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Benefit Booklet 2023

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 Products Accident Insurance From a fall to a car accident this coverage offers a range of benefits to help cover medical or non medical related expenses due to a covered accident Hospital Confinement Indemnity Insurance Medical Bridge Provides benefits to help cover the cost of a hospital stay and other medical procedures Disability Insurance Provides financial protection to cover income loss from a covered disability Critical Illness Insurance Provides lumpsum benefits for a covered critical illness such as a heart attack or stroke Term Whole Life Insurance Provides a predictable way to provide life coverage at more affordable prices during high need years For more information contact Shelley Hartsell 704 883 4838 Shelley Hartsell ColonialLifeSales com BROKER EMPLOYER 2 23 NS 1017472

Accident Insurance Accidents happen in places where you and your family spend the most time at work in the home and on the playground and they re unexpected How you care for them shouldn t be In your lifetime which of these accidental injuries have happened to you or someone you know l Sports related accidental injury l Broken bone l Burn l Concussion l Laceration l Back or knee injuries l Car accidents l Falls spills l Dislocation l Accidental injuries that send you to the Emergency Room Urgent Care or doctor s office Colonial Life s Accident Insurance is designed to help you fill some of the gaps caused by increasing deductibles co payments and out of pocket costs related to an accidental injury The benefit to you is that you may not need to use your savings or secure a loan to pay expenses Plus you ll feel better knowing you can have greater financial security What additional features are included l Worldwide coverage l Portable l Compliant with Healthcare Spending Account HSA guidelines Will my accident claim payment be reduced if I have other insurance You re paid regardless of any other insurance you may have with other insurance companies and the benefits are paid directly to you unless you specify otherwise What if I change employers If you change jobs or leave your employer you can take your coverage with you at no additional cost Your coverage is guaranteed renewable as long as you pay your premiums when they are due or within the grace period Can my premium change Colonial Life can change your premium only if we change it on all policies of this kind in the state where your policy was issued How do I file a claim Visit coloniallife com or call our Customer Service Department at 1 800 325 4368 for additional information Accident 1 0 Premier with Health Screening Benefit

Benefits listed are for each covered person per covered accident unless otherwise specified Initial Care l Accident Emergency Treatment 200 l X ray Benefit 60 l Ambulance 600 l Air Ambulance 2 000 Common Accidental Injuries Dislocations Separated Joint Hip Knee except patella Ankle Bone or Bones of the Foot other than Toes Collarbone Sternoclavicular Lower Jaw Shoulder Elbow Wrist Bone or Bones of the Hand Collarbone Acromioclavicular and Separation One Toe or Finger Non Surgical 9 600 4 800 3 840 2 400 1 440 1 440 480 480 Surgical 19 200 9 600 7 680 4 800 2 880 2 880 960 960 Fractures Depressed Skull Non Depressed Skull Hip Thigh Body of Vertebrae Pelvis Leg Bones of Face or Nose except mandible or maxilla Upper Jaw Maxilla Upper Arm between Elbow and Shoulder Lower Jaw Mandible Kneecap Ankle Foot Shoulder Blade Collarbone Vertebral Process Forearm Wrist Hand Rib Coccyx Finger Toe Non Surgical 9 000 3 600 5 400 2 700 1 260 1 260 1 260 1 080 1 080 1 080 900 720 360 Surgical 18 000 7 200 10 800 5 400 2 520 2 520 2 520 2 160 2 160 2 160 1 800 1 440 720 Your Colonial Life policy also provides benefits for the following injuries received as a result of a covered accident l Burn based on size and degree 1 000 to 12 000 l Coma 12 500 l Concussion 150 l Emergency Dental Work 100 Extraction 400 Crown Implant or Denture l Lacerations based on size 50 to 800 Requires Surgery l Eye Injury 300 l Tendon Ligament Rotator Cuff 750 one 1 500 two or more l Ruptured Disc 750 l Torn Knee Cartilage 750 Surgical Care l Surgery cranial open abdominal or thoracic 1 500 l Surgery hernia 150 l Surgery arthroscopic or exploratory 300 l Blood Plasma Platelets 300

Transportation Lodging Assistance If injured covered person must travel more than 50 miles from residence to receive special treatment and confinement in a hospital l Transportation 600 per round trip up to 3 round trips l Lodging family member or companion 150 per night up to 30 days for a hotel motel lodging costs Accident Hospital Care l Hospital Admission 2 000 per accident l Hospital ICU Admission 4 000 per accident We will pay either the Hospital Admission or Hospital Intensive Care Unit ICU Admission but not both l Hospital Confinement 300 per day up to 365 days per accident l Hospital ICU Confinement 600 per day up to 15 days per accident Accident Follow Up Care l Accident Follow Up Doctor Visit 50 up to 4 visits per accident l Medical Imaging Study 300 per accident limit 1 per covered accident and 1 per calendar year l Occupational or Physical Therapy 35 per treatment up to 10 days l Appliances 125 such as wheelchair crutches l Prosthetic Devices Artificial Limb 750 one 1 500 more than 1 l Rehabilitation Unit 150 per day up to 15 days per covered accident and 30 days per calendar year Maximum of 30 days per calendar year Accidental Dismemberment l Loss of Finger Toe 1 250 one 2 400 two or more l Loss or Loss of Use of Hand Foot Sight of Eye 12 000 one 24 000 two or more Catastrophic Accident For severe injuries that result in the total and irrecoverable l Loss of one hand and one foot l Loss of both hands or both feet l Loss or loss of use of one arm and one leg or l Loss or loss of use of both arms or both legs l Loss of the sight of both eyes l Loss of the hearing of both ears l Loss of the ability to speak Named Insured 25 000 Spouse 25 000 Child ren 12 500 365 day elimination period Amounts reduced for covered persons age 65 and over Payable once per lifetime for each covered person Accidental Death l Named Insured l Spouse l Child ren Accidental Death 50 000 50 000 10 000 Common Carrier 200 000 200 000 40 000

Health Screening Benefit l 50 per covered person per calendar year Provides a benefit if the covered person has one of the health screening tests performed This benefit is payable once per calendar year per person and is subject to a 30 day waiting period Tests include l Blood test for triglycerides l Bone marrow testing l Breast ultrasound l CA 15 3 blood test for breast cancer l CA125 blood test for ovarian cancer l Carotid doppler l CEA blood test for colon cancer l Chest x ray l Colonoscopy l Echocardiogram ECHO l Electrocardiogram EKG ECG l Fasting blood glucose test l Flexible sigmoidoscopy l Hemoccult stool analysis l Mammography l Pap smear l PSA blood test for prostate cancer l Serum cholesterol test to determine level of HDL and LDL l Serum protein electrophoresis blood test for myeloma l Stress test on a bicycle or treadmill l Skin cancer biopsy l Thermography l ThinPrep pap test l Virtual colonoscopy My Coverage Worksheet For use with your Colonial Life benefits counselor Who will be covered check one Employee Only Spouse Only One Child Only Employee Spouse One Parent Family with Employee One Parent Family with Spouse Two Parent Family When are covered accident benefits available check one On and Off Job Benefits Off Job Only Benefits EXCLUSIONS We will not pay benefits for losses that are caused by or are the result of hazardous avocations felonies or illegal occupations racing semi professional or professional sports sickness suicide or self inflicted injuries war or armed conflict in addition to the exclusions listed above we also will not pay the Catastrophic Accident benefit for injuries that are caused by or are the result of birth intoxication For cost and complete details see your Colonial Life benefits counselor Applicable to policy form Accident 1 0 HS NC This is not an insurance contract and only the actual policy provisions will control Accident 1 0 Premier with Health Screening Benefit Colonial Life 1200 Colonial Life Boulevard Columbia South Carolina 29210 coloniallife com 2014 Colonial Life Accident Insurance Company Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand 6 14 71741 NC

For more information talk with your benefits counselor ColonialLife com Hospital Confinement Indemnity Insurance Plan 1 Our Individual Medical BridgeSM insurance can help with medical costs that your health insurance may not cover These benefits are available for you your spouse and eligible dependent children Hospital confinement _2__0_0_0_____________ Maximum of one benefit per covered person per calendar year Observation room 100 per visit Maximum of two visits per covered person per calendar year Rehabilitation unit confinement 100 per day Maximum of 15 days per confinement with a 30 day maximum per covered person per calendar year Waiver of premium Available a er 30 continuous days of a covered hospital confinement of the named insured Health savings account HSA compatible This plan is compatible with HSA guidelines This plan may also be o ered to employees who do not have HSAs Colonial Life Accident Insurance Company s Individual Medical Bridge o ers an HSA compatible plan in most states THIS POLICY PROVIDES LIMITED BENEFITS EXCLUSIONS We will not pay benefits for injuries received in accidents or for sicknesses which are caused by a alcoholism or drug addiction b dental procedures c elective procedures and cosmetic surgery d felonies or illegal occupations e pregnancy of a dependent child f psychiatric or psychological conditions g suicide or injuries which any covered person intentionally does to himself or herself or h war We will not pay benefits for hospital confinement i due to giving birth within the first nine months a er the e ective date of the policy or j for a newborn who is neither injured nor sick k The policy may have additional exclusions and limitations which may a ect any benefits payable PRE EXISTING CONDITION LIMITATION l We will not pay benefits for loss during the first 12 months a er the e ective date due to a pre existing condition m A preexisting condition is a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within the 12 months before the e ective date of the policy n This limitation applies to the following benefits if applicable Hospital Confinement Daily Hospital Confinement Enhanced Intensive Care Unit Confinement and Rehabilitation Unit Confinement This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The policy has exclusions and limitations which may a ect any benefits payable Applicable to policy form IMB7000 including state abbreviations where used for example IMB7000 TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company This form is not complete without form 562973 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 IMB7000 PLAN 1 1 21 562880

Hospital Confinement Indemnity Insurance Exclusions and Limitations STATE SPECIFIC EXCLUSIONS AK a Replaced by intoxicants and narcotics CA a Replaced by intoxicants or controlled substances c Replaced by cosmetic surgery CT a Replaced by intoxication or drug addiction d Replaced by felonies e Exclusion does not apply DE a Exclusion does not apply IL a Replaced by alcoholism intoxication or drug addiction e Exclusion does not apply g Exclusion does not apply KS a Replaced by intoxicants and narcotics f Exclusion does not apply h Replaced by war or armed conflict i Exclusion does not apply j or requires necessary care and treatment of medically diagnosed congenital defects birth abnormalities or routine and necessary immunizations KY a Replaced by intoxicants narcotics and hallucinogenics LA a Replaced by intoxicants and narcotics MI g Exclusion does not apply MN a Replaced by narcotic addiction e Exclusion does not apply g Exclusion does not apply MO a Replaced by drug addiction NC i Exclusion does not apply OR a Exclusion does not apply d Replaced by felony i Replace nine months with six months SC f Replaced by mental or emotional disorders SD a Exclusion does not apply TN a Replaced by intoxicants and narcotics e Exclusion does not apply TX a Replaced by intoxicants and narcotics WA a Only sicknesses caused by alcoholism or drug addiction are excluded not accidents STATE SPECIFIC PRE EXISTING CONDITION LIMITATIONS NV WY m applies within the six months before the policy e ective date CT m Pre existing Condition means having a sickness or physical condition for which any covered person was treated received medical advice or had taken medication within 12 months before the e ective date of this policy FL m Pre existing Condition means any covered person having a sickness or physical condition that during the 12 months immediately preceding the e ective date of this policy had manifested itself in such a manner as would cause an ordinarily prudent person to seek medical advice diagnosis care or treatment or for which medical advice diagnosis care or treatment was recommended or received Routine follow up care during the 12 months immediately preceding the e ective date of this policy to determine whether a breast cancer has recurred in a covered person who has been previously determined to be free of breast cancer does not constitute medical advice diagnosis care or treatment for purposes of determining pre existing conditions unless evidence of breast cancer is found during or as a result of the follow up care GA m Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken prescription medication within 12 months before the e ective date of this policy IL m Pre existing Condition means having a sickness or physical condition for which any covered person was diagnosed treated had medical testing by a legally qualified physician or received medical advice or had taken medication within 12 months prior to the e ective date of this policy ME m Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing or received medical advice within 12 months before the e ective date of this policy NC m Pre existing Condition means having those conditions whether diagnosed or not for which any covered person received medical advice diagnosis care or treatment was received or recommended within one year period immediately preceding the e ective date of this policy If you are 65 or older when this policy is issued pre existing conditions will include only conditions specifically eliminated by rider OR Pre existing Condition means having a sickness or physical condition for which any covered person was diagnosed received treatment care or medical advice within the 6 month period immediately preceding the e ective date of this policy Insureds in California Oregon and South Dakota must be covered by comprehensive health insurance before applying for hospital indemnity insurance This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may a ect any benefits payable Applicable to policy form IMB7000 including state abbreviations where used for example IMB7000 TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company This form is not complete without base form 562880 562911 or 562942 Underwritten by Colonial Life Accident Insurance Company Columbia SC 2022 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company IMB7000 EXCLUSIONS AND LIMITATIONS 3 22 562973 1

48 ONLY of American adults say they have enough savings to cover three months of living expenses in the event they re not earning any income 1 Talk with your Colonial Life benefits counselor to learn more More than one in four of today s 20 year olds can expect to be out of work for at least a year because of a disabling condition before they reach the normal retirement age 1 How can you protect your income If you become disabled you could be out of work for a period of time Without your income how would you pay for your everyday living expenses Fortunately Colonial Life Accident Insurance Company offers financial protection options that can help you What can cause a disability Regardless of your age or health a disability could keep you out of work for weeks or months Some of the most common conditions associated with short term disability claims are arthritis pregnancy back problems dislocations sprains and fractures 2 How reliable is your safety net While many with disabilities look to workers compensation or Social Security Disability Insurance for help these resources aren t always reliable Even if they can help you still might be unable to meet all of your financial obligations More than 65 of workers who apply for Social Security Disability Insurance are denied 3 At least 51 million working adults in the United States are without disability insurance other than the basic coverage available through Social Security 1 The disability worksheet on the back can help you determine your income needs

Disability needs worksheet Colonial Life and the Council for Disability Awareness CDA are working together to increase awareness of the need for benefits to help protect employees income Use this worksheet to help figure out how much income you would need to sustain your standard of living if you were disabled This worksheet is only meant to give you a rough estimate and may not include every expense in your budget 1 Rent or mortgage 2 Transportation gas car bus etc 3 Utilities phone internet TV electricity gas water 4 Food and necessities 5 Other expenses Total monthly expenses add lines 1 5 together MONTHLY EXPENSES Round to the nearest hundred ColonialLife com Help preserve your way of life With short term disability insurance You may receive monthly benefits if you become disabled because of a covered accident or sickness Partial disability could enable you to work part time and still receive 50 of the total disability benefits In most cases you can keep your coverage even if you leave your employer Learn more about how disability insurance can help protect your income by talking with your benefits counselor 1 Council for Disability Awareness The Crisis of Disability Coverage in America 2018 2 Colonial Life internal data 2018 3 Social Security Administration Selected Data from Social Security s Disability Program 2018 Insurance products are 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 11 19 101165 7

Specified Critical Illness Insurance For more information talk with your benefits counselor ColonialLife com 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 15K 25K 50 Critical illness benefit For the diagnosis of this covered critical illness condition 1 Cancer Heart attack myocardial infarction Stroke End stage renal kidney failure Major organ failure Permanent paralysis due to a covered accident Coma Blindness Occupational infectious HIV or occupational infectious hepatitis B C or D Coronary artery bypass graft surgery disease2 Carcinoma in situ This percentage of the face amount is payable 100 100 100 100 100 100 100 100 100 25 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 Subsequent diagnosis of a different critical illness3 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 Subsequent diagnosis of the same critical illness3 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 2 carcinoma in situ and occupational infectious HIV or occupational infectious hepatitis B C or D CRITICAL ILLNESS 1 0 WITH CANCER AND SUBSEQUENT DIAGNOSIS

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 1 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 graft 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 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 is not an insurance contract and only the actual policy provisions will control 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 The policy 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 2019 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 4 19 101825 1

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

Benefits worksheet For use with your benefits counselor HOW MUCH COVERAGE DO YOU NEED YOU ___________________ Select the option Paid Up at Age 70 Paid Up at Age 100 SPOUSE _______________ Select the option Paid Up at Age 70 Paid Up at Age 100 DEPENDENT STUDENT ____________ Paid Up at Age 70 Paid Up at Age 100 Select any optional riders S pouse term life rider _____________ face amount for ________ year term period Children s term life rider _____________ face amount Accidental death benefit rider Chronic care accelerated death benefit rider Critical illness accelerated death benefit rider Guaranteed purchase option rider Waiver of premium benefit rider Additional coverage options Spouse term life rider Cover your spouse up to a maximum death benefit of 50 000 10 year and 20 year spouse term riders are available Juvenile whole life policy You can purchase a policy while children are young and premiums are low whether or not you buy a policy on yourself You may also increase the coverage when the child is 18 21 and 24 without providing proof of good health The plan is paid up at age 70 Children s term life rider You may 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 benefit rider The beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70 The benefit 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 benefit rider If a licensed health care practitioner certifies that you have a chronic illness you may receive an advance on all or a portion of the death benefit available in a one time lump sum or monthly payments 2 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 bathing continence dressing eating toileting and transferring Premiums are waived during the benefit period Critical illness accelerated death benefit rider If you suffer a heart attack myocardial infarction stroke or end stage renal kidney failure a 5 000 benefit is payable 2 A subsequent diagnosis benefit is included Guaranteed purchase option rider If you are age 50 or younger when you purchase the policy you can add the rider which allows you to purchase additional whole life coverage without having to answer health questions at three different points in the future You may purchase up to your initial face amount not to exceed a total combined maximum of 100 000 for all options Waiver of premium benefit rider Premiums 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 Once you are no longer disabled premium payments will resume 1 Loan should be repaid to protect the policy s value 2 Any payout would reduce the death benefit Benefits may be taxable as income Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits To learn more talk with your benefits counselor ColonialLife com EXCLUSIONS AND LIMITATIONS If 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 benefit We will terminate this policy and return the premiums paid without interest minus any loans and loan interest to you Product may vary by state For costs and complete details of the coverage call or write your Colonial Life benefits counselor or the company This brochure is applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD RIWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 RIWL5000 GPO R IWL5000 GPO and applicable state variations 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 6 19 101935

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 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 year Select any optional riders Spouse term life rider _____________ face amount for ______ year term period Children s term life rider _____________ face amount Accidental death benefit rider Optional riders At an additional cost you can purchase the following riders for even more financial protection Spouse term life rider Your spouse can have up to 50 000 of coverage for a 10 year or 20 year term period Children s term life rider You 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 benefit rider The beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70 The benefit 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 benefit rider If a licensed health care practitioner certifies that you have a chronic illness you may receive an advance on all or a portion of the death benefit 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 Premiums are waived during the benefit period Critical illness accelerated death benefit rider Chronic care accelerated If you suffer a heart attack myocardial infarction stroke or end stage renal kidney failure a 5 000 benefit is payable 1 A subsequent diagnosis benefit is included Critical illness Waiver of premium benefit rider Waiver of premium Premiums 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 3 death benefit rider accelerated death benefit rider benefit rider 1 Any payout would reduce the death benefit Benefits may be taxable as income Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits 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 LIMITATIONS To learn more talk with your Colonial Life benefits counselor If 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 benefit 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 benefits payable Applicable to policy forms ICC18 ITL5000 ITL5000 and rider forms ICC18 R ITL5000 STR R ITL5000 STR ICC18 R ITL5000 CTR RITL5000 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 benefits 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 ColonialLife com FOR EMPLOYEES 6 22 101895 3

Deductions per year 52 Accident 1 0 for NC l On Off Job Accident Coverage Premier with health screening These rates were prepared on 9 5 2023 and are valid for 90 days Applicable to policy forms ACCIDENT 1 0 HS and ACCIDENT 1 0 NS ISSUE AGE 17 80 NAMED INSURED 6 12 EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY 8 38 9 16 11 42 Individual Medical Bridge for NC Applicable to policy form Individual Medical Bridge l 2000 Hospital Confinement Benefit and Outpatient Surgical Procedure Benefit with a calendar year maximum of 1500 ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENT CHILDREN EMPLOYEE SPOUSE AND DEPENDENT CHILDREN 17 49 50 59 60 64 65 75 7 52 10 57 14 13 20 31 14 27 20 10 26 83 38 51 10 41 13 45 17 01 23 49 17 16 22 99 29 71 41 67 Individual Disability ISTD3000 for NC AA Risk Class l Off Job Accident Off Job Sickness with First Day Hospital 3 Month Benefit Period ELIMINATION PERIOD ISSUE AGE 800 0 days Accident 7 days Sickness monthly benefit amount 17 49 50 64 65 74 6 33 7 51 10 54 1 000 7 92 9 39 13 18 Applicable to policy form Individual Disability 1 200 9 50 11 27 15 81 1 400 11 08 13 15 18 45 1 600 12 66 15 03 21 08 Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Health Screening Benefit Cancer Benefit Non Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY 10 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 1 45 1 91 2 39 3 11 3 73 4 86 6 73 8 28 10 95 13 01 2 19 2 91 3 64 4 75 5 70 7 48 10 34 12 71 16 82 19 98 1 82 2 28 2 76 3 48 4 10 5 25 7 10 8 67 11 35 13 42 Applicable to policy form CI 1 0 TWO PARENT FAMILY 2 58 3 30 4 04 5 14 6 09 7 84 10 71 13 11 17 21 20 40 Page 1 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Continued Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Health Screening Benefit Cancer Benefit Non Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY 15 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 1 92 2 61 3 34 4 41 5 35 7 04 9 85 12 17 16 18 19 26 2 91 3 98 5 09 6 75 8 17 10 83 15 13 18 69 24 85 29 59 2 47 3 17 3 89 4 97 5 90 7 63 10 40 12 75 16 77 19 88 20 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 2 39 3 32 4 28 5 72 6 96 9 22 12 96 16 05 21 41 25 52 3 62 5 05 6 53 8 74 10 64 14 19 19 91 24 67 32 88 39 21 3 13 4 05 5 02 6 45 7 70 10 01 13 70 16 84 22 19 26 35 Tobacco Rates ISSUE AGE 10 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 NAMED INSURED 1 84 2 60 3 55 4 68 5 85 7 52 10 22 12 98 16 56 19 86 EMPLOYEE SPOUSE 2 81 3 99 5 44 7 18 9 00 11 56 15 69 19 94 25 43 30 51 ONE PARENT FAMILY 2 23 2 99 3 94 5 07 6 25 7 91 10 61 13 35 16 95 20 28 Applicable to policy form CI 1 0 TWO PARENT FAMILY 3 49 4 57 5 68 7 34 8 76 11 39 15 68 19 28 25 44 30 22 4 41 5 84 7 31 9 53 11 42 14 93 20 65 25 45 33 67 40 04 TWO PARENT FAMILY 3 21 4 36 5 84 7 57 9 39 11 93 16 08 20 31 25 82 30 92 Page 2 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Continued Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Health Screening Benefit Cancer Benefit Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY 15 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 2 51 3 65 5 07 6 77 8 53 11 02 15 07 19 23 24 59 29 54 3 84 5 61 7 79 10 38 13 12 16 96 23 16 29 53 37 76 45 38 3 10 4 24 5 66 7 35 9 12 11 61 15 66 19 78 25 18 30 17 20 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 3 18 4 70 6 59 8 85 11 21 14 53 19 93 25 47 32 62 39 22 4 87 7 22 10 13 13 59 17 24 22 36 30 62 39 11 50 10 60 25 3 96 5 48 7 38 9 64 11 99 15 32 20 72 26 21 33 41 40 05 Term Life ITL5000 for NC l 20 Year Term Base Plan Chronic Care Accelerated Death Benefit Non Tobacco Rates ISSUE AGE 15 000 25 000 16 1 93 2 60 17 1 93 2 60 18 1 93 2 60 19 1 93 2 60 20 1 93 21 1 93 2 60 2 60 22 1 93 2 60 23 1 93 2 60 24 1 93 2 60 25 1 93 2 60 26 1 96 2 66 27 1 99 2 70 28 2 02 2 76 29 2 06 30 2 09 2 81 2 87 31 2 13 2 93 50 000 2 68 2 68 2 68 2 68 2 68 2 68 2 68 2 68 2 68 2 68 2 69 2 70 2 71 2 72 2 73 2 76 75 000 3 55 3 55 3 55 3 55 3 55 3 55 3 55 3 55 3 55 3 55 3 57 3 58 3 60 3 61 3 63 3 67 Applicable to policy form CI 1 0 TWO PARENT FAMILY 4 43 6 16 8 38 10 97 13 71 17 51 23 74 30 08 38 35 46 00 5 65 7 96 10 91 14 38 18 02 23 10 31 41 39 85 50 88 61 08 Applicable to policy form ITL5000 100 000 4 44 4 44 4 44 4 44 4 44 4 44 4 44 4 44 4 44 4 44 4 46 4 48 4 50 4 52 4 54 4 60 Page 3 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Continued Term Life ITL5000 for NC l 20 Year Term Base Plan Chronic Care Accelerated Death Benefit Non Tobacco Rates ISSUE AGE 15 000 25 000 32 2 18 3 01 33 2 22 3 09 34 2 26 3 16 35 2 31 3 23 36 2 34 3 29 37 2 38 3 36 38 2 42 3 42 39 2 47 40 2 53 3 50 3 59 41 2 59 3 70 42 2 67 3 83 43 2 77 4 02 44 2 90 4 23 45 3 06 4 49 46 3 23 4 77 47 3 43 5 10 48 3 64 49 3 88 5 45 5 85 50 4 14 6 30 51 4 44 6 80 52 4 79 7 36 53 5 17 8 01 54 5 61 8 74 55 6 09 9 53 56 6 61 10 40 57 7 18 58 7 80 11 35 12 39 59 8 49 13 53 60 9 25 14 80 61 6 61 10 40 62 7 26 11 48 63 7 98 12 69 64 8 78 14 02 65 9 65 15 46 50 000 2 82 2 88 2 94 3 03 3 15 3 31 3 51 3 74 4 01 4 28 4 58 4 90 5 24 5 61 6 00 6 44 6 93 7 46 8 02 8 64 9 32 10 03 10 82 11 68 12 64 13 71 14 95 16 37 18 00 19 89 22 04 24 47 27 12 30 01 Tobacco Rates ISSUE AGE 16 17 18 19 15 000 3 10 3 12 3 13 3 15 25 000 4 56 4 59 4 61 4 64 50 000 4 45 4 45 4 45 4 45 75 000 3 76 3 85 3 95 4 09 4 26 4 51 4 81 5 16 5 55 5 97 6 42 6 89 7 39 7 95 8 55 9 21 9 93 10 73 11 58 12 50 13 51 14 59 15 78 17 06 18 50 20 12 21 96 24 09 26 55 29 37 32 61 36 24 40 22 44 55 75 000 6 21 6 21 6 21 6 21 Applicable to policy form ITL5000 100 000 4 70 4 82 4 96 5 15 5 38 5 71 6 12 6 58 7 09 7 65 8 25 8 88 9 56 10 28 11 09 11 98 12 94 13 99 15 13 16 36 17 70 19 15 20 72 22 44 24 37 26 51 28 97 31 83 35 09 38 86 43 17 48 02 53 33 59 09 100 000 7 98 7 98 7 98 7 98 Page 4 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Continued Term Life ITL5000 for NC l 20 Year Term Base Plan Chronic Care Accelerated Death Benefit Tobacco Rates ISSUE AGE 15 000 25 000 20 3 16 4 66 21 3 18 4 68 22 3 19 4 71 23 3 21 4 73 24 3 22 4 76 25 3 23 4 78 26 3 26 4 81 27 3 27 28 3 29 4 84 4 87 29 3 32 4 91 30 3 35 4 96 31 3 40 5 05 32 3 48 5 18 33 3 55 5 31 34 3 62 5 43 35 3 70 5 55 36 3 76 37 3 83 5 66 5 77 38 3 89 5 88 39 3 97 6 00 40 4 06 6 15 41 4 18 6 35 42 4 35 6 62 43 4 57 7 01 44 4 86 7 48 45 5 21 46 5 61 8 07 8 73 47 6 06 9 49 48 6 57 10 33 49 7 12 11 26 50 7 73 12 27 51 8 39 13 38 52 9 11 14 56 53 9 87 15 85 54 10 70 55 11 58 17 22 18 69 56 12 54 20 28 57 13 58 22 01 58 14 72 23 92 59 15 96 25 98 60 17 29 28 21 50 000 4 45 4 45 4 45 4 45 4 45 4 45 4 46 4 47 4 48 4 49 4 50 4 56 4 65 4 77 4 92 5 12 5 37 5 69 6 11 6 63 7 25 7 93 8 65 9 41 10 21 11 07 12 01 13 10 14 36 15 79 17 33 18 89 20 48 22 08 23 73 25 46 27 28 29 19 31 24 33 42 35 73 75 000 6 21 6 21 6 21 6 21 6 21 6 21 6 23 6 24 6 26 6 27 6 29 6 37 6 51 6 69 6 92 7 23 7 60 8 09 8 71 9 49 10 41 11 44 12 52 13 66 14 85 16 14 17 56 19 19 21 08 23 23 25 54 27 88 30 26 32 66 35 14 37 73 40 46 43 34 46 40 49 67 53 14 Applicable to policy form ITL5000 100 000 7 98 7 98 7 98 7 98 7 98 7 98 8 00 8 02 8 04 8 06 8 08 8 19 8 38 8 61 8 92 9 32 9 82 10 48 11 31 12 35 13 57 14 94 16 38 17 90 19 50 21 20 23 11 25 29 27 81 30 67 33 75 36 86 40 03 43 25 46 55 50 00 53 63 57 47 61 57 65 92 70 55 Page 5 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Continued Term Life ITL5000 for NC l 20 Year Term Base Plan Chronic Care Accelerated Death Benefit Tobacco Rates ISSUE AGE 15 000 25 000 61 12 10 19 57 62 12 91 20 89 63 13 73 22 28 64 14 60 23 72 65 15 48 25 18 50 000 38 22 40 86 43 65 46 52 49 46 Whole Life Plus IWL5000 for NC l Adult Base Plan Paid Up at Age 100 Chronic Care Accelerated Death Benefit Non Tobacco Rates ISSUE AGE 15 000 25 000 50 000 18 3 18 5 29 10 57 19 3 18 5 30 10 59 20 3 19 5 31 10 61 21 3 19 5 32 10 63 22 3 20 5 33 10 66 23 3 20 5 34 10 68 24 3 21 5 36 10 72 25 3 24 5 40 10 80 26 3 29 27 3 36 5 48 5 60 10 95 11 20 28 3 45 29 3 57 5 76 5 95 11 52 11 89 30 3 69 6 15 12 30 31 3 81 6 36 12 72 32 3 95 6 58 13 17 33 4 10 6 83 13 65 34 4 25 7 08 14 17 35 4 42 36 4 59 7 36 7 66 14 73 15 32 37 4 78 7 98 15 96 38 5 00 8 33 16 67 39 5 23 8 72 17 44 40 5 48 9 14 18 26 41 5 75 9 59 19 17 42 6 05 10 08 20 15 43 6 36 10 61 21 20 Applicable to policy form ITL5000 75 000 56 86 60 83 65 01 69 33 73 72 100 000 75 52 80 80 86 38 92 13 97 99 Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC 75 000 15 86 15 89 15 92 15 95 15 99 16 02 16 08 16 19 16 43 16 80 17 28 17 84 18 45 19 08 19 75 20 48 21 25 22 09 22 98 23 94 25 00 26 15 27 40 28 76 30 22 31 80 100 000 21 16 21 19 21 23 21 27 21 33 21 37 21 44 21 59 21 91 22 40 23 04 23 78 24 59 25 44 26 35 27 31 28 35 29 46 30 64 31 92 33 32 34 86 36 54 38 35 40 31 42 40 Page 6 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Continued Whole Life Plus IWL5000 for NC l Adult Base Plan Paid Up at Age 100 Chronic Care Accelerated Death Benefit Non Tobacco Rates ISSUE AGE 15 000 25 000 50 000 44 6 69 45 7 03 46 7 38 47 7 74 48 8 11 49 8 49 50 8 90 51 9 33 52 9 81 53 10 34 54 10 92 55 11 53 56 12 20 57 12 91 58 13 66 59 14 47 60 15 34 61 16 27 62 17 28 63 18 38 64 19 55 65 20 82 66 22 16 67 23 61 68 25 15 69 26 81 70 28 63 71 30 67 72 32 97 73 35 58 74 38 53 75 41 88 76 45 66 77 49 86 78 54 54 79 59 71 11 15 11 72 12 31 12 90 13 52 14 15 14 82 15 54 16 34 17 23 18 20 19 23 20 33 21 51 22 76 24 11 25 56 27 13 28 81 30 64 32 59 34 70 36 94 39 35 41 92 44 70 47 73 51 12 54 94 59 29 64 23 69 81 76 08 83 10 90 90 99 52 22 31 23 45 24 62 25 81 27 03 28 30 29 64 31 09 32 69 34 46 36 38 38 46 40 68 43 02 45 54 48 23 51 12 54 25 57 62 61 26 65 19 69 39 73 88 78 69 83 85 89 39 95 46 102 23 109 89 118 58 128 46 139 62 152 16 166 19 181 79 199 04 Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC 75 000 33 46 35 17 36 92 38 71 40 56 42 46 44 46 46 65 49 03 51 67 54 58 57 69 61 01 64 54 68 30 72 34 76 69 81 38 86 43 91 90 97 79 104 09 110 82 118 04 125 77 134 09 143 19 153 36 164 84 177 87 192 68 209 43 228 25 249 29 272 69 298 56 100 000 44 61 46 90 49 23 51 62 54 07 56 61 59 29 62 19 65 39 68 90 72 76 76 92 81 34 86 05 91 07 96 46 102 25 108 49 115 24 122 53 130 38 138 78 147 77 157 38 167 69 178 78 190 91 204 47 219 78 237 17 256 91 279 24 304 33 332 39 363 58 398 08 Page 7 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Continued Whole Life Plus IWL5000 for NC l Adult Base Plan Paid Up at Age 100 Chronic Care Accelerated Death Benefit Tobacco Rates ISSUE AGE 15 000 25 000 50 000 18 4 79 19 4 93 20 5 07 21 5 19 22 5 31 23 5 42 24 5 52 25 5 62 26 5 70 27 5 78 28 5 85 29 5 95 30 6 04 31 6 16 32 6 29 33 6 47 34 6 65 35 6 86 36 7 07 37 7 30 38 7 56 39 7 84 40 8 13 41 8 46 42 8 84 43 9 27 44 9 73 45 10 23 46 10 74 47 11 26 48 11 79 49 12 34 50 12 93 51 13 58 52 14 35 53 15 24 7 99 8 22 8 44 8 65 8 85 9 03 9 21 9 36 9 50 9 63 9 77 9 90 10 07 10 26 10 50 10 77 11 08 11 42 11 78 12 18 12 60 13 06 13 55 14 11 14 73 15 44 16 22 17 04 17 90 18 76 19 65 20 57 21 54 22 63 23 91 25 39 15 97 16 43 16 87 17 29 17 70 18 06 18 41 18 72 18 99 19 26 19 53 19 81 20 13 20 53 21 00 21 55 22 16 22 85 23 57 24 36 25 21 26 12 27 10 28 21 29 47 30 88 32 44 34 10 35 80 37 53 39 30 41 14 43 08 45 28 47 83 50 79 Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC 75 000 23 96 24 65 25 31 25 94 26 55 27 09 27 62 28 08 28 49 28 89 29 30 29 71 30 20 30 79 31 49 32 32 33 24 34 27 35 35 36 54 37 81 39 17 40 65 42 32 44 20 46 33 48 66 51 14 53 70 56 29 58 96 61 72 64 62 67 92 71 74 76 18 100 000 31 94 32 87 33 75 34 60 35 40 36 14 36 83 37 44 37 98 38 51 39 05 39 61 40 27 41 06 42 00 43 09 44 33 45 69 47 14 48 71 50 40 52 23 54 21 56 42 58 94 61 76 64 88 68 19 71 60 75 06 78 61 82 29 86 18 90 55 95 65 101 57 Page 8 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Continued Whole Life Plus IWL5000 for NC l Adult Base Plan Paid Up at Age 100 Chronic Care Accelerated Death Benefit Tobacco Rates ISSUE AGE 15 000 25 000 50 000 54 16 23 27 05 54 10 55 17 28 28 82 57 63 56 18 36 30 61 61 22 57 19 44 32 41 64 81 58 20 52 34 21 68 42 59 21 61 36 02 72 03 60 22 73 37 88 75 76 61 23 93 39 88 79 76 62 25 24 42 08 84 16 63 26 69 44 49 88 97 64 28 24 47 07 94 14 65 29 88 49 79 99 58 66 31 55 52 58 105 18 67 33 28 55 47 110 93 68 35 06 58 43 116 87 69 36 91 61 52 123 03 70 38 91 64 85 129 70 71 41 21 68 68 137 36 72 43 91 73 18 146 37 73 47 00 78 32 156 64 74 50 38 83 96 167 94 75 54 05 90 08 180 17 76 57 98 96 62 193 23 77 62 11 103 52 207 05 78 66 46 110 77 221 53 79 70 98 118 30 236 59 Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC 75 000 81 16 86 45 91 83 97 22 102 63 108 05 113 64 119 64 126 24 133 45 141 21 149 37 157 77 166 40 175 29 184 55 194 55 206 06 219 56 234 95 251 90 270 25 289 85 310 57 332 29 354 89 100 000 108 20 115 27 122 44 129 63 136 83 144 08 151 52 159 51 168 31 177 93 188 28 199 17 210 36 221 85 233 72 246 07 259 39 274 74 292 74 313 28 335 87 360 33 386 46 414 10 443 06 473 19 Important Notice Insurance coverage has exclusions and limitations that may affect benefits payable For a complete description of benefits limitations and exclusions please refer to an outline of coverage sample policy certificate proposal description or see your Colonial Life benefits counselor Coverage type benefits and rates vary by state Coverage may not be available in all states Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices Colonial Life products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand 2023 Colonial Life Accident Insurance Company Colonial Life and the Colonial Life logo separately and in combination are service marks of Colonial Life Accident Insurance Company All rights reserved Shelley Hartsell Shelley Hartsell ColonialLifeSales com 704 883 4838 Page 9 of 9 Underwritten by Colonial Life Accident Insurance Company See page 9 for Important Notice

Diesel Doctors 2023 Last Name First M I DOB Street Address Apartment Unit City Phone Job Title Sex Spouse s Name State E mail Address Date of Hire Social Security No Sex ZIP Tobacco Y or N Spouse s DOB Height Weight Dependent 1 Sex Dependent DOB Dependent 2 Sex Dependent DOB Beneficiary Name Address DOB phone relationship WEEKLY RATES Accident From everyday mishaps to broken bones burns cuts to more extensive accidents Colonial pays 200 for seeking treatment The more severe the accident the more money paid 50K Life insurance 50 Wellness for each family member on the plan Individual 6 12 Ind Spouse 8 38 Ind Child 9 16 Family 11 42 Hospital Colonial pays 2000 for a 24 hr hospital admission Outpatient surgical benefit Ind 17 49 7 52 50 59 10 57 60 64 14 13 65 75 20 31 Ind Sp 17 49 14 27 50 59 20 10 60 64 26 83 65 75 38 51 Ind Child 17 49 10 41 50 59 13 45 60 64 17 01 65 75 23 49 Family 17 49 17 16 50 59 22 99 60 64 29 71 65 75 41 67 Short Term Disability This provides a source of income while you re taking care of yourself 1000 monthly 3 months 0 7 Age 17 49 7 92 50 64 9 39 65 74 13 18 I would like a rate Annual or hourly income _____ Amount allowed _____ Rate ___ Critical Care Cancer Lump Sum payout 10K 50K 100 Wellness I would like a rate ________ Example 20K payout 35 39 yr old nontobacco 6 77 Life I would like a rate _________ Waive all employee funded benefit options Signature _______________________________ Date ___________________

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

Policyholder Service Guide At Colonial Life our goal is to give you an excellent customer experience that is simple modern and personal Getting started Consider your options The easiest way to manage your business with us is through the My Colonial Life policyholder section of ColonialLife com Whether online or by phone we ll provide the service you need To sign up for the website 1 Visit ColonialLife com 2 Click Register at the top right 3 On the sign up page click Join the Policyholder Website Need ColonialLife com Submit your claim using our eClaims system 3 File health screening wellness and doctor s office visit claims up to 18 months 3 3 Check the status of your claim 3 3 Review print or download a copy of your policy certificate 3 Access claim and service forms 3 3 Access your claim correspondence 3 3 3 Complete a notification for a life claim 3 3 Update your contact information After providing some basic information you ll be ready to go 800 325 4368 Filing claims eClaims With the eClaims feature on ColonialLife com you can file claims online by simply answering a few questions and uploading your supporting documentation You re able to spend less time on paperwork and we re able to process your claim faster With eClaims you can file most claims online including Accident Hospital confinement indemnity Disability Critical illness Cancer Vision You can access eClaims through your computer or mobile device and upload any required supporting documentation Once you re logged in to ColonialLife com visit the Claims Center and select File an Online Claim to get started

Contact us Online ColonialLife com Log in and click on Contact Us to email us Telephone 1 800 325 4368 Contact Center representatives are available Monday through Friday 8 a m to 8 p m ET Information is available 24 7 through our automated phone system Please have your Social Security or policy number ready when you call Hearing impaired customers Customers with a Telecommunications Device for the Deaf TDD should call 803 798 4040 If you do not have a TDD call Voiance Telephone Interpretation Services at 844 495 6105 to reach us Health screening wellness claims The quickest way to receive the applicable benefits for your health screening wellness services is to file online For health screening wellness claims within 18 months of the date you are filing the claim click on File a Wellness Claim Online on the Claims Center page If you do not want to file online you can use the automated customer service center at 1 800 325 4368 For health screening wellness claims over 18 months you ll be directed to print out a paper claim form under the claims and service forms section on the Claims Center page Paper claims If you don t want to file online download the form you need by visiting the Claims Center page on ColonialLife com and clicking on claims and service forms For instructions on how to correctly complete your claim form view the claims videos on the Claims Center page Be sure that you complete all sections of the claim form Also include a diagnosis from your doctor along with copies of any appropriate bills if required Keep a copy of your claim information for your records When we receive information regarding your claim you ll be notified by telephone or email If you select the electronic messaging option you ll receive a call when the claim is processed Claim tips and information When submitting your claim make sure to include all required supporting documentation as this will allow us to process your claim quicker To view correspondence pertaining to your claim visit ColonialLife com Once you log in to your secure account select My Correspondence from the home page Whether you submit your claims online or by paper form you can select optional services that authorize us to Communicate claims information via electronic messaging to your phone number Send claim benefits overnight by deducting a fee from your claim payment Release information to your benefits representative plan administrator or family member You can always check the status of your claim on the My Colonial Life site at ColonialLife com ColonialLife com Applicable to vision rider on the individual dental plan 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 4 16 43233 37