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Benefits BookletNS-15576 (9-17)Conifer House
Welcome to Your Voluntary Benefits Having a choice is important, Colonial Life’s benefits enhance your benefit package. Whether you are single, married or raising children these voluntary benefits can provide you and your family financial security for the unexpected. Please complete interest survey link below to connect with a benefit counselor to learn more about the coverage available and to customize plans based on your need and budget. All employees must complete their enrollment with a benefits counselor, in person or virtually through a computer screen share. Colonial Life policies are not automatically issued for coverage - you must complete the enrollment process for issuance of coverage. Confirmation of your elections will be provided at the conclusion of your enrollment.The information contained in this booklet is only a summary of coverage and is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. If there are differences between the information in the booklet and the contract, the contract will govern.Colonial Life District Office - 503-808-9130
Group Term Life InsuranceBasic coverageOur group term life insurance can help provide nancial security to your loved ones if something were to happen to you. Your employer is paying for all or a portion of your basic group term life coverage. Benets are payable directly to named beneciaries and can be used in any way they see t, including to help with:Immediate costs• Funeral expenses• Medical billsOngoing living expenses• Mortgage• Utilities• GroceriesFuture needs• College tuition• Savings for retirementYour employer is providing group term life coverage in the amount of: $ ___________________________Why group term life insurance is a good option• Death benet and living benets (accelerated death benet)1• Lower cost option• Coverage during high-need years• Benet payment typically tax-free2 Additional benets and servicesBuilt-in accelerated death benet1 provides an advance of up to 75% of the death benet, to a maximum of $150,000, if diagnosed with a terminal illness.3Health Advocate Employee Assistance Program (EAP) provides 24-hour condential personal support and referral service, including a medical bill saver service. Face-to-face sessions and video counseling with mental health professionals are available.4• Online: ColonialLife.com/EAP • Telephone: 1-888-645-1772Life planning services offer nancial and legal counseling services, as well as grief support and referral, for up to 12 months after a claim.4GROUP TERM LIFE INSURANCE – BASIC COVERAGE10,000
Get the most out of your coveragePortability: You may be able to continue your coverage if you change jobs or retire. Conversion: After the group term period ends, you may be eligible to convert to a whole life policy without health questions. Waiver of premium: Your premium payments may be eligible for waiver if you become disabled. To learn more, talk with your Colonial Life benets counselor.1 Accelerated death benet payments will reduce the amount the policy pays upon the covered person’s death. 2 The benet paid under the accelerated death benet provision may be taxable.3 Terminal illness means an injury or sickness that results in the covered person having a life expectancy of 12 months or less and from which there is no reasonable prospect of recovery. A life expectancy of 24 months or less in IL, KS, MA, TX and WA.4 The Employee Assistance Program and Life Planning Services, provided by Health Advocate, are available with Colonial Life & Accident Insurance Company’s Group Term Life offering. Terms and availability of service are subject to change. The service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact the company for full details.This life insurance does not specically cover funeral goods or services and may not cover the entire cost of your funeral at the time of your death. The beneciary of this life insurance may use the proceeds for any purpose, unless otherwise directed.Coverage amounts will be reduced if a covered person has reached age 70 but not 75, to 65% of the original amount. At age 75, the coverage amount will be reduced to 50% of the original amount. Once reductions begin, there will be no further increases in the covered person’s life benet amount.Coverage amount applied for after the above age reduction will be issued at the reduced benet amounts. 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 benets payable. Applicable to policy form GTL1.0-P and certicate form GTL1.0-C (including state abbreviations where used, for example: GTL1.0-P-TX and GTL1.0-C-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 2-24 | 101535-5ColonialLife.com
For more information, talk with your benefits counselor.GROUP MEDICAL BRIDGE – PLAN 5Group Hospital Confinement Indemnity InsurancePlan 5Group Medical BridgeSM insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement benefit .......................................................$_______________ per dayMaximum of one day per covered person per calendar yearDoctor oice visit benefit ........................................................................... $25 per dayMaximum of ________ days per calendar year for ____________________ coverageEmergency room visit benefit .....................................................................$150 per dayMaximum of one day per covered person per calendar yearDiagnostic procedure benefit .......................................................$_______________ per dayMaximum of one day per covered person per calendar yearOutpatient surgical procedure benefit Tier 1.......................................................................................$_______________ per day Tier 2.......................................................................................$_______________ per dayMaximum of $________________ per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedureDiagnostic proceduresThe following is a list of common diagnostic procedures that may be covered. Breast– Biopsy (incisional, needle, stereotactic) Cardiac– Angiogram– Arteriogram– Thallium stress test– Transesophageal echocardiogram (TEE) Diagnostic radiology– Computerized tomography scan (CT scan)– Electroencephalogram (EEG)– Magnetic resonance imaging (MRI)– Myelogram– Nuclear medicine test– Positron emission tomography scan (PET scan) Digestive– Barium enema/lower GI series– Barium swallow/upper GI series– Esophagogastroduodenoscopy (EGD) Ear, nose, throat, mouth– Laryngoscopy Gynecological– Amniocentesis– Cervical biopsy– Cone biopsy– Endometrial biopsy– Hysteroscopy– Loop electrosurgical excisional procedure (LEEP) Liver– Biopsy Lymphatic– Biopsy Miscellaneous– Bone marrow aspiration/biopsy Renal– Biopsy Respiratory– Biopsy– Bronchoscopy– Pulmonary function test (PFT) Skin– Biopsy– Excision of lesion Thyroid– Biopsy Urinary– Cystoscopy250010003000100020003/5individual/family
THIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONS We will not pay benefits for losses which are caused by: dental procedures, elective procedures, cosmetic surgery, felonies or illegal occupations, pregnancy of a dependent child, psychiatric or psychological conditions, suicide, intentional injuries, war, armed forces service or giving birth within the first six months aer the certificate eective date. We will not pay benefits for hospital confinement of a newborn who is neither injured nor sick. We will not pay benefits for loss during the first six months aer the eective date due to a pre-existing condition, which means a sickness or physical condition for which a covered person was treated by a doctor, received advice from a doctor or had taken medication prescribed by a doctor within the six-month period immediately preceding the certificate eective date.For cost and complete details, see your Colonial Life benefits counselor. Applicable to certificate number GMB1.0-C-OR-R. This is not an insurance contract and only the actual certificate provisions will control.ColonialLife.com Breast– Breast reduction Cardiac– Angioplasty– Cardiac catheterization Digestive– Exploratory laparoscopy– Laparoscopic appendectomy– Laparoscopic cholecystectomy Ear, nose, throat, mouth– Ethmoidectomy– Mastoidectomy– Septoplasty– Stapedectomy– Tympanoplasty– Tympanotomy Eye– Cataract surgery– Corneal surgery (penetrating keratoplasty)– Glaucoma surgery (trabeculectomy)– Vitrectomy Tier 2 outpatient surgical procedures Gynecological– 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 massThe 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 certificate. Tier 1 outpatient surgical procedures Breast– Axillary node dissection– Breast capsulotomy– Breast reconstruction– Lumpectomy Cardiac– Pacemaker insertion Digestive– Colonoscopy– Fistulotomy– Hemorrhoidectomy (external)– Lysis of adhesions Skin– Laparoscopic hernia repair– Skin graing Ear, nose, throat, mouth– Adenoidectomy– Removal of oral lesions– Myringotomy– Tonsillectomy– Tracheostomy Gynecological– Dilation and curettage (D&C)– Endometrial ablation– Lysis of adhesions Liver– Paracentesis Musculoskeletal system– Carpal/cubital repair or release– Dislocation (closed reduction treatment) other than a finger or toe– Foot surgery (bunionectomy, exostectomy,arthroplasty, hammertoe repair)– Fracture (closed reduction treatment) other than a rib, finger or toe– Removal of orthopedic hardware– Removal of tendon lesion3-18 | 100028-3-ORUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
For more information, talk with your benefits counselor.Group Hospital Confinement Indemnity InsuranceHealth Screening BenefitFor cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number GMB1.0-P-R (including state abbreviations where used, for example: GMB1.0-P-EE-R-TX). Coverage may vary by state and may not be available in all states. This is not an insurance contract and only the actual policy provisions will control.©2016 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.GROUP MEDICAL BRIDGE HEALTH SCREENING BENEFIT | 8-16 | 100029-3ColonialLife.comHealth Screening Benefit ........................................................................... $50 per dayMaximum of one day per covered person per calendar year Blood test for triglycerides Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) Carotid Doppler CEA (blood test for colon cancer) Chest X-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopyGroup Medical BridgeSM insurance’s health screening benefit can help pay for health and wellness tests you have each year.
Accident InsurancePreferred PlanIAC4000 – PREFERRED PLANOUR COVERAGE INCLUDES:All of this can help you get back on your feet. Nobody expects an accident to happen. But if it does, your main focus should be on recovery, not how you’re going to pay your bills. Colonial Life accident insurance provides benefits directly to you to use however you like – from medical costs to everyday expenses. Whether it's a fall or a car accident, your benefits oer support when you need it. DOCTORʼS OFFICE VISITOver the next several weeks, he had three follow-up appointments with his doctor.URGENT CARE CENTER VISITMilo went to an urgent care center and received immediate care.DIAGNOSTIC PROCEDUREThe doctor ordered an X-ray and discovered Milo had fractured his hand.LACERATIONThe doctor also found that Milo had a cut on his hand.MEDICAL EQUIPMENTMilo was discharged with a splint.MILOʼS BENEFITSWith Colonial Life accident benefits, Milo’s parents were able to pay the annual deductible and co-payments.Accident emergency treatment $125X-ray $40Laceration (no stitches) $30Fracture (hand) $475Medical equipment (splint) $40Accident follow-up treatment (3 visits)$165Total: $875For illustrative purposes only.Benefit amounts may vary and may not cover all expenses. The policy has exclusions and limitations.Milo was running on the playground when he tripped and injured his hand. Benefits payabledirectly to you No medical questionsto qualify for coverage Coverage for simpleand complex injuries Benefits payable, regardless of otherinsurance Worldwide coverage Keep coverage nomatter where you go Works alongside yourhealth savings account(HSA)
INITIAL CAREAccident emergency treatment ........................................................................ $125Hospital emergency room, urgent care facility or physician’s oiceAccidental injury due to an automobile accident .................................................. $250 Air ambulance ........................................................................................... $2,400 Ambulance – ground or water .......................................................................... $250 Observation room (up to two days per calendar year) .................................. $175 per day X-ray ........................................................................................................... $40 COMMON ACCIDENTAL INJURIESBurn (based on size and degree)......................................................... $1,000 – $15,000Burn – skin gra ......................................................... 50% of applicable burn benefitComa (lasting for seven or more consecutive days).............................................$15,000Concussion ................................................................................................. $200 Dislocation – separated joint¾ Non-surgical – repair .................................................................... $125 – $2,750Incomplete dislocation – or dislocation without anesthesia .................... 25% of benefit Examples: elbow: $600 | ankle: $1,250 | knee: $1,375 | hip: $2,750 ¾ Surgical – repair .......................................................................... $250 – $5,500 Examples: elbow: $1,200 | ankle: $2,500 | knee: $2,750 | hip: $5,500Emergency dental work .........................................................................$125 – $350Dental extraction or dental crown, denture or implantEye injury – with surgical repair or removal of a foreign object ................................... $350 Fracture – complete¾ Non-surgical – repair .................................................................... $300 – $3,750Chip fracture ............................................................................. 25% of benefit Examples: hand: $475 | foot: $475 | collarbone: $775 | leg: $1,250¾ Surgical – repair .......................................................................... $600 – $7,500 Examples: hand: $950 | foot: $950 | collarbone: $1,550 | leg: $2,500Hearing-loss injuries1 .................................................................................... $140 Knee cartilage – torn (with surgical repair) ........................................................... $800 Laceration (based on repair and length) ....................................................... $30 – $750 Ruptured disc (with surgical repair) ................................................................... $950 Tendon/ligament/rotator cu (with surgical repair) ¾ One ......................................... $800 ¾ Two or more ........................ $1,600 HOSPITAL CAREHospital admission ..................................................................................... $1,250 Hospital confinement (up to 365 days) ..................................................... $300 per dayHospital sub-acute intensive care unit confinement (up to 30 days) ................. $400 per dayIntensive care unit admission ........................................................................ $2,500 Intensive care unit confinement (up to 15 days) .......................................... $550 per daySURGICAL CAREBlood/plasma/platelets – transfusion ................................................................ $400 Surgery (based on type of repair and surgery) ............................................ $250 – $1,900Benefits are per covered person per covered accident unless stated otherwise.Olivia was driving to the store when she got into a car accident.AMBULANCE AND EMERGENCY ROOM VISITOlivia was admitted to the hospital for surgery on her leg. She was confined for three days.Over the next several weeks, she had six follow-up appointments with her doctor.Olivia had eight sessions of physical therapy to help regain the strength in her leg.The doctor ordered an X-ray and discovered Olivia had fractured her thigh (femur). He also ordered a CT scan of her head to check for brain injury.OLIVIA'S BENEFITSOlivia’s accident benefits helped cover her annual deductible and co-payments.Ambulance $250Accidental injury due to an automobile accident$250Accident emergency treatment $125X-ray $40Medical imaging study (CT) $250Hospital admission $1,250Hospital confinement (3 days) $900Thigh fracture – femur (surgical) $5,600Surgery (exploratory/arthroscopic) $350Medical equipment (crutches) $125Accident follow-up treatment (6 visits)$330Physical therapy (8 days) $360Total: $9,830Olivia arrived by ambulance to the nearest emergency room and received immediate care.DIAGNOSTIC PROCEDURESHOSPITAL ADMISSION, CONFINEMENT AND SURGERYDOCTORʼS OFFICE VISITSPHYSICAL THERAPYFor illustrative purposes only.Benefit amounts may vary and may not cover all expenses. The policy has exclusions and limitations.
For more information, talk with your benefits counselor.IAC4000 – PREFERRED PLANTRANSPORTATION & LODGINGTransportation for hospital confinement ..................................................... $700 per round trip(up to three round trips, 50+ miles from home)Lodging – companion (up to 30 days) .................................................................. $150 per dayFOLLOW-UP CAREAccident follow-up treatment – including transportation/telemedicine ...................................$55 (up to six benefits per covered person per covered accident and up to 12 benefits per covered person per calendar year)Medical equipment¾ Tier 1 ............................................................................................................... $40 Arm sling, cane, medical ring cushion, neck brace or wrist/ankle splint ¾ Tier 2 ............................................................................................................. $125 Bedside commode, cold therapy system (cryotherapy), crutches, leg brace, shower chair, walker or walking boot ¾ Tier 3 ............................................................................................................. $250 Back brace, body jacket, continuous passive movement (CPM), halo, electric scooter, hospital bed (including rental), knee scooter, stair li chair, wheelchairMedical imaging study – CT, CAT scan, EEG, EMG, MR or MRI................................................. $250 (one per calendar year)Pain management for epidural anesthesia – non-surgical ................................................... $125 Post-traumatic stress disorder (PTSD) .......................................................................... $250 Prosthetic device/artificial limb¾ One ............................................ $950 ¾ More than one ..............................$1,900¾ Repair/replacement2 ................................................................................... $475/$950Rehabilitation unit confinement ....................................................................... $175 per day(up to 15 days, not to exceed 30 days per calendar year)Therapy – occupational, physical or speech (up to 10 days) ......................................... $45 per dayACCIDENTAL DISMEMBERMENTAccidental dismemberment ........................................................................... $600 – $25,000¾ Loss, loss of use or paralysis – hand, arm, foot, leg, sight of eye¾ Loss, loss of use – finger, toe, partial dismemberment of finger or toeAccidental dismemberment due to a catastrophic accidentNamed insured, spouse or child ...........................................................................$30,0003¾ Total and irrecoverable loss, loss of use or paralysis – 180-day elimination period¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination; or¾ Loss of hearing in both ears, or loss of ability to speakACCIDENTAL DEATHAccidental death¾ Named insured, spouse .................................................................................. $40,000¾ Child ......................................................................................................... $10,000Accidental death common carrierExamples of common carriers are mass transit trains, buses and planes¾ Named insured, spouse ................................................................................. $160,000¾ Child ......................................................................................................... $30,000
ColonialLife.com4-21 | 101954-11 One benefit for each injured ear per covered person per lifetime. 2 One repair or replacement per prosthetic device/artificial limb per covered person per lifetime.3 Payable once per lifetime per covered person. Also, PA does not have a 180-day elimination period. TN has a 90-day elimination period.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be oered to employees who do not have HSAs.THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of a covered personʼs felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness, suicide or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we will not pay Accidental Dismemberment Due to Catastrophic Accident benefits for injuries a child sustains during birth, or for injuries that are the result of intoxication or use of narcotics.State Variations for Exclusions and LimitationsKS: Not applicable to "for injuries a child sustains during birth."MI: Not applicable to "suicide or injuries which any covered person intentionally does to himself" or for injuries that are the result of intoxication or use of narcotics." OR: Replace "felonies or illegal occupations" with "felonies."PA: Not applicable to "injuries a child sustains during birth" or "injuries that are the result of intoxication or use of narcotics."SC: Not applicable to "hazardous avocations, racing, semi-professional or professional sports."WA: Replace "felonies or illegal occupations" with "felonies, riots or insurrections." Replace "intoxication or use of narcotics" with "alcoholism or drug addiction." Not applicable to "hazardous avocations, racing, semi-professional or professional sports."This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy forms IAC4000 (plus state abbreviations where applicable, such as IAC4000-TX). Coverage may vary by state and may not be available in all states. Premium will vary according to the family coverage type.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.
For more information, talk with your benefits counselor.ColonialLife.comSubsequent diagnosis of a dierent critical illness3If you receive a benefit for a specified critical illness, and later you are diagnosed with a dierent specified critical illness, the original percentage of the face amount is payable for that particular specified critical illness.Subsequent diagnosis of the same critical illness3If 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 gra surgery/disease,2 carcinoma in situ, and occupational infectious HIV or occupational infectious hepatitis B, C or D.Specified Critical Illness InsuranceIf 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: $_______________ For the diagnosis of this covered critical illness condition:1This percentage of the face amount is payable:Cancer 100%Heart attack (myocardial infarction) 100%Stroke 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 D100%Coronary artery bypass gra surgery/disease225%Carcinoma in situ 25%Critical illness benefitCRITICAL ILLNESS 1.0 WITH CANCER AND SUBSEQUENT DIAGNOSIS 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.elect $5,000 to$20,000
ColonialLife.com1 Please refer to the policy for complete definitions of covered conditions. 2 Benefit for coronary artery disease applicable in lieu of benefit for coronary artery bypass gra surgery when health savings account (HSA) compliant plan is selected.3 Dates of diagnoses of a covered specified critical illness must be separated by at least 180 days.THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONS AND LIMITATIONS FOR SPECIFIED CRITICAL ILLNESSWe will not pay benefits for a specified critical illness that occurs as a result of a covered person’s: felonies; pre-existing condition; psychiatric or psychological condition; or war or armed conflict. This is not an insurance contract and only the actual policy provisions will control. Applicable to policy form CI-1.0-PL7-OR, CI-1.0-PL8-OR or CI-1.0-PL10-OR. Please see your Colonial Life benefits counselor for details.7-17 | 101825-ORUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.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.
Individual Dental InsuranceEnhanced Plan $3,000 | 100% | 80% | 50%This benet summary provides a quick reference for the dental plan benets. Policy detailsPolicy year maximum benefit• Per person (applies to Class A, B and C services)$3,000 Deductible• Per person (up to maximum of three per policy year)$50Enhanced Plan dental coverage at a glanceCo-insurance In-network1Out-of-network2 (MAC)Class A: Preventive services 100% 100%Class B: Basic services 80% 80%Class C: Major services 50% 50%Carryover benets3Carryover amount Per covered family memberThreshold limit Carryover account limit$400 $800 $1,600 How carryover benefits work Receive a $400 benefit in your carryover account to use in the next benefit year when you meet these conditions:• One cleaning and one routine exam and• Total paid dental claims for Class A, B or C services below $800 (your threshold limit, the maximum amount of benets an insured can receive during a policy year and still be able to receive the carryover benet) Your carryover account can grow up to $1,600 to help pay for claims if you exceed your yearly maximum benefits.31764147-OR INDIVIDUAL DENTAL - ENHANCED PLAN
Covered services In-network coverage1Out-of-network coverage2 (MAC)Waiting periodClass A: Preventive services• Routine exams and cleanings ‐ Twice every 12 months ‐ One additional cleaning per 12 months if member is in second or third trimester of pregnancy4• X-rays (bitewing x-rays) ‐ Up to four lms, once every 12 months• Full mouth/panoramic x-rays ‐ Once every ve years• Fluoride treatment ‐ Up to age 16, once every 12 months• Sealants ‐ Up to age 16, once every 36 months• Space maintainers ‐ Up to age 16, once every 24 months• Oral cancer screening ‐ For age 40+, once every 12 months100% 100% No waiting periodClass B: Basic services• Fillings• Posterior composite restorations• Simple extractions• Repair of crowns, dentures or bridges• Periodontics (gum treatments)• Endodontics (root canals)• Emergency treatment80% 80% No waiting periodClass C: Major services• Oral surgery (extractions and impacted teeth)• Anesthesia (covered with complex oral surgery)• Inlays and onlays• Crowns, bridges, dentures and endosteal implants• Crown lengthening 50% 50% 12-month waiting periodContact your Colonial Life benets representative to learn more.1 In-network benets are for covered dental services provided by a participating dentist. Participating dentists have agreed to accept negotiated fees as payment in full, subject to any deductibles, co-insurance and benet maximums, and will le claims for you.2 Out-of-network benets are for covered dental services provided by a non-participating dentist. Benets are provided at the lesser of the dentist’s actual fee or the Maximum Allowable Charge (MAC), a scheduled amount determined by Colonial Life, subject to any deductibles, co-insurance and benet maximums. Dentists haven’t agreed to accept the charges as payment in full, and additional out-of-pocket costs (balance billing) may apply. You may have to le a claim to receive benets.3 You must be covered for 12 consecutive months to receive the carryover benet. The carryover benet may not be used for orthodontic treatment or services. A break in dental coverage will eliminate the carryover account balance.4 Member may have one additional periodontal maintenance in place of an additional cleaning.THIS POLICY PROVIDES LIMITED BENEFITS. A NETWORK ACCESS PLAN IS AVAILABLE.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IDN8100-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 3-24 | 1764147-ORColonialLife.com1764147-OR
Individual Dental InsuranceVision Rider Our vision coverage helps you and your family maintain your vision wellness, with coverage for eye exams and optical materials, such as eyeglasses or contact lenses. This benet summary provides a quick reference to the rider’s benets.Co-pays (per insured)1Benefits (once per 12 months) In-network Out-of-networkVision exam $10 N/AContact lenses fitting $25 N/AMaterials $25 N/ABenets and allowances1Benets In-network Out-of-networkVision exam Covered in full after co-pay $35 allowanceContact lenses fittingStandard2Up to $60 allowance after co-payN/ASpecialty3Up to $100 allowance after co-payN/AMaterials: Eyeglass lenses and frames4Single vision Covered in full after co-pay Up to $25 allowanceBifocals Covered in full after co-pay Up to $40 allowanceTrifocals Covered in full after co-pay Up to $50 allowanceLenticular Up to $120 allowance Up to $50 allowanceProgressives Up to $70 allowance Up to $40 allowancePolycarbonate lenses (for children to age 19 only)Covered in full after co-pay N/AFrames Up to $170 allowance Up to $50 allowanceMaterials: Contact lenses5Elective Up to $170 allowance Up to $100 allowanceNon-elective Up to $210 allowance Up to $210 allowanceMAXIMIZE YOUR BENEFITS Maximize your vision benets with any provider in our large, nationwide network, including independent optometrists, ophthalmologists, and retail stores such as: • Walmart and Sam’s ClubOptical• Target Optical• Pearle Vision• VisionworksYou can choose different providers for eye exams, eyeglasses and contact lenses.ID CARDS• Vision ID cards are mailed to your home address within 10 business days of enrolling, separate from dental ID cards.• Only the primary insured’sname will be listed.1820767-OR INDIVIDUAL DENTAL - VISION RIDER
Special savings on material purchases6Some network providers offer special pricing and discounts for certain vision materials, including lens add-ons and a second pair of glasses. See the chart below for details. Participating providers are designated as “Value Added” or “Service Plus” in the provider directory at ColonialLifeDental.com.VALUE ADDED PROVIDERSSpecial pricing and discounts on lens options for first pair of glasses (add-ons for insured purchases)• UV Coating ...................................$15• Solid tinting/gradient tinting ........$15• Standard scratch-resistant coating ........................................$15• Standard antireective coating ....................................... $45• Premium antireective coating ....................................... $70• Ultra-antireective coating ........................20% discount • Polarized lenses ...........................$75• Transition lenses .........................$75• Progressive lenses: ‐ Standard .................................$110 ‐ Premium ................................ $170 ‐ Ultra ......................... 20% discount • Standard polycarbonate lenses ......................................... $40• High index (single vision) ‐ 1.56–1.60 .................................. $60 ‐ 1.66+ .........................20% discount • High index (multifocal) ‐ 1.56–1.60 ...................................$75 ‐ 1.66+ .........................20% discount Special pricing and discounts on purchase of second pair of glasses• Single vision plastic lenses ......... $40• Bifocal plastic lenses ...................$60• Trifocal lenses..............................$70• Progressive lenses (standard) ...................................$110• Progressive lenses (premium and ultra) ..................... 20% discountDiscount on frames, contact lenses and other products• Frames ................................................ Up to 35% discount• Contact lenses ..........5 to 15% discount, depending on type• Other products ...............20% discount on nonprescription sunglasses and other products/solutionsSERVICE PLUS PROVIDERSReceive up to a 20% discount for the following add-ons to insured purchases• UV Coating• Solid tinting/gradient tinting• Standard scratch-resistant coating• Standard antireective coating• Premium antireective coating• Transition lenses• Standard polycarbonate lensesNote: Not a covered benet. Prices shown reect member payment. Discounts reect percentage off the regular price.1 You are responsible for paying the provider directly for any co-pays, amounts over your allowance, and for any services or materials that are not covered under this rider.2 The standard contact lenses tting exam fee applies to a new or existing contact lens user who wears spherical disposable, daily wear, or extended wear lenses only. This includes follow-ups. 3 The specialty contact lenses tting exam fee applies to a new or existing contact lens user who wears toric, gas permeable, mono-t or multi-focal lens. This includes follow-ups. 4 Eyeglass lenses and frames are paid in lieu of the contact lenses benet.5 The contact lenses benet is paid in lieu of eyeglass lenses and frames.6 These schedules are subject to change without notice. Added value discounts may not be available in all geographical areas and may vary by network. Not all providers, such as Walmart, Sam’s Club and Costco Optical, choose to participate in these programs. Some frames and lens items may have manufacturer restrictions and cannot be discounted. Special lens packages that combine multiple lens enhancements at value price points are not covered by these added value programs. Programs may not be combined with any other promotions or discounts.THIS POLICY PROVIDES LIMITED BENEFITS. A NETWORK ACCESS PLAN IS AVAILABLE.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IDN8100-OR and rider form R-VSN8100-OR. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 4-24 | 1820767-ORColonialLife.com1820767-OR
Dental PPO Member GuideDental insurance coverage provides valuable protection for both your smile and your wallet. Below is information to help use the plan.USING THE DENTAL & VISION NETWORKS• The name of the dental network is Unum DentalNetwork.1 The name of the vision network, if applicable to your coverage, is First Look.• To nd a provider, visit ColonialLifeDental.com• Con rm your provider’s name and address. Network providers who practice at multiple o ces may not be contracted in-network at every o ce.• When scheduling your appointment identify yourself as a “Colonial Life Dental member” and let them know tocheck the network information on your member ID card.• Unable to locate your dentist or eye doctor in ourgrowing network? Refer your provider by calling the Contact Center at 888-400-9304 or emailingnetworkrecruiting@coloniallife.com.Scan this code or go directly to ColonialLifeDental.com.ID CARDS• ID cards are mailed to your home address within 10 business days of enrolling. • Only the main insured’s name will be listed.• Vision coverage, if purchased, includes a separate ID card.• Below are samples of ID cards and the mailing envelope they are sent in.CLA OE WIN 9/188485 Goodwood BoulevardBaton Rouge, LA 70806-7878IMPORTANT! Your insurance documents are enclosed.
CONTACT CENTEROur dental contact center is available to answer your questions.Monday–Friday 8 a.m.– 8 p.m. ETSaturdays 10 a.m.–4 p.m. ETTheir phone number is 888-400-9304.Need assistance not related to dental? Visit ColonialLife.com 24/7 or call contact center at 800-325-4368.ColonialLifeDental.com1. Unum Dental Network is marketed in all states except CT, NC, NJ, NM, WA and WV. In CT, FL, NM, VA, WA and WV, the network will reect on ID cards as Starmount Dental Network / Dentemax Plus. In LA, ID cards will reect as Starmount Dental Network / DenteMax. And in NC and NJ, ID cards will reect as DenteMax Plus.No benets will be paid for replacement of teeth missing prior to the effective date of coverage.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 9-22 | 818100-1MANAGE YOUR BENEFITS AT COLONIALLIFEDENTAL.COMIt’s simple to access your dental and vision benets information. You can:• Search for in-network providers• Login to your dental and vision member portal to:• Print ID cards • View claim history • Access coverage information• Access resources like: • Virtual Dental Visits • Dental Health CenterCLAIMS• Pre-treatment Estimates: We recommend that your provider submits this when treatment is expected to exceed $300. A claims examiner will review the treatment plan in advance and advise how the plan will pay so you know what your cost will be.• Claim Forms: Most providers will le claims on your behalf, but if youdo need to submit your own claim, you can nd the forms you need onColonialLifeDental.com.
Individual Short-Term Disability Insurance ISTD3000 BASEYou never know when a disability could impact your way of life. Fortunately, there’s a way to help protect your income. If a covered accident or sickness prevents you from earning a paycheck, disability insurance can provide a monthly benefit to help you cover your ongoing expenses.Benefits worksheetHow much coverage do I need?Monthly benefit amount for o-job accident and o-job sickness: ______________Choose a monthly benefit amount between $400 and $6,500.*If your plan includes on-job accident/sickness benefits, the benefit is 50% of the o-job amount.What is the benefit period?Benefit period: _______ monthsThe partial disability benefit period is three months.When may my total disability benefits start?Aer an accident: _______ days Aer a sickness: _______ daysCan you aord to not protect your income? You don’t have the same lifestyle expenses as the next person. That’s why you need disability coverage that can be customized to fit your specific needs.Aer calculating your monthly expenses, your benefits counselor can help you complete the benefits worksheet.ColonialLife.com*Subject to income requirementsMONTHLY EXPENSESRound to the nearest hundred.1 Rent or mortgage $2 Transportation $3 Utilities (phone, internet, electricity/gas, water, etc.) $4 Food and necessities $5 Other expenses $ Total monthly expenses (add lines 1-5 together) $3 or 127/714/14
EXCLUSIONS AND LIMITATIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of: cosmetic surgery, felonies or illegal occupations, flying, hazardous avocations, intoxicants and narcotics, mental or nervous disorders, racing, semi-professional or professional sports, substance abuse, suicide or injuries which you intentionally do to yourself, war or armed conflict. We will not pay for losses due to you giving birth within the first nine months aer the coverage eective date of the policy. We will not pay for loss when the disability is a pre-existing condition as described in the policy.Pre-existing condition means a sickness or physical condition, whether diagnosed or not, for which you were treated by a physician, had medical testing, received medical advice from a physician or had taken medication prescribed by a physician within 12 months before the policy coverage eective date shown on the policy schedule.Aer this policy has been in force for 12 months from the policy coverage eective date shown on the policy schedule, we will pay benefits for any pre-existing condition not excluded by name or specific description if the covered disability began at least 12 months aer the policy coverage eective date and the elimination period has been satisfied.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form ISTD3000-OR and rider form ISTD3000-ADIB-OR. This is not an insurance contract and only the actual policy and rider provisions will control.4-19 | 101629-2-ORProduct information Total disability definitionTotally disabled or total disability means you are: unable to perform the material and substantial duties of your occupation, not, in fact, working at any occupation, and under the regular and appropriate care of a physician.How partial disability worksIf you are able to return to work part-time aer at least 14 days of being paid for a total disability, you may be able to still receive 50% of your total disability benefit.Waiver of premiumWe will waive your premium payments aer 90 consecutive days of a covered disability.Geographical limitationsIf you are disabled while outside of the United States, Canada or Mexico, you may receive benefits for up to 60 days before you have to return to the U.S. in order to continue receiving benefits.Issue ageCoverage is available from ages 17 to 74.Keep your coverage You can keep your coverage to age 75 at no additional cost, even if you change jobs, as long as you pay your premiums when they are due.For more information, talk with your benefits counselor.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
Term Life InsurancePeace 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 nancial security to help them cover their ongoing living expenses.Advantages of term life insuranceLower cost when compared to cash value life insuranceSame benet payout throughout the duration of the policySeveral term period options for exibility during high-need yearsBenet for the beneciary that is typically tax freeBenets and features• Stand-alone spouse policy available whether or not you buy a policyfor yourself• Guaranteed premiums that do not increase during the selected term• Ability to convert all or a portion of the benet amount into cash valuelife insurance• Flexibility to keep the policy if you change jobs or retire• Built-in terminal illness accelerated death benet that provides up to 75% of the policy’s death benet (up to $150,000) if you’re diagnosed with a terminal illness1• Premium savings for face amounts over $250,000 based on your health44% of Americans say their household would face nancial hardship within six months should a wage earner die unexpectedly.LIMRA, 2022 Life Insurance Barometer Study.GAP54% 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)
Optional ridersAt an additional cost, you can purchase the following riders for even more nancial protection.Spouse term life riderYour spouse can have up to $50,000 of coverage for a 10-year or 20-year term period.Children’s term life riderYou can purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy — not both.Accidental death benet riderThe beneciary may receive an additional benet if the covered person dies as a result of an accident before age 70. The benet doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benet riderIf a licensed health care practitioner certies that you have a chronic illness, you may receive an advance on all or a portion of the death benet, available in a one-time lump sum or monthly payments.1 A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living.² Premiums are waived during the benet period. Critical illness accelerated death benet riderIf you suffer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benet is payable.1 A subsequent diagnosis benet is included.Waiver of premium benet riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period.3How much coverage do you need? YOU $ _________________Select the term period: 10-year 15-year 20-year 30-year SPOUSE $ _____________Select the term period: 10-year 15-year 20-year 30-yearSelect any optional riders: Spouse term life rider $ _____________ faceamount for ______-yearterm period Children’s term life rider $ _____________ faceamount Accidental death benet rider Chronic care accelerated death benet rider Critical illness accelerated death benet rider Waiver of premiumbenet riderTo learn more, talk with your Colonial Life benets counselor.1. Any payout would reduce the death benet. Benets may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benets. 2. Activities of daily living are bathing, continence, dressing, eating, toileting and transferring. 3. You must resume premium payments once you are no longer disabled.EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage effective date or the date of reinstatement, we will not pay the death benet. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you.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 benets payable. Applicable to policy forms ICC18-ITL5000/ITL5000 and rider forms ICC18-R-ITL5000-STR/R-ITL5000-STR, ICC18-R-ITL5000-CTR/R-ITL5000-CTR, ICC18-R-ITL5000-WP/R-ITL5000-WP, ICC18-R-ITL5000-ACCD/R-ITL5000- ACCD, ICC18-R-ITL5000-CI/R-ITL5000-CI, ICC18-R-ITL5000-CC/R-ITL5000-CC (plus state abbreviations where applicable, for example ITL5000-TX). For cost and complete details of the coverage, call or write your Colonial Life benets counselor or the company.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.FOR EMPLOYEES 6-22 | 101895-3ColonialLife.com
Filing online means never waiting for mail or dealing with fax machines and complex paper forms . Our guided question wizard walks you through the process and checks for missing information that could cause delays. Opting for direct deposit can also get approved payments to you up to a week faster than paper check. NEED TO FILE A CLAIM?Here’s what you can do on Colonial Life for Policyholders:Update yourpersonal info& preferencesFile claimswith a simple,guided form Opt for instant alerts by email or textView claim statusor policy details anytimeCheck your claim status by logging into your account at ColonialLife.com/access. You can also sign up for text or email alerts so you know instantly if status changes or more information is needed. For your convenience, you can login anytime with a mobile device to photograph and upload documents with your camera.AFTER YOU FILE:Find out how simple your claims and benefits experience can be by learning more about the Colonial Life for Policyholders portal. Just visit ColonialLife.com to see what this online account administration platform can do for you.LEARN MOREBECOME A MEMBER TODAY:Go to ColonialLife.com/access to register.Click “create an account”, fill out the required information and click Submit.Enjoy faster service and improved benefits awareness.123THE PORTALOFFERS YOU:Faster service than calling/emailingConfirmation when a claim has been submittedSimplified bill payment and managementAnswers to frequently asked questions and live chat assistance if you don’t see what you are looking for.Colonial Life for Policyholders PortalA faster, simpler way to manage your benefitsColonial Life for Policyholders is an online portal created with you in mind. It’s the most convenient and ecient way to file a claim and manage your benefits. Colonial Life 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.43233-41Set up directdeposit forapproved payments