Benefit Booklet 2023 24
Colonial Life provides benefits that employees want for the unexpected moments in life Whether planning for retirement growing their families or saving for college they know an injury or illness won t derail their dreams Life is anything but expected That s why we re here Plan options Accident insurance Helps offset unexpected medical expenses such as ER fees deductibles and co payments that can result from a fracture dislocation or other covered accidental injury 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 Pays 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 For more information Shelley Hartsell 704 883 4838 Shelley Hartsell ColonialLifeSales com
Accident Insurance Accidents happen in places where you and your family spend the most time at work in the home and on the playground and they re unexpected How you care for them shouldn t be In your lifetime which of these accidental injuries have happened to you or someone you know l Sports related accidental injury l Broken bone l Burn l Concussion l Laceration l Back or knee injuries l Car accidents l Falls spills l Dislocation l Accidental injuries that send you to the Emergency Room Urgent Care or doctor s office Colonial Life s Accident Insurance is designed to help you fill some of the gaps caused by increasing deductibles co payments and out of pocket costs related to an accidental injury The benefit to you is that you may not need to use your savings or secure a loan to pay expenses Plus you ll feel better knowing you can have greater financial security What additional features are included l Worldwide coverage l Portable l Compliant with Healthcare Spending Account HSA guidelines Will my accident claim payment be reduced if I have other insurance You re paid regardless of any other insurance you may have with other insurance companies and the benefits are paid directly to you unless you specify otherwise What if I change employers If you change jobs or leave your employer you can take your coverage with you at no additional cost Your coverage is guaranteed renewable as long as you pay your premiums when they are due or within the grace period Can my premium change Colonial Life can change your premium only if we change it on all policies of this kind in the state where your policy was issued How do I file a claim Visit coloniallife com or call our Customer Service Department at 1 800 325 4368 for additional information Accident 1 0 Premier with Health Screening Benefit
Benefits listed are for each covered person per covered accident unless otherwise specified Initial Care l Accident Emergency Treatment 200 l X ray Benefit 60 l Ambulance 600 l Air Ambulance 2 000 Common Accidental Injuries Dislocations Separated Joint Hip Knee except patella Ankle Bone or Bones of the Foot other than Toes Collarbone Sternoclavicular Lower Jaw Shoulder Elbow Wrist Bone or Bones of the Hand Collarbone Acromioclavicular and Separation One Toe or Finger Non Surgical 9 600 4 800 3 840 2 400 1 440 1 440 480 480 Surgical 19 200 9 600 7 680 4 800 2 880 2 880 960 960 Fractures Depressed Skull Non Depressed Skull Hip Thigh Body of Vertebrae Pelvis Leg Bones of Face or Nose except mandible or maxilla Upper Jaw Maxilla Upper Arm between Elbow and Shoulder Lower Jaw Mandible Kneecap Ankle Foot Shoulder Blade Collarbone Vertebral Process Forearm Wrist Hand Rib Coccyx Finger Toe Non Surgical 9 000 3 600 5 400 2 700 1 260 1 260 1 260 1 080 1 080 1 080 900 720 360 Surgical 18 000 7 200 10 800 5 400 2 520 2 520 2 520 2 160 2 160 2 160 1 800 1 440 720 Your Colonial Life policy also provides benefits for the following injuries received as a result of a covered accident l Burn based on size and degree 1 000 to 12 000 l Coma 12 500 l Concussion 150 l Emergency Dental Work 100 Extraction 400 Crown Implant or Denture l Lacerations based on size 50 to 800 Requires Surgery l Eye Injury 300 l Tendon Ligament Rotator Cuff 750 one 1 500 two or more l Ruptured Disc 750 l Torn Knee Cartilage 750 Surgical Care l Surgery cranial open abdominal or thoracic 1 500 l Surgery hernia 150 l Surgery arthroscopic or exploratory 300 l Blood Plasma Platelets 300
Transportation Lodging Assistance If injured covered person must travel more than 50 miles from residence to receive special treatment and confinement in a hospital l Transportation 600 per round trip up to 3 round trips l Lodging family member or companion 150 per night up to 30 days for a hotel motel lodging costs Accident Hospital Care l Hospital Admission 2 000 per accident l Hospital ICU Admission 4 000 per accident We will pay either the Hospital Admission or Hospital Intensive Care Unit ICU Admission but not both l Hospital Confinement 300 per day up to 365 days per accident l Hospital ICU Confinement 600 per day up to 15 days per accident Accident Follow Up Care l Accident Follow Up Doctor Visit 50 up to 4 visits per accident l Medical Imaging Study 300 per accident limit 1 per covered accident and 1 per calendar year l Occupational or Physical Therapy 35 per treatment up to 10 days l Appliances 125 such as wheelchair crutches l Prosthetic Devices Artificial Limb 750 one 1 500 more than 1 l Rehabilitation Unit 150 per day up to 15 days per covered accident and 30 days per calendar year Maximum of 30 days per calendar year Accidental Dismemberment l Loss of Finger Toe 1 250 one 2 400 two or more l Loss or Loss of Use of Hand Foot Sight of Eye 12 000 one 24 000 two or more Catastrophic Accident For severe injuries that result in the total and irrecoverable l Loss of one hand and one foot l Loss of both hands or both feet l Loss or loss of use of one arm and one leg or l Loss or loss of use of both arms or both legs l Loss of the sight of both eyes l Loss of the hearing of both ears l Loss of the ability to speak Named Insured 25 000 Spouse 25 000 Child ren 12 500 365 day elimination period Amounts reduced for covered persons age 65 and over Payable once per lifetime for each covered person Accidental Death l Named Insured l Spouse l Child ren Accidental Death 50 000 50 000 10 000 Common Carrier 200 000 200 000 40 000
Health Screening Benefit l 50 per covered person per calendar year Provides a benefit if the covered person has one of the health screening tests performed This benefit is payable once per calendar year per person and is subject to a 30 day waiting period Tests include l Blood test for triglycerides l Bone marrow testing l Breast ultrasound l CA 15 3 blood test for breast cancer l CA125 blood test for ovarian cancer l Carotid doppler l CEA blood test for colon cancer l Chest x ray l Colonoscopy l Echocardiogram ECHO l Electrocardiogram EKG ECG l Fasting blood glucose test l Flexible sigmoidoscopy l Hemoccult stool analysis l Mammography l Pap smear l PSA blood test for prostate cancer l Serum cholesterol test to determine level of HDL and LDL l Serum protein electrophoresis blood test for myeloma l Stress test on a bicycle or treadmill l Skin cancer biopsy l Thermography l ThinPrep pap test l Virtual colonoscopy My Coverage Worksheet For use with your Colonial Life benefits counselor Who will be covered check one Employee Only Spouse Only One Child Only Employee Spouse One Parent Family with Employee One Parent Family with Spouse Two Parent Family When are covered accident benefits available check one On and Off Job Benefits Off Job Only Benefits EXCLUSIONS We will not pay benefits for losses that are caused by or are the result of hazardous avocations felonies or illegal occupations racing semi professional or professional sports sickness suicide or self inflicted injuries war or armed conflict in addition to the exclusions listed above we also will not pay the Catastrophic Accident benefit for injuries that are caused by or are the result of birth intoxication For cost and complete details see your Colonial Life benefits counselor Applicable to policy form Accident 1 0 HS NC This is not an insurance contract and only the actual policy provisions will control Accident 1 0 Premier with Health Screening Benefit Colonial Life 1200 Colonial Life Boulevard Columbia South Carolina 29210 coloniallife com 2014 Colonial Life Accident Insurance Company Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand 6 14 71741 NC
Disability Insurance How you can protect your income If you become disabled you could be out of work for a while Without your income how would you pay for your everyday living expenses Fortunately Colonial Life offers financial protection options that can help you What can cause a disability Many accidents or sicknesses can lead to short term disability claims including pregnancy and childbirth injuries from a major accident including dislocations sprains and fractures back problems side effects from medicines or medical procedures and some mental illnesses Regardless of your age or health a disabling sickness or accidental injuries could keep you out of work for weeks or even months How reliable is your safety net While many people with disabilities look to workers compensation or Social Security Disability Insurance SSDI for help these resources aren t always reliable In fact 68 of workers who apply for SSDI are denied 1 Even if these resources can help they might not be enough to meet your financial obligations How to help yourself You can be better prepared to preserve your way of life with short term disability insurance Disability insurance features Benefits payable directly to you in regular payments if you can t work because of a covered accident or sickness injury or illness Disability benefits may be available if you return to work part time In most cases you can keep your coverage even if you change jobs as long as you pay your premiums when due Your Colonial Life benefits counselor can help you determine the amount of coverage that s right for you Nearly 70 of Americans worry about having enough emergency savings to cover a month s worth of living expenses 2 25 of 20 year olds can expect to be out of work for at least a year for a disabling condition before they retire 3 DISABILITY INSURANCE
Disability Insurance Worksheet You can tailor disability coverage to fit your specific needs Talk with your benefits counselor about your expenses and other paid leave benefits such as state paid medical leave to help determine the coverage that s right for you 4 MONTHLY EXPENSES Rent or mortgage insurance minor home repairs Transportation car note bus fare insurance gas maintenance Utilities cell phone Wi Fi electricity gas water Food and household necessities toiletries cleaning supplies Childcare daycare after school care Health medical needs and prescription drugs Other gym fitness streaming cable extracurricular Total monthly expenses add lines 1 7 together ROUND TO THE NEAREST HUNDRED Your state s paid medical leave approximate benefits if any Monthly benefit _____________ Benefit period up to _____________ Talk with your Colonial Life benefits counselor to learn more about disability insurance ColonialLife com 1 Social Security Administration SSI Annual Statistical Report 2021 2 Bankrate Bankrate s 2023 annual emergency savings report 2023 3 Social Security Administration Disability and Death Probability Tables for Insured Workers 2022 4 State paid medical leave PML benefits fall under state specific program names For example in New Jersey it may be referred to as Temporary Disability Insurance TDI Not available in all states For policies issued or delivered in the Commonwealth of Virginia THIS IS AN EXCEPTED BENEFITS POLICY IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy forms ISTD3000 and rider form ISTD3000 ADIB including state abbreviations where used for example ISTD3000 TX and ISTD3000 ADIB TX policy form DIS1000 including state abbreviations where used for example DIS1000 TX policy form ED DIS 1 0 including state abbreviations where used for example ED DIS 1 0 TX policy form ICC21 DIP3000 and rider form ICC21 DIP3000 R DIS policy form GDIS P and certificate form GDIS C including state abbreviations where used for example GDIS P EE TX and GDIS C EE TX and policy form VSTDMP and certificate form VSTDC including state abbreviations where used for example VSTDMP TX and VSTDC TX Not applicable in Oregon for policy form ICC21 DIP3000 and rider form ICC21 DIP3000 R DIS For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company An insurance producer may contact you Underwritten by Colonial Life Accident Insurance Company Columbia SC 2023 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company FOR EMPLOYEES 6 23 101165 10
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
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
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
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
Deductions per year: 52 These rates were prepared on 11/14/2023 and are valid for 90 days.Accident 1.0 for NCApplicable to policy forms ACCIDENT 1.0-HS and ACCIDENT1.0-NSlOn/Off-Job Accident CoverageISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYPremier with health screening 17-80 $6.12 $8.38 $9.16 $11.42Individual Disability - ISTD3000 for NC A Risk ClassApplicable to policy form Individual DisabilitylOff Job Accident & Off Job Sickness with First Day Hospital3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,200* $1,400* $1,600* $1,800* $2,000**monthly benefit amount0 days Accident/7 days Sickness 17-49 $10.27 $11.99 $13.70 $15.41 $17.1250-64 $12.57 $14.67 $16.76 $18.86 $20.9565-74 $18.22 $21.26 $24.30 $27.33 $30.37Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening Benefit, Cancer BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $1.45 $2.19 $1.82 $2.5825-29 $1.91 $2.91 $2.28 $3.3030-34 $2.39 $3.64 $2.76 $4.0435-39 $3.11 $4.75 $3.48 $5.1440-44 $3.73 $5.70 $4.10 $6.0945-49 $4.86 $7.48 $5.25 $7.8450-54 $6.73 $10.34 $7.10 $10.7155-59 $8.28 $12.71 $8.67 $13.1160-64 $10.95 $16.82 $11.35 $17.2165-70 $13.01 $19.98 $13.42 $20.40$20,000 17-24 $2.39 $3.62 $3.13 $4.4125-29 $3.32 $5.05 $4.05 $5.8430-34 $4.28 $6.53 $5.02 $7.3135-39 $5.72 $8.74 $6.45 $9.5340-44 $6.96 $10.64 $7.70 $11.4245-49 $9.22 $14.19 $10.01 $14.9350-54 $12.96 $19.91 $13.70 $20.6555-59 $16.05 $24.67 $16.84 $25.4560-64 $21.41 $32.88 $22.19 $33.6765-70 $25.52 $39.21 $26.35 $40.04Clear Site IndustrialPage 1 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening Benefit, Cancer BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$30,000 17-24 $3.34 $5.05 $4.45 $6.2325-29 $4.72 $7.20 $5.83 $8.3830-34 $6.18 $9.41 $7.28 $10.5935-39 $8.32 $12.74 $9.43 $13.9140-44 $10.19 $15.58 $11.30 $16.7545-49 $13.58 $20.91 $14.76 $22.0150-54 $19.19 $29.49 $20.30 $30.6055-59 $23.83 $36.62 $25.01 $37.8060-64 $31.86 $48.94 $33.04 $50.1265-70 $38.02 $58.43 $39.27 $59.68Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $1.84 $2.81 $2.23 $3.2125-29 $2.60 $3.99 $2.99 $4.3630-34 $3.55 $5.44 $3.94 $5.8435-39 $4.68 $7.18 $5.07 $7.5740-44 $5.85 $9.00 $6.25 $9.3945-49 $7.52 $11.56 $7.91 $11.9350-54 $10.22 $15.69 $10.61 $16.0855-59 $12.98 $19.94 $13.35 $20.3160-64 $16.56 $25.43 $16.95 $25.8265-70 $19.86 $30.51 $20.28 $30.92$20,000 17-24 $3.18 $4.87 $3.96 $5.6525-29 $4.70 $7.22 $5.48 $7.9630-34 $6.59 $10.13 $7.38 $10.9135-39 $8.85 $13.59 $9.64 $14.3840-44 $11.21 $17.24 $11.99 $18.0245-49 $14.53 $22.36 $15.32 $23.1050-54 $19.93 $30.62 $20.72 $31.4155-59 $25.47 $39.11 $26.21 $39.8560-64 $32.62 $50.10 $33.41 $50.8865-70 $39.22 $60.25 $40.05 $61.08Clear Site Industrial(Continued...)Page 2 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening Benefit, Cancer BenefitTobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$30,000 17-24 $4.52 $6.92 $5.69 $8.1025-29 $6.80 $10.45 $7.98 $11.5630-34 $9.64 $14.81 $10.82 $15.9935-39 $13.03 $20.01 $14.21 $21.1840-44 $16.56 $25.48 $17.74 $26.6545-49 $21.55 $33.16 $22.72 $34.2750-54 $29.65 $45.55 $30.82 $46.7355-59 $37.95 $58.29 $39.06 $59.4060-64 $48.68 $74.77 $49.86 $75.9465-70 $58.58 $90.00 $59.83 $91.24Whole Life Plus (IWL5000) for NCApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100, Accelerated Death Benefit for Long-Term Care ServicesNon-Tobacco RatesISSUE AGE $10,000 $20,000 $30,00018 $4.24 $8.48 $12.7219 $4.26 $8.50 $12.7620 $4.26 $8.50 $12.7821 $4.28 $8.54 $12.8222 $4.28 $8.56 $12.8423 $4.28 $8.58 $12.8624 $4.30 $8.62 $12.9225 $4.32 $8.68 $13.0026 $4.40 $8.80 $13.1827 $4.50 $9.00 $13.5028 $4.62 $9.26 $13.8829 $4.80 $9.56 $14.3430 $4.94 $9.90 $14.8431 $5.12 $10.24 $15.3632 $5.28 $10.60 $15.9033 $5.50 $11.00 $16.5034 $5.70 $11.40 $17.1035 $5.92 $11.86 $17.7836 $6.16 $12.34 $18.50Clear Site Industrial(Continued...)Page 3 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Whole Life Plus (IWL5000) for NCApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100, Accelerated Death Benefit for Long-Term Care ServicesNon-Tobacco RatesISSUE AGE $10,000 $20,000 $30,00037 $6.42 $12.86 $19.2838 $6.72 $13.40 $20.1239 $7.02 $14.02 $21.0440 $7.34 $14.70 $22.0441 $7.70 $15.42 $23.1442 $8.12 $16.20 $24.3243 $8.52 $17.04 $25.5644 $8.98 $17.92 $26.9045 $9.42 $18.84 $28.2646 $9.90 $19.80 $29.7047 $10.40 $20.80 $31.1648 $10.90 $21.78 $32.6849 $11.40 $22.84 $34.2450 $11.96 $23.90 $35.8851 $12.56 $25.12 $37.6852 $13.20 $26.42 $39.6253 $13.92 $27.84 $41.7854 $14.70 $29.40 $44.1055 $15.54 $31.08 $46.6256 $16.46 $32.94 $49.4057 $17.46 $34.90 $52.3658 $18.50 $36.98 $55.4859 $19.60 $39.22 $58.8260 $20.78 $41.60 $62.3861 $22.08 $44.18 $66.2662 $23.46 $46.90 $70.3863 $24.92 $49.84 $74.7464 $26.48 $52.98 $79.4465 $28.16 $56.30 $84.4666 $30.02 $60.02 $90.0667 $32.00 $64.02 $96.0268 $34.12 $68.28 $102.4069 $36.44 $72.84 $109.2870 $38.90 $77.82 $116.7071 $39.04 $78.08 $117.12Clear Site Industrial(Continued...)Page 4 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Whole Life Plus (IWL5000) for NCApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100, Accelerated Death Benefit for Long-Term Care ServicesNon-Tobacco RatesISSUE AGE $10,000 $20,000 $30,00072 $41.90 $83.82 $125.7273 $45.16 $90.32 $135.4874 $48.86 $97.72 $146.5875 $53.06 $106.12 $159.1676 $57.80 $115.58 $173.3877 $63.12 $126.24 $189.3678 $69.06 $138.12 $207.1879 $75.66 $151.34 $227.00Tobacco RatesISSUE AGE $10,000 $20,000 $30,00018 $6.40 $12.80 $19.2019 $6.60 $13.16 $19.7620 $6.76 $13.52 $20.2821 $6.94 $13.88 $20.8222 $7.10 $14.20 $21.2823 $7.24 $14.48 $21.7224 $7.38 $14.78 $22.1425 $7.50 $15.00 $22.5026 $7.62 $15.24 $22.8427 $7.72 $15.44 $23.1628 $7.82 $15.68 $23.5029 $7.96 $15.90 $23.8430 $8.08 $16.16 $24.2431 $8.24 $16.50 $24.7432 $8.44 $16.86 $25.3033 $8.66 $17.32 $25.9634 $8.90 $17.82 $26.7235 $9.18 $18.34 $27.5236 $9.46 $18.94 $28.4037 $9.80 $19.58 $29.3438 $10.12 $20.26 $30.3839 $10.48 $20.96 $31.4640 $10.90 $21.76 $32.6641 $11.32 $22.66 $33.98Clear Site Industrial(Continued...)Page 5 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Whole Life Plus (IWL5000) for NCApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100, Accelerated Death Benefit for Long-Term Care ServicesTobacco RatesISSUE AGE $10,000 $20,000 $30,00042 $11.84 $23.66 $35.5043 $12.40 $24.78 $37.1844 $13.02 $26.04 $39.0645 $13.68 $27.36 $41.0446 $14.38 $28.74 $43.1247 $15.08 $30.16 $45.2648 $15.80 $31.62 $47.4249 $16.56 $33.10 $49.6650 $17.34 $34.68 $52.0251 $18.24 $36.48 $54.7252 $19.28 $38.54 $57.8253 $20.48 $40.94 $61.4254 $21.80 $43.62 $65.4255 $23.22 $46.46 $69.7056 $24.72 $49.44 $74.1657 $26.20 $52.40 $78.6258 $27.68 $55.40 $83.0859 $29.18 $58.36 $87.5460 $30.70 $61.40 $92.1061 $32.34 $64.68 $97.0462 $34.12 $68.26 $102.3863 $36.08 $72.14 $108.2264 $38.12 $76.28 $114.4065 $40.30 $80.62 $120.9266 $42.64 $85.24 $127.8867 $45.00 $90.00 $135.0068 $47.46 $94.90 $142.3469 $49.98 $99.98 $149.9670 $52.72 $105.42 $158.1471 $53.10 $106.18 $159.2872 $56.50 $113.00 $169.5073 $60.38 $120.76 $181.1474 $64.66 $129.30 $193.9675 $69.28 $138.54 $207.8276 $74.22 $148.44 $222.66Clear Site Industrial(Continued...)Page 6 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Whole Life Plus (IWL5000) for NCApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100, Accelerated Death Benefit for Long-Term Care ServicesTobacco RatesISSUE AGE $10,000 $20,000 $30,00077 $79.46 $158.92 $238.3878 $84.96 $169.92 $254.8879 $90.68 $181.38 $272.06Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 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.Shelley Hartsell | Shelley.Hartsell@ColonialLifeSales.com | (704) 883-4838Clear Site Industrial(Continued...)Page 7 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
!ank you!" Colonial Life Voluntary Benefits Please contact:!!Shelley Hartsell!Benefits Specialist!704-883-4838Shelley.Hartsell@ColonialLifeSales.com