paralysis due to a covered accident 100 Coma 100 Blindness 100 Occupational infectious HIV or occupational infectious hepatitis B C or D 100 Coronary artery bypass graft surgery disease3 25 Carcinoma in situ 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 CRITICAL ILLNESS 1 0 WITH CANCER AND SUBSEQUENT DIAGNOSIS

Specified Critical Illness Insurance Exclusions limitations and additional disclosures State specific variations on exclusions AK Alcoholism or Drug Addiction Exclusion does not apply CT Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction Felonies or Illegal Occupations replaced with Felonies DE Alcoholism or Drug Addiction Exclusion does not apply FL Alcoholism or Drug Addiction Exclusion does not apply Psychiatric or Psychological Condition Exclusion does not apply ID Alcoholism or Drug Addiction Exclusion does not apply Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional Disorders IN Accidents or Sicknesses Occurring While the Policy is not In Force Exclusion added KY Alcoholism or Drug Addiction Exclusion does not apply Hallucinogenics added to Intoxicants and Narcotics Exclusion MD Alcoholism or Drug Addiction Exclusion does not apply Felonies or Illegal Occupations Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Suicide or Self Inflicted Injuries Exclusion replaced with Self Destruction or Self Inflicted Injuries MO Alcoholism or Drug Addiction Exclusion replaced with Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Illegal Activities NH Intoxicants and Narcotics exclusion does not apply NJ Alcoholism or Drug Addiction replaced with Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional Disease or Disorder OR Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Suicide or Self Inflicted Injuries Exclusion does not apply Felonies or Illegal Occupations Exclusion replaced with Felonies SC Alcoholism or Drug Addiction Exclusion does not apply Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional Disorders 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 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 Psychiatric or Psychological Condition Exclusion does not apply War or Armed Conflict Exclusion replaced with War State specific pre existing condition limitations FL 12 12 Pre existing Condition means having a sickness or physical condition that during the 12 months immediately preceding the Policy Coverage Effective Date of this policy had manifested itself in such a manner as would cause an ordinarily prudent person to seek medical advice diagnosis care or treatment or for which medical advice diagnosis care or treatment was recommended or received IA 12 12 Pre existing Condition means having a condition for which medical advice or treatment or medication was recommended by a physician or received from a physician within 12 months preceding the Policy Coverage Effective Date of the covered person s policy MD 12 12 Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken medication within 12 months before the Policy Coverage Effective Date of this policy A condition admitted or disclosed on the application will be covered unless the disease or condition is excluded by name or specific description effective on the date of loss NC 12 12 Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken medication within 12 months before the Policy Coverage Effective Date of this policy If a covered person is 65 or older when this policy is issued pre existing conditions for that covered person will include only conditions specifically eliminated by rider NH 6 6 Pre existing condition means having a sickness or physical condition for which any covered person was diagnosed treated had medical testing or received medical advice within 6 months before the Policy Coverage Effective Date of this policy NJ 6 6 Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken medication within six months before the Policy Coverage Effective Date of this policy NV 6 12 Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken medication within six months before the Policy Coverage Effective Date of this policy

Critical Illness Insurance Health Screening Benefit The optional health screening benefit can help you reduce the risk of serious illness through early detection Health screening benefit __50 00_____________ Maximum of one screening test per covered person per calendar year Blood test for triglycerides Pap smear Bone marrow testing PSA blood test for prostate cancer Breast ultrasound Serum cholesterol test for HDL and LDL levels CA 15 3 blood test for breast cancer CA 125 blood test for ovarian cancer Carotid Doppler CEA blood test for colon cancer Chest X ray Colonoscopy Echocardiogram ECHO Electrocardiogram EKG ECG For more information talk with your benefits counselor Fasting blood glucose test Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy Flexible sigmoidoscopy Hemoccult stool analysis Mammography ColonialLife com THIS POLICY INSURANCE PROVIDES LIMITED BENEFITS Insureds in GA MA MN and VT must be covered by comprehensive health insurance before applying for critical illness or cancer insurance This information is not intended to be a complete description of the insurance coverage available The policy insurance or its provisions may vary or be unavailable in some states The policy insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form CI 1 0 P and GCC1 0 P and certificate form GCC1 0 C including state abbreviations where used for example CI 1 0 P TX GCC1 0 P TX and GCC1 0 C TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company Underwritten by Colonial Life Accident Insurance Company Columbia SC 2021 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GROUP CRITICAL CARE CRITICAL ILLNESS 1 0 HEALTH SCREENING BENEFIT 5 21 100355 4

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

WHOLE LIFE Accelerated Death Benefit for Long Term Care Services Advances the base plan s death benefit in monthly indemnity payments to help pay for the qualified long term care services needed as a result of the insured s inability to perform at least two of the six activities of daily living ADLs for a period of at least 90 days or the insured s requiring substantial supervision due to severe cognitive impairment A written certification provided by a licensed health care practitioner must be provided The maximum benefit amount is equal to the policy death benefit less any indebtedness Claim payments are made monthly and are a percentage of the death benefit Rates are per thousand tobacco distinct and based on policy face amount and issue age The rider terminates on the first to occur base policy terminates or the date the death benefit is exhausted from long term care benefit payments A 90 day elimination period applies No benefits are payable for care or service received during this time There is a six month pre existing conditions limitation period The rider includes a built in Waiver of Premium due to payments of the long term care benefit which waives any monthly deductions on the policy when long term care benefits are being paid The rider may be added to employee or spouse Whole Life Plus plans It may also be added to a dependent student policy ages 18 26 It may only be added to policies at the point of initial sale The rider cannot be added to existing policies

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 Shelley Hartsell Benefits Specialist 704 883 4838 Shelley Hartsell ColonialLifeSales com