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CharlotteJewishPreschoolBenefitBooklet

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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 copayments and deductibles that are not covered by most major medical plans Disability insurance Helps replace a portion of your income to help make ends meet if you become disabled from a covered accident or covered sickness Critical illness Cancer insurance 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 Life insurance Enables you to tailor coverage for your individual needs and helps provide financial security for your family members

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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

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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

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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

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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

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For more information talk with your benefits counselor ColonialLife com Hospital Confinement Indemnity Insurance Plan 1 Our Individual Medical Bridge 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 __2_5_0__0____________ Maximum of one benefit per covered person per calendar year Observation room 100 per visit Maximum of two visits per covered person per calendar year Rehabilitation unit confinement 100 per day Maximum of 15 days per confinement with a 30 day maximum per covered person per calendar year Waiver of premium Available a er 30 continuous days of a covered hospital confinement of the named insured Health savings account HSA compatible This plan is compatible with HSA guidelines This plan may also be o ered to employees who do not have HSAs Colonial Life Individual Medical Bridge o ers an HSA compatible plan in most states THIS POLICY PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this coverage EXCLUSIONS 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 preexisting 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 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 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 Underwritten by Colonial Life Accident Insurance Company Columbia SC 2023 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company IMB7000 PLAN 1 8 23 562880 1

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For more information talk with your benefits counselor Hospital Confinement Indemnity Insurance Plan 2 Our Individual Medical Bridge 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 __1_5__0_0_________ Maximum of one benefit per covered person per calendar year Observation room 100 per visit Maximum of two visits per covered person per calendar year Rehabilitation unit confinement 100 per day Maximum of 15 days per confinement with a 30 day maximum per covered person per calendar year Waiver of premium Available a er 30 continuous days of a covered hospital confinement of the named insured Outpatient surgical procedure Tier 1 ____5_0__0________ Tier 2 ____7_5__0________ Maximum of _1__5_0_0___________ per covered person per calendar year for all covered outpatient surgical procedures combined The surgeries listed below are only a sampling of the surgeries that may be covered Surgeries must be performed by a doctor in a hospital or ambulatory surgical center For complete details and definitions please refer to your policy 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 gra ing IMB7000 PLAN 2

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Tier 2 outpatient surgical procedures Breast Breast reconstruction Breast reduction Cardiac Angioplasty Cardiac catheterization Digestive Exploratory laparoscopy Laparoscopic appendectomy Laparoscopic cholecystectomy Ear nose throat mouth Ethmoidectomy Mastoidectomy Septoplasty Stapedectomy Tympanoplasty Eye Cataract surgery Corneal surgery penetrating keratoplasty Glaucoma surgery trabeculectomy Vitrectomy Gynecological Hysterectomy Myomectomy Musculoskeletal system Arthroscopic knee surgery with meniscectomy knee cartilage repair Arthroscopic shoulder surgery Clavicle resection Dislocations open reduction with internal fixation Fracture open reduction with internal fixation Removal or implantation of cartilage Tendon ligament repair Thyroid Excision of a mass Urologic Lithotripsy ColonialLife com THIS POLICY PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this coverage EXCLUSIONS 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 preexisting 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 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 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 Underwritten by Colonial Life Accident Insurance Company Columbia SC 2023 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 8 23 562911 1

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

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Disability Insurance Worksheet You can tailor disability coverage to fit your specific needs Talk with your benefits counselor about your expenses and other paid leave benefits such as state paid medical leave to help determine the coverage that s right for you 4 MONTHLY EXPENSES Rent or mortgage insurance minor home repairs Transportation car note bus fare insurance gas maintenance Utilities cell phone Wi Fi electricity gas water Food and household necessities toiletries cleaning supplies Childcare daycare after school care Health medical needs and prescription drugs Other gym fitness streaming cable extracurricular Total monthly expenses add lines 1 7 together ROUND TO THE NEAREST HUNDRED Your state s paid medical leave approximate benefits if any Monthly benefit _____________ Benefit period up to _____________ Talk with your Colonial Life benefits counselor to learn more about disability insurance ColonialLife com 1 Social Security Administration SSI Annual Statistical Report 2021 2 Bankrate Bankrate s 2023 annual emergency savings report 2023 3 Social Security Administration Disability and Death Probability Tables for Insured Workers 2022 4 State paid medical leave PML benefits fall under state specific program names For example in New Jersey it may be referred to as Temporary Disability Insurance TDI Not available in all states For policies issued or delivered in the Commonwealth of Virginia THIS IS AN EXCEPTED BENEFITS POLICY IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy forms ISTD3000 and rider form ISTD3000 ADIB including state abbreviations where used for example ISTD3000 TX and ISTD3000 ADIB TX policy form DIS1000 including state abbreviations where used for example DIS1000 TX policy form ED DIS 1 0 including state abbreviations where used for example ED DIS 1 0 TX policy form ICC21 DIP3000 and rider form ICC21 DIP3000 R DIS policy form GDIS P and certificate form GDIS C including state abbreviations where used for example GDIS P EE TX and GDIS C EE TX and policy form VSTDMP and certificate form VSTDC including state abbreviations where used for example VSTDMP TX and VSTDC TX Not applicable in Oregon for policy form ICC21 DIP3000 and rider form ICC21 DIP3000 R DIS For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company An insurance producer may contact you Underwritten by Colonial Life Accident Insurance Company Columbia SC 2023 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company FOR EMPLOYEES 6 23 101165 10

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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

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Subsequent diagnosis of a different critical illness4 If you receive a benefit for a specified critical illness and later you are diagnosed with a different specified critical illness the original percentage of the face amount is payable for that particular specified critical illness For more information talk with your Colonial Life benefits counselor Subsequent diagnosis of the same critical illness4 If you receive a benefit for a specified critical illness and later you are diagnosed with the same specified critical illness 25 of the original face amount is payable Critical illness conditions that do not qualify are cancer coronary artery bypass graft surgery disease carcinoma in situ and occupational infectious HIV or occupational infectious hepatitis B C or D Cancer vaccine benefit 50 This benefit is payable if you or your covered family members incur a charge for any FDA approved cancer vaccine while your policy is inforce ColonialLife com Specified Critical Illness Insurance and Critical Illness 1 0 are marketing names of the insurance policy filed as Limited Benefit Health Coverage for Specified Critical Illness In ME and NH the policy is called Limited Benefit Health Coverage for Specified Disease In SC the policy is an Individual Specified Disease policy In VT the policy is an Individual Limited Benefit Insurance policy 1 Please refer to the policy for complete definitions of covered conditions 2 In NH Stroke is referred to as Severe Stroke 3 Benefit for coronary artery disease applicable in lieu of benefit for coronary artery bypass graft surgery when health savings account HSA compliant plan is selected 4 Dates of diagnoses of a covered specified critical illness must be separated by at least 180 days THIS POLICY PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this insurance EXCLUSIONS AND LIMITATIONS FOR SPECIFIED CRITICAL ILLNESS We will not pay benefits for a specified critical illness that occurs as a result of a covered person s alcoholism or drug addiction felonies or illegal occupations intoxicants and narcotics pre existing condition psychiatric or psychological condition suicide or self inflicted injuries or war or armed conflict This information is not intended to be a complete description of the insurance coverage available The policy or its provisions may vary or be unavailable in some states The policy has exclusions and limitations which may affect any benefits payable Applicable to policy form CI 1 0 CI 1 0 PL7 CI 1 0 PL8 or CI 1 0 PL10 including state abbreviations where used for example CI 1 0 TX 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 2023 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company FOR EMPLOYEES 5 23 101825 4

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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

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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

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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

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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

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CHARLOTTE JEWISH PRESCHOOL Deductions per year 26 Accident 1 0 for NC l On Off Job Accident Coverage Premier with health screening These rates were prepared on 10 11 2023 and are valid for 90 days Applicable to policy forms ACCIDENT 1 0 HS and ACCIDENT 1 0 NS ISSUE AGE 17 80 NAMED INSURED 12 24 EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY 16 76 18 32 22 85 Individual Medical Bridge for NC l 2500 Hospital Confinement Benefit 50 Health Screening Benefit ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE 17 49 50 59 60 64 65 75 16 29 22 08 29 70 43 11 30 67 41 77 56 17 81 48 Applicable to policy form Individual Medical Bridge EMPLOYEE AND DEPENDENT CHILDREN 22 29 28 08 35 70 49 71 EMPLOYEE SPOUSE AND DEPENDENT CHILDREN 36 67 47 77 62 17 88 08 Individual Medical Bridge for NC Applicable to policy form Individual Medical Bridge l 1500 Hospital Confinement Benefit and Outpatient Surgical Procedure Benefit with a calendar year maximum of 1500 50 Health Screening Benefit Enhanced Intensive Care Unit Confinement benefit ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENT CHILDREN EMPLOYEE SPOUSE AND DEPENDENT CHILDREN 17 49 50 59 60 64 65 75 14 91 19 75 25 22 35 54 28 11 37 29 47 68 67 20 19 09 23 93 29 41 40 13 32 29 41 47 51 85 71 80 Individual Disability ISTD3000 for NC B Risk Class l Off Job Accident Off Job Sickness with First Day Hospital 3 Month Benefit Period ELIMINATION PERIOD ISSUE AGE 800 0 days Accident 7 days Sickness monthly benefit amount 17 49 50 64 65 74 15 58 19 31 28 14 1 000 19 48 24 14 35 17 Applicable to policy form Individual Disability 1 200 23 37 28 97 42 20 1 400 27 27 33 79 49 24 1 600 31 16 38 62 56 27 Page 1 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Health Screening Benefit Cancer Benefit Non Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY 10 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 2 88 3 81 4 77 6 21 7 45 9 71 13 45 16 54 21 90 26 01 4 38 5 81 7 29 9 50 11 40 14 95 20 67 25 43 33 64 39 97 3 62 4 54 5 51 6 94 8 19 10 50 14 19 17 33 22 68 26 84 20 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 4 77 6 62 8 56 11 42 13 91 18 44 25 91 32 10 42 81 51 02 7 24 10 10 13 06 17 49 21 27 28 38 39 83 49 34 65 77 78 41 6 25 8 10 10 04 12 90 15 39 20 01 27 39 33 67 44 37 52 68 30 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 6 67 9 44 12 34 16 64 20 37 27 16 38 37 47 65 63 71 76 04 10 10 14 40 18 83 25 47 31 15 41 81 58 98 73 24 97 89 116 86 8 88 11 65 14 56 18 85 22 59 29 51 40 59 50 01 66 07 78 53 Applicable to policy form CI 1 0 TWO PARENT FAMILY 5 17 6 60 8 07 10 29 12 18 15 69 21 41 26 21 34 43 40 80 8 81 11 67 14 63 19 06 22 84 29 86 41 30 50 90 67 34 80 07 12 46 16 75 21 18 27 83 33 50 44 03 61 20 75 60 100 24 119 35 Page 2 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Health Screening Benefit Cancer Benefit Tobacco Rates ISSUE AGE 10 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 20 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 30 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 NAMED INSURED 3 67 5 19 7 08 9 34 11 70 15 02 20 42 25 96 33 11 39 71 6 34 9 39 13 17 17 70 22 41 29 05 39 85 50 93 65 24 78 44 9 02 13 59 19 27 26 05 33 11 43 08 59 28 75 90 97 36 117 16 EMPLOYEE SPOUSE 5 63 7 98 10 89 14 35 18 00 23 12 31 38 39 87 50 86 61 01 9 74 14 44 20 26 27 18 34 47 44 72 61 24 78 23 100 20 120 50 13 84 20 90 29 63 40 01 50 95 66 32 91 10 116 58 149 54 180 00 ONE PARENT FAMILY 4 45 5 97 7 87 10 13 12 48 15 81 21 21 26 70 33 90 40 54 7 91 10 96 14 74 19 27 23 97 30 62 41 42 52 41 66 81 80 10 11 37 15 94 21 62 28 41 35 47 45 44 61 64 78 11 99 71 119 65 Applicable to policy form CI 1 0 TWO PARENT FAMILY 6 41 8 72 11 67 15 14 18 78 23 86 32 17 40 61 51 64 61 84 11 30 15 92 21 83 28 75 36 04 46 20 62 81 79 70 101 77 122 17 16 20 23 12 31 98 42 37 53 30 68 54 93 46 118 80 151 89 182 49 Page 3 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 Whole Life Plus IWL5000 for NC ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC l Adult Base Plan Paid Up at Age 100 Accelerated Death Benefit for Long Term Care Services Non Tobacco Rates ISSUE AGE 10 000 20 000 30 000 18 8 48 16 98 25 46 19 8 50 17 00 25 50 20 8 52 17 04 25 54 21 8 54 17 08 25 62 22 8 56 17 12 25 68 23 8 58 17 14 25 72 24 8 60 17 22 25 82 25 8 68 17 34 26 00 26 8 80 17 60 26 40 27 9 00 18 00 27 00 28 9 26 29 9 56 30 9 90 31 10 22 32 10 60 33 11 00 34 11 40 18 54 19 12 19 80 20 46 21 20 22 00 22 82 27 78 28 68 29 68 30 72 31 80 32 98 34 20 35 11 86 36 12 34 37 12 86 38 13 40 39 14 02 23 70 24 64 25 70 26 82 28 04 35 56 36 98 38 52 40 22 42 06 40 14 70 41 15 42 29 40 30 84 44 06 46 26 42 16 20 43 17 04 44 17 92 45 18 84 46 19 80 32 40 34 08 35 84 37 68 39 60 48 62 51 12 53 76 56 50 59 40 47 20 78 48 21 78 41 56 43 56 62 36 65 36 49 22 82 50 23 90 51 25 12 52 26 42 45 64 47 84 50 22 52 82 68 46 71 74 75 34 79 24 Page 4 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 Whole Life Plus IWL5000 for NC ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC l Adult Base Plan Paid Up at Age 100 Accelerated Death Benefit for Long Term Care Services Non Tobacco Rates ISSUE AGE 10 000 20 000 30 000 53 27 84 55 70 83 54 54 29 40 55 31 08 58 80 62 14 88 20 93 20 56 32 94 57 34 90 58 36 98 59 39 22 60 41 60 65 86 69 80 73 98 78 44 83 18 98 80 104 72 110 98 117 66 124 78 61 44 16 62 46 92 88 34 93 82 132 50 140 74 63 49 84 99 68 149 50 64 52 96 105 92 158 90 65 56 30 112 64 168 94 66 60 02 120 08 180 10 67 64 02 128 04 192 06 68 68 28 136 54 204 82 69 72 84 145 70 218 54 70 77 80 155 60 233 42 71 78 08 156 14 234 22 72 83 82 167 62 251 44 73 90 32 180 64 270 96 74 97 72 195 44 293 16 75 106 10 76 115 58 212 22 231 18 318 34 346 76 77 126 24 78 138 12 79 151 32 252 48 276 24 302 66 378 70 414 38 454 00 Tobacco Rates ISSUE AGE 18 19 20 21 22 10 000 12 80 13 16 13 52 13 88 14 20 20 000 25 62 26 34 27 06 27 74 28 38 30 000 38 40 39 50 40 56 41 60 42 58 Page 5 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 Whole Life Plus IWL5000 for NC ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC l Adult Base Plan Paid Up at Age 100 Accelerated Death Benefit for Long Term Care Services Tobacco Rates ISSUE AGE 10 000 20 000 30 000 23 14 48 28 96 43 44 24 14 76 25 15 02 29 52 30 02 44 28 45 02 26 15 24 27 15 44 28 15 68 29 15 90 30 16 16 30 46 30 90 31 34 31 80 32 32 45 70 46 36 47 00 47 70 48 50 31 16 48 32 16 86 32 98 33 74 49 48 50 60 33 17 32 34 17 82 35 18 34 36 18 94 37 19 56 38 20 26 39 20 96 34 64 35 62 36 72 37 86 39 14 40 50 41 96 51 94 53 42 55 06 56 80 58 72 60 74 62 92 40 21 76 41 22 66 42 23 68 43 24 78 44 26 04 43 52 45 32 47 34 49 60 52 08 65 32 67 98 71 02 74 38 78 10 45 27 36 46 28 74 54 72 57 48 82 08 86 26 47 30 16 48 31 62 49 33 12 50 34 68 51 36 48 60 34 63 24 66 22 69 36 72 96 90 50 94 84 99 32 104 04 109 46 52 38 56 53 40 94 77 10 81 92 115 66 122 86 54 43 62 87 24 130 84 55 46 46 92 92 139 36 56 49 44 98 88 148 30 57 52 40 104 80 157 20 Page 6 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 Whole Life Plus IWL5000 for NC ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC l Adult Base Plan Paid Up at Age 100 Accelerated Death Benefit for Long Term Care Services Tobacco Rates ISSUE AGE 10 000 20 000 30 000 58 55 36 110 76 166 14 59 58 36 116 70 175 04 60 61 40 122 80 184 20 61 64 68 129 36 194 04 62 68 26 136 50 204 76 63 72 14 144 26 216 40 64 76 28 152 54 228 82 65 80 62 161 24 241 86 66 85 24 170 50 255 76 67 90 00 179 98 269 98 68 94 92 69 99 98 70 105 42 71 106 18 72 113 00 73 120 76 74 129 30 189 80 199 96 210 88 212 36 225 98 241 54 258 60 284 68 299 92 316 30 318 54 339 00 362 28 387 90 75 138 54 76 148 44 77 158 92 78 169 92 79 181 38 277 10 296 88 317 84 339 84 362 76 415 64 445 32 476 76 509 76 544 14 Term Life ITL5000 for NC l 20 Year Term Base Plan Chronic Care Accelerated Death Benefit Non Tobacco Rates ISSUE AGE 10 000 20 000 16 3 20 4 55 17 3 20 4 55 18 3 20 4 55 19 3 20 4 55 20 3 20 4 55 21 3 20 4 55 22 3 20 4 55 30 000 5 90 5 90 5 90 5 90 5 90 5 90 5 90 Applicable to policy form ITL5000 Page 7 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Term Life ITL5000 for NC l 20 Year Term Base Plan Chronic Care Accelerated Death Benefit Non Tobacco Rates ISSUE AGE 10 000 20 000 23 3 20 4 55 24 3 20 4 55 25 3 20 4 55 26 3 23 4 63 27 3 28 4 71 28 3 32 4 79 29 3 37 30 3 41 4 88 4 97 31 3 46 32 3 53 5 08 5 20 33 3 58 5 32 34 3 64 5 44 35 3 70 5 55 36 3 74 37 3 80 5 64 5 74 38 3 85 39 3 91 5 85 5 98 40 3 98 6 12 41 4 08 6 30 42 4 18 6 52 43 4 33 6 81 44 4 50 7 15 45 4 70 7 56 46 4 93 8 02 47 5 19 48 5 47 8 54 9 10 49 5 79 9 74 50 6 15 10 45 51 6 55 11 25 52 7 01 12 17 53 7 52 13 20 54 8 10 14 36 55 8 74 15 62 56 9 43 57 10 19 17 01 18 53 58 11 03 59 11 95 20 20 22 03 60 12 95 24 05 61 14 07 17 03 30 000 5 90 5 90 5 90 6 01 6 14 6 26 6 40 6 53 6 70 6 88 7 05 7 23 7 40 7 54 7 68 7 84 8 03 8 25 8 51 8 86 9 28 9 80 10 41 11 09 11 87 12 72 13 68 14 75 11 11 11 92 12 79 13 73 14 76 15 91 17 21 18 68 20 39 22 35 24 62 Applicable to policy form ITL5000 Page 8 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Term Life ITL5000 for NC l 20 Year Term Base Plan Chronic Care Accelerated Death Benefit Non Tobacco Rates ISSUE AGE 10 000 20 000 62 15 33 18 75 63 16 73 20 69 64 18 26 22 81 65 19 94 25 11 30 000 27 20 30 10 33 29 36 75 Tobacco Rates ISSUE AGE 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 10 000 4 77 4 79 4 81 4 83 4 84 4 87 4 89 4 90 4 92 4 94 4 96 4 99 5 01 5 05 5 09 5 15 5 26 5 35 5 46 5 56 5 64 5 73 5 82 5 91 6 03 6 19 6 41 6 72 7 11 7 57 8 10 8 70 20 000 7 69 7 73 7 76 7 81 7 84 7 88 7 92 7 96 7 99 8 04 8 08 8 13 8 17 8 23 8 32 8 45 8 66 8 87 9 07 9 26 9 43 9 60 9 78 9 98 10 21 10 54 10 98 11 59 12 36 13 29 14 35 15 57 30 000 10 61 10 67 10 72 10 78 10 84 10 90 10 95 11 01 11 07 11 13 11 19 11 26 11 33 11 43 11 56 11 76 12 07 12 37 12 68 12 97 13 22 13 48 13 74 14 03 14 39 14 87 15 55 16 45 17 61 19 00 20 60 22 42 Applicable to policy form ITL5000 Page 9 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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CHARLOTTE JEWISH PRESCHOOL Continued Term Life ITL5000 for NC l 20 Year Term Base Plan Chronic Care Accelerated Death Benefit Tobacco Rates ISSUE AGE 10 000 20 000 48 9 37 16 91 49 10 12 18 39 50 10 94 20 02 51 11 82 21 78 52 12 77 23 69 53 13 79 25 73 54 14 88 55 16 06 27 93 30 27 56 17 33 57 18 73 32 81 35 60 58 20 25 38 65 59 21 91 41 95 60 23 68 45 51 61 25 55 62 27 48 31 69 33 80 63 29 45 64 31 42 36 04 38 33 65 33 39 40 68 30 000 24 43 26 67 29 10 23 41 25 32 27 25 29 23 31 30 33 48 35 78 38 24 40 85 43 63 46 61 49 78 53 12 56 57 60 09 Applicable to policy form ITL5000 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 Page 10 of 10 Underwritten by Colonial Life Accident Insurance Company See page 10 for Important Notice

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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

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Thank you Colonial Life Voluntary Benefits Please contact Shelley Hartsell Benefits Specialist 704 883 4838 Shelley Hartsell ColonialLifeSales com