Design Ventures LLC Enrollment S : simplebooklet.com

Medical Plan Benefit and Cost Comparison Summary Company Name LD Signs LLC DBA Design Ventures Effective Date 02 01 2025 Base Plan Mid Plan Buy Up Plan BlueCross BlueShield BlueCross BlueShield Blue Cross Blue Shield S9E5ADT G9L1CHC P621CHC In network Out of network In network Out of network In network Out of network Individual Deductible 6 100 N A 2 250 4 500 1 350 2 700 Family Deductible 12 200 N A 6 750 13 500 4 050 8 100 Individual Out of Pocket Max 8 350 N A 6 750 Unlimited 1 350 Unlimited Family Out of Pocket Max 16 700 N A 18 400 Unlimited 4 050 Unlimited Coinsurance Policy Holder 20 after Ded N A 20 after Ded 30 after Ded 0 after Ded 20 after Ded Primary Care Office 55 N A 35 30 after Ded 30 20 after Ded Specialist Care 100 N A 70 30 after Ded 55 20 after Ded Benefit items Emergency Room Urgent Care In Patient Hospital Out Patient Hospital Prescription Drug Tiers 750 Copay 20 after Ded 100 N A 350 visit N A 20 after Ded 300 visit N A 20 after Ded 500 Copay 20 after Ded 75 30 after Ded 400 Copay 0 after Ded 30 20 after Ded 300 visit 250 visit 150 visit 250 visit 20 after Ded 30 after Ded 0 after Ded 20 after Ded 100 visit 200 visit 100 visit 200 visit 20 after Ded 30 after Ded 0 after Ded 20 after Ded 0 10 50 100 150 250 0 10 50 100 150 250 0 10 35 75 150 250 Pay Period Cost 52 Pay Period Cost 52 Pay Period Cost 52 Employee 26 25 46 86 55 40 Employee Spouse 157 48 281 16 332 39 Employee Child ren 157 48 281 16 332 39 Employee Family 288 71 515 47 609 39 Preferred Pharmacy after deductible

Page 3

Page 4

Page 5

Group Accident Insurance Our coverage includes Premier Plan If you are in an accident your focus should be on recovery not how you re going to pay your bills Colonial Life accident insurance can pay benefits directly to you to use however you like from medical costs to everyday expenses Whether you ve had a fall or a car accident these benefits can offer financial support when you need it Benefits payable directly to you No medical questions to qualify for coverage Coverage for simple and complex injuries Benefits payable regardless of other insurance Worldwide coverage BENEFITS STORY Works alongside your Health Savings Account HSA Milo was working in his yard when he tripped and injured his hand With Colonial Life accident benefits Milo was able to pay the annual deductible and co payments for his health insurance plan without using his savings or taking on debt MILO S ACCIDENT BENEFITS Milo went to an urgent care facility and received immediate care Treatment in a physician s office or urgent care facility The doctor ordered an X ray and discovered Milo had fractured his hand X ray Fracture hand The doctor also found that Milo had a cut on his hand but did not require stitches Laceration no repair 75 Milo was discharged with a splint Durable medical equipment 65 Over the next several weeks Milo had two follow up appointments with his doctor Physician follow up visits 2 visits For illustrative purposes only Benefit amounts may vary and may not cover all expenses Total 150 60 1 200 50 x 2 100 1 650 GROUP ACCIDENT GAC4100 PREMIER PLAN

Page 6

Give your benefits a boost We know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life Group Accident includes a Benefit Booster to provide additional financial support for serious accidents If you have more than 5 000 in payable benefits for a covered accident we will give you a 500 boost to your benefits to help you with whatever expenses you have Payable once per Insured per covered accident BENEFITS STORY Olivia was driving to the store when she got into a car accident Olivia s benefits helped her cover her medical expenses when she was injured in a car accident helping her to focus on her recovery OLIVIA S ACCIDENT BENEFITS 400 250 250 Olivia arrived by ambulance at the nearest emergency room and received immediate care Ambulance Emergency department visit Injury due to auto accident 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 X ray Medical imaging Fracture thigh 60 400 4 200 Olivia required surgery for her leg Surgical repair thigh fracture General anesthesia 4 200 300 Olivia boarded her pet for two nights after her surgery Pet boarding 2 days 20 x 2 40 Olivia had eight sessions of physical therapy to help regain the strength in her leg and two follow up appointments with her doctor Therapy services 8 sessions Physician follow up visits 2 visits 55 x 8 440 50 x 2 100 Olivia s benefits for this accident totaled more than 5 000 Benefit Booster For illustrative purposes only Benefit amounts may vary and may not cover all expenses Total 500 11 140 Benefits are per covered person per covered accident unless stated otherwise Injury benefits Burns based on size and degree 750 21 000 Concussion 500 Connective tissue damage 100 200 Eye injury 400 Hearing loss injuries 120 Maximum once per lifetime per ear per insured Injury due to auto accident 250 Internal injuries 200 Knee cartilage meniscus injury 200 Lacerations 75 1 200 Loss of a digit partial 400 800 Loss of a digit 1 000 3 000 Ruptured or herniated disc 200 400

Page 7

Fracture benefits Injury 200 5 000 Examples finger 200 wrist 1 200 hip 4 200 Surgical repair of fracture 100 Payable as an additional of the applicable fractures benefit Chip fracture 25 Payable as a of the applicable fractures benefit Dislocation benefits Injury 260 4 000 Examples elbow 600 ankle 1 600 hip 4 000 Surgical repair of dislocation 100 Payable as an additional of the applicable dislocations benefit Incomplete dislocation 25 Payable as a of the applicable dislocations benefit Treatment benefits Prosthetic device or artificial limb 1 750 3 500 Skin grafts due to burns 50 Payable as a of the applicable burn benefit Skin grafts not due to burns 375 750 Transfusions 500 Transportation 200 per trip Maximum 6 one way trips Treatment in a physician s office or urgent care facility 150 Maximum 4 per year X ray or ultrasound 60 Surgery benefits Anesthesia 150 300 Connective tissue surgery 150 2 200 Eye surgery 400 General surgery Abdominal thoracic or cranial 2 000 Air ambulance 2 000 Exploratory surgery 275 Ambulance ground or water 400 Hernia surgery 400 Durable medical equipment 65 250 Knee cartilage meniscus surgery 150 1 050 Emergency dental repair 200 600 Outpatient surgical facility 400 Emergency department 250 Maximum 4 per year Ruptured or herniated disc surgery 150 2 000 Family care 50 per day Maximum of one benefit per day for all insureds combined up to a maximum of three days per covered accident regardless of the number of children Injections to prevent or limit infection 50 Lodging 250 per day Maximum 30 days Medical imaging 400 Pain management injections 150 Pet boarding 20 per day Maximum of one benefit per day for all insureds combined up to a maximum of three days per covered accident regardless of the number of pets that are boarded Recovery care benefits At home care 125 per day Maximum 5 days Benefit Booster 500 Physician follow up visits 50 Maximum 6 days per covered accident and 24 days per calendar year Rehabilitation or sub acute rehabilitation unit confinement 200 per day Maximum 15 days per covered accident and 30 days per calendar year Therapy services speech physical therapy occupational therapy 55 per day Maximum 15 days Options checked below have been chosen by your employer to enhance your Group Accident Coverage Recovery Plus package Gunshot wound benefit Behavioral health therapy 55 per day Maximum 15 days This benefit can help pay your medical expenses if you receive a non fatal gunshot wound It offers you a lump sum for a covered injury regardless of any other insurance you may have and includes on off job coverage Post traumatic stress disorder PTSD 200 Prescription drug 25 Additional therapy services chiropractic acupuncture alternative therapy 55 Existing therapy services benefit maximum applies to additional therapy services maximum 15 days Injury due to felonious act of violence or sexual assault 250 Maximum once per insured per calendar year with an accompanying police report Gunshot wound _________ This benefit covers a non fatal gunshot wound from a conventional firearm that requires treatment by a doctor and overnight hospitalization within 24 hours of the injury If you are shot more than once in a 24 hour period we can pay benefits only for the first wound

Page 8

Group Hospital Indemnity Insurance Plan 1 HSA Compliant Group Medical BridgeSM insurance can help with medical costs associated with a hospital stay that your health insurance may not cover These benefits are available for you your spouse and eligible dependent children Hospital confinement _______________ per day Maximum of one day per covered person per calendar year Waiver of premium Available after 30 continuous days of a covered confinement of the named insured Daily hospital confinement 100 per day Maximum of 365 days per covered person per confinement Re confinement for the same or related condition within 90 days of discharge is considered a continuation of a previous confinement Health savings account HSA compatible This plan is compatible with HSA guidelines and any other HSA plan that a covered family member may participate in It may also be offered to employees who do not have HSAs For more information talk with your benefits counselor Colonial Life Accident Insurance Company s Group Medical Bridge offers an HSA compatible plan in most states PA Hospital Confinement Admission benefit replaces the Hospital Confinement benefit THIS POLICY PROVIDES LIMITED BENEFITS EXCLUSIONS We will not pay any benefits for injuries received in accidents or for sicknesses which are caused by contributed to by or occur as a result of the following exclusions and limitations a alcoholism or drug addiction b dental procedures c elective procedures and cosmetic surgery d felonies or illegal occupations e mental or nervous disorders f pregnancy of a dependent child g suicide or injuries which any covered person intentionally does to himself or herself h war or i giving birth within the first nine months after the effective date of the certificate j We will not pay benefits for hospital confinement or daily hospital confinement if included of a newborn child following his birth unless he is injured or sick k The policy may have additional exclusions and limitations which may affect any benefits payable ColonialLife com PRE EXISTING CONDITION LIMITATIONS l We will not pay benefits for loss during the first 12 months after the certificate effective date due to a pre existing condition m A pre existing condition is a sickness or physical condition whether diagnosed or not for which a covered person was treated had medical testing received medical advice or had taken medication within the 12 months before the certificate effective date n This limitation applies to the following benefits if applicable Hospital Confinement and Daily Hospital Confinement This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P and certificate form GMB7000 C including state abbreviations where applicable such as policy forms GMB7000 P AU TX and GMB7000 P EE TX and certificate forms GMB7000 C AU TX and GMB7000 C EE TX Coverage may vary by state and may not be available in all states This form is not complete without form 101733 Underwritten by Colonial Life Accident Insurance Company Columbia SC 2018 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GMB7000 PLAN 1 11 18 101917

Page 9

Page 10

Diagnosis of cancer benefit Covered cancer benefits For this condition 1 The amount payable is Diagnosis of cancer internal or invasive 100 of the face amount Diagnosis of carcinoma in situ 25 of the face amount Skin cancer 500 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 certificate is inforce Colonial Life The benefits of good hard work 1 Please refer to the certificate for complete definitions of covered conditions 2 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 3 Dates of diagnoses of a covered critical illness must be separated by at least 180 days THIS POLICY PROVIDES LIMITED BENEFITS Colonial Life com Insureds in MA must be covered by comprehensive health insurance before applying for this coverage EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benefit or Benefit Payable Upon Subsequent Diagnosis of a Critical Illness that occurs as a result of a covered person s alcoholism or drug addiction felonies or illegal occupations intoxicants and narcotics psychiatric or psychological conditions suicide or injuries which any covered person intentionally does to himself war or armed conflict or pre existing condition unless the covered person has satisfied the pre existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Diagnosis of Cancer Benefit Diagnosis of Carcinoma in Situ Benefit the Cancer Treatment and Care Benefit or the Skin Cancer Benefit for a covered person s cancer internal or invasive carcinoma in situ or skin cancer that is diagnosed or treated outside the territorial limits of the United States its possessions or the countries of Canada and Mexico is a pre existing condition unless the covered person has satisfied the pre existing condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having cancer internal or invasive carcinoma in situ or skin cancer No pre existing condition limitation will be applied for dependent children who are born or adopted while you are covered under the policy and who are continuously covered from the date of birth or adoption This is not an insurance contract and only the actual certificate provisions will control Applicable to certificate form GCCl 0 C including state abbreviations where used for example GCCl 0 C lX The certificate or its provisions may vary or be unavailable in some states Please see your Colonial Life benefits counselor for details Underwritten by Colonial Life Accident Insurance Company Columbia SC 2016 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 11 16 I 100361 1

Page 11

Deductions per year 12 These rates were prepared on 3 22 2024 and are valid for 90 days Group Accident GAC4100 for TX Applicable to policy forms GAC4100 P GAC4100 C l Additional Benefits On Off Job Accident Coverage BENEFIT LEVEL AD D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENT CHILD REN EMPLOYEE SPOUSE AND DEPENDENT CHILD REN Premier Premier 15 75 24 56 35 18 44 20 17 99 Group Medical Bridge GMB7000 for TX Age Banded Applicable to Policy Forms GMB7000 P GMB7000 C l Without Wellbeing Assistance HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY Level 2 1000 17 49 50 59 60 64 65 99 9 50 12 30 17 20 24 10 17 10 24 40 35 80 50 10 13 55 16 35 21 25 28 15 21 15 28 45 39 85 54 15 HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY Level 4 2000 17 49 50 59 60 64 65 99 18 90 24 50 34 30 48 10 34 00 48 60 71 40 100 00 26 95 32 55 42 35 56 15 42 05 56 65 79 45 108 05 Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD Group Critical Illness GCI6000 for TX l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 50 Benefit Non Tobacco Rates 15 000 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 8 90 11 45 14 15 20 15 26 15 36 05 45 80 59 30 79 85 97 25 97 25 13 05 16 95 20 85 30 00 39 00 54 30 69 60 90 15 121 35 148 05 148 05 8 90 11 45 14 15 20 15 26 15 36 05 45 80 59 30 79 85 97 25 97 25 13 05 16 95 20 85 30 00 39 00 54 30 69 60 90 15 121 35 148 05 148 05 Underwritten by Colonial Life Accident Insurance Company See page 2 for Important Notice

Page 12

Continued Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD Group Critical Illness GCI6000 for TX l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 50 Benefit Non Tobacco Rates 30 000 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 14 90 20 00 25 40 37 40 49 40 69 20 88 70 115 70 156 80 191 60 191 60 21 60 29 40 37 20 55 50 73 50 104 10 134 70 175 80 238 20 291 60 291 60 14 90 20 00 25 40 37 40 49 40 69 20 88 70 115 70 156 80 191 60 191 60 21 60 29 40 37 20 55 50 73 50 104 10 134 70 175 80 238 20 291 60 291 60 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 12 50 16 70 20 90 30 50 40 10 55 85 71 45 93 05 125 90 153 80 153 80 22 10 30 50 38 90 58 10 77 30 108 80 140 00 183 20 248 90 304 70 304 70 18 15 24 45 30 75 45 15 59 70 84 15 108 60 141 60 191 55 234 00 234 00 31 80 44 40 57 00 85 80 114 90 163 80 212 70 278 70 378 60 463 50 463 50 12 50 16 70 20 90 30 50 40 10 55 85 71 45 93 05 125 90 153 80 153 95 22 10 30 50 38 90 58 10 77 30 108 80 140 00 183 20 248 90 304 70 305 00 18 15 24 45 30 75 45 15 59 70 84 15 108 60 141 60 191 55 234 00 234 15 31 80 44 40 57 00 85 80 114 90 163 80 212 70 278 70 378 60 463 50 463 80 Tobacco Rates 15 000 30 000 Important Notice Insurance coverage has exclusions and limitations that may affect benefits payable For a complete description of benefits limitations and exclusions please refer to an outline of coverage sample policy certificate proposal description or see your Colonial Life benefits counselor Coverage type benefits and rates vary by state Coverage may not be available in all states Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices Colonial Life products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand Underwritten by Colonial Life Accident Insurance Company See page 2 for Important Notice

Design Ventures LLC Enrollment S

Page 1

Page 2