Benefit Booklet 2024 Enrollment Phone Number 833 703 1967 Employer Code F8914343 Enroll here:
Colonial Life provides benefits that employees want for the unexpected moments in life Whether planning for retirement growing their families or saving for college they know an injury or illness won t derail their dreams For more information Christina Cobb 704 620 2473 Christina Cobb ColonialLifeSales com Life is anything but expected That s why we re here Plan options Accident insurance Helps offset unexpected medical expenses such as emergency room fees deductibles and co payments that can result from a fracture dislocation or other covered accidental injury Critical illness Cancer Supplements your major medical coverage by providing a lump sum benefit you can use to pay the direct and indirect costs related to a covered critical illness and cancer Short Term Disability Provides financial protection to cover income loss from a covered disability Dental Vision Covers a wide range of treatments from routine cleanings to root canals Eye exams materials glasses or contacts Life insurance Enables you to tailor coverage for your individual needs and helps provide financial security for your family members
Group Accident InsurancePremier PlanIf 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 benets 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 benets can offer nancial support when you need it.Our coverage includes:• Benets payable directly to you• No medical questions to qualify for coverage• Coverage for simple and complex injuries• Benets payable regardless of other insurance• Worldwide coverage• Works alongside your Health Savings Account (HSA)BENEFITS STORY Milo was working in his yard when he tripped and injured his hand.With Colonial Life accident benets, 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 BENEFITSMilo went to an urgent care facility and received immediate care.Treatment in a physician’s office or urgent care facility$150The doctor ordered an X-ray and discovered Milo had fractured his hand.• X-ray• Fracture (hand)$60$1,200The doctor also found that Milo had a cut on his hand but did not require stitches. Laceration (no repair) $75Milo was discharged with a splint. Durable medical equipment $65Over the next several weeks, Milo had two follow-up appointments with his doctor. Physician follow-up visits (2 visits)$50 x 2 = $100Total $1,650For illustrative purposes only. Benet amounts may vary and may not cover all expenses. GROUP ACCIDENT (GAC4100) — PREMIER PLAN
Give your benets a boostWe know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life. Group Accident includes a Benet Booster* to provide additional nancial support for serious accidents. If you have more than $5,000 in payable benets for a covered accident, we will give you a $500 boost to your benets to help you with whatever expenses you have. *Payable once per Insured per covered accidentBENEFITS STORY Olivia was driving to the store when she got into a car accident.Olivia’s benets helped her cover her medical expenses when she was injured in a car accident, helping her to focus on her recovery.OLIVIA’S ACCIDENT BENEFITSOlivia arrived by ambulance at the nearest emergency room and received immediate care.• Ambulance• Emergency department visit• Injury due to auto accident$400$250 $250The 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 $4,200Olivia required surgery for her leg.• Surgical repair (thigh fracture)• General anesthesia$4,200 $300Olivia boarded her pet for two nights after her surgery. Pet boarding (2 days) $20 x 2 = $40Olivia 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 = $100Olivia’s benefits for this accident totaled more than $5,000.Benefit Booster $500Total $11,140For illustrative purposes only. Benet amounts may vary and may not cover all expenses. Benets are per covered person per covered accident unless stated otherwiseInjury benets • 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
Fracture benets• Injury .......................................$200–$5,000 Examples: nger: $200 | wrist: $1,200 | hip: $4,200• Surgical repair of fracture ............................100%(Payable as an additional % of the applicable fractures benet)• Chip fracture ........................................25% (Payable as a % of the applicable fractures benet)Dislocation benets• 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 benet)• Incomplete dislocation ................................25%(Payable as a % of the applicable dislocations benet)Treatment benets• Air ambulance .....................................$2,000 • Ambulance (ground or water) ......................... $400 • Durable medical equipment ......................$65–$250• Emergency dental repair ........................$200–$600• Emergency department .............................. $250(Maximum 4 per year) • Family care ................................... $50 per day (Maximum of one benet 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 benet 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)• Prosthetic device or articial limb ............$1,750–$3,500• Skin grafts (due to burns) .............................50%(Payable as a % of the applicable burn benet)• Skin grafts (not due to burns) ....................$375–$750• Transfusions ........................................ $500 • Transportation ............................... $200 per trip (Maximum 6 one-way trips)• Treatment in a physician’s oce or urgent care facility ...$150(Maximum 4 per year) • X-ray or ultrasound ....................................$60Surgery benets• Anesthesia ....................................$150–$300• Connective tissue surgery .....................$150–$2,200• Eye surgery ......................................... $400• General surgery –Abdominal, thoracic, or cranial ...................$2,000 –Exploratory surgery ...............................$275 • Hernia surgery ...................................... $400 • Knee cartilage (meniscus) surgery ..............$150–$1,050• Outpatient surgical facility ............................$400 • Ruptured or herniated disc surgery ............ $150–$2,000Recovery care benets• At-home care ................................ $125 per day(Maximum 5 days) • Benet 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 connement .............................$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• Behavioral health therapy ...................$55 per day (Maximum 15 days)• Post-traumatic stress disorder (PTSD) ............ $200 • Prescription drug .................................$25 • Additional therapy services (chiropractic, acupuncture, alternative therapy) ......$55 (Existing therapy services benet maximum applies to additional therapy services, maximum 15 days)• Injury due to felonious act of violence or sexual assault ................................ $250(Maximum once per insured per calendar year, with an accompanying police report) Gunshot wound benetThis benet can help pay your medical expenses if you receive a non-fatal gunshot wound. It offers you a lump sum for a covered injury regardless of any other insurance you may have and includes on/off-job coverage.• Gunshot wound .............................$_________This benet covers a non-fatal gunshot wound from a conventional rearm 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 benets only for the rst wound.
Disability InsuranceHow you can protect your incomeIf you become disabled, you could be out of work for a while. Without your income, how would you pay for your everyday living expenses? Fortunately, Colonial Life offers nancial protection options that can help you. What can cause a disability? Many accidents or sicknesses can lead to short term disability claims, including pregnancy and childbirth; injuries from a major accident including dislocations, sprains and fractures; back problems; side effects from medicines or medical procedures; and some mental illnesses. Regardless of your age or health, a disabling sickness or accidental injuries could keep you out of work for weeks or even months.How reliable is your safety net? While many people with disabilities look to workers’ compensation or Social Security Disability Insurance (SSDI) for help, these resources aren’t always reliable. In fact, 68% of workers who apply for SSDI are denied.1 Even if these resources can help, they might not be enough to meet your nancial obligations.How to help yourself You can be better prepared to preserve your way of life with short term disability insurance. Disability insurance features:• Benets payable directly to you in regular payments if you can’t work because of a covered accident or sickness (injury or illness).• Disability benets may be available if you return to work part time. • In most cases, you can keep your coverage even if you change jobs, as long as you pay your premiums when due.Your Colonial Life benets counselor can help you determine the amount of coverage that’s right for you.70%of Americans worry about having enough emergency savings to cover a month’s worth of living expenses.2Nearly25%of 20 year olds can expect to be out of work for at least a year for a disabling condition before they retire.3DISABILITY INSURANCE
Disability Insurance Worksheet You can tailor disability coverage to t your specic needs. Talk with your benets counselor about your expenses and other paid leave benets, such as state paid medical leave, to help determine the coverage that’s right for you.4MONTHLY EXPENSES ROUND TO THE NEAREST HUNDREDRent or mortgage (insurance, minor home repairs) $Transportation (car note, bus fare, insurance, gas, maintenance)$Utilities (cell phone, Wi-Fi, electricity/gas, water) $Food and household necessities (toiletries, cleaning supplies)$Childcare (daycare, after-school care) $Health (medical needs and prescription drugs) $Other (gym/fitness, streaming/cable, extracurricular) $Total monthly expenses (add lines 1-7 together) $Your state’s paid medical leave approximate benefits (if any):Monthly benefit: _____________ Benefit period up to: _____________Talk with your Colonial Life benets counselor to learn more about disability insurance.ColonialLife.com1. Social Security Administration, SSI Annual Statistical Report, 2021.2. Bankrate, Bankrate’s 2023 annual emergency savings report, 2023. 3. Social Security Administration, Disability and Death Probability Tables for Insured Workers, 2022.4. State paid medical leave (PML) benets fall under state-specic program names. For example, in New Jersey, it may be referred to as Temporary Disability Insurance (TDI). Not available in all states.For policies issued or delivered in the Commonwealth of Virginia, THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy forms ISTD3000 and rider form ISTD3000-ADIB (including state abbreviations where used, for example: ISTD3000-TX and ISTD3000-ADIB-TX ), policy form DIS1000 (including state abbreviations where used, for example DIS1000-TX), policy form ED-DIS 1.0 (including state abbreviations where used, for example ED-DIS 1.0-TX), policy form ICC21-DIP3000 and rider form ICC21-DIP3000-R-DIS, policy form GDIS-P and certicate form GDIS-C (including state abbreviations where used, for example: GDIS-P-EE-TX and GDIS-C-EE-TX), and policy form VSTDMP and certicate form VSTDC (including state abbreviations where used, for example VSTDMP-TX and VSTDC-TX). Not applicable in Oregon for policy form ICC21-DIP3000 and rider form ICC21-DIP3000-R-DIS. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. An insurance producer may contact you.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 6-23 | 101165-10
Individual Dental InsuranceStandard Plan $1,000 | 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)$1,000 Deductible• Per person (applies to Class B and C services only) • Maximum of three per family per policy year$50Standard 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 max$200 $500 $800 How carryover benefits work Receive a $200 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 $500 (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 $800 to help pay for claims if you exceed your policy year maximum benefit.3INDIVIDUAL DENTAL - STANDARD PLAN
Covered services In-network coverage1Out-of-network coverage2 (MAC)Waiting periodClass A: Preventive services• Routine exams and cleanings ‐ Two per 12-month period ‐ 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• 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• Full mouth/panoramic x-rays ‐ Once every ve years• Fillings• Posterior composite restorations• Simple extractions• Emergency treatment80% 80% No waiting periodClass C: Major services• Oral surgery (surgical extractions and impacted teeth)• Anesthesia (covered with complex oral surgery)• Repair of crowns, dentures or bridges• Periodontics (gum treatments)• Endodontics (root canals)• Inlays and onlays• Crowns, bridges, dentures and endosteal implants• Crown lengthening 50% 50% 12-month waiting period5Contact your Colonial Life benets counselor 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. In Alaska only, benets are based on usual, customary, and reasonable charges (80th UCR) for the same covered procedure by providers of similar training or experience in the general geographic area, reviewed and updated periodically. Benets are subject to any deductibles, co-insurance and maximums. Dentists haven't agreed to accept reimbursement as payment in full. Additional out-of-pocket costs 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; any break in coverage will eliminate the carryover account balance. The carryover benet may not be used for orthodontic treatment or services.4 Member may have one additional periodontal maintenance in place of an additional cleaning.5 Six-month waiting period in Vermont. Summary of Dental Benets and Coverage Disclosure Matrix (SDBC) is available at ColonialLifeDental.com/California.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 (including state abbreviations where used, for example: IDN8100-TX).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 4-24 | 1763264ColonialLife.com
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, after co-pay In-network Out-of-networkVision exam Covered in full $35 allowanceContact lenses fitting, after co-payStandard2Up to $60 allowance Up to $45 allowanceSpecialty3Up to $100 allowance Up to $75 allowanceMaterials: Eyeglass lenses and frames, after co-pay4Single vision Covered in full Up to $25 allowanceBifocals Covered in full Up to $40 allowanceTrifocals Covered in full 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 Up to $30 allowanceFrames Up to $170 allowance Up to $50 allowanceMaterials: Contact lenses, after co-pay5Elective 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 eye doctors, and retail stores such as: • Walmart and Sam’s Club Optical• 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.• Digital ID cards are available on the policyholders portal when your coverage starts.• Only the primary insured’s name will be listed.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 forms IDN8100-AR and IDN8100-NC, and rider forms R-VSN8100-AR and R-VSN8100-NC. 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 5-24 | 1820767 -AR-NCColonialLife.com
Group Critical Illness and Cancer Insurance Plan 2 When life takes an unexpected turn your focus should be on recovery not finances Colonial Life s group critical illness and cancer insurance helps relieve financial worries by providing a lump sum benefit payable directly to you to use as needed Coverage amount ___ _1_0K__ _ _5_0_K_________________ Critical illness and cancer benefits COVERED CONDITION1 Benign brain tumor Coma End stage renal kidney failure Heart attack myocardial infarction Loss of hearing Loss of sight Loss of speech Major organ failure requiring transplant Occupational infectious HIV or occupational infectious hepatitis B C or D Permanent paralysis due to a covered accident2 Stroke Sudden cardiac arrest Coronary artery disease PERCENTAGE OF APPLICABLE COVERAGE AMOUNT 100 100 100 100 100 100 100 100 100 100 100 100 25 COVERED CANCER CONDITION PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Invasive cancer including all breast cancer 100 Non invasive cancer 25 Skin cancer initial diagnosis 400 per lifetime BENEFITS STORY Preparing for a lifelong journey Rebecca was born with Down syndrome Her parents critical illness and cancer coverage provided a benefit that can help cover expenses related to Rebecca s care and her changing needs How their coverage helped A hospital stay and treatment for corrective heart surgery Physical therapy to build muscle strength Special needs daycare For illustrative purposes only GCI6000 PLAN 2
Key benefits Available coverage for spouse and eligible dependent children at 50 of your coverage amount Cover your eligible dependent children at no additional cost Receive coverage regardless of medical history within specified limits Works alongside your health savings account HSA Benefits payable regardless of other insurance For more information talk with your benefits counselor Subsequent diagnosis of a different critical illness3 If you receive a benefit for a critical illness and are later diagnosed with a different critical illness 100 of the coverage amount may be payable for that particular critical illness Subsequent diagnosis of the same critical illness3 If you receive a benefit for a critical illness and are later diagnosed with the same critical illness 4 25 of the coverage amount is payable for that critical illness Reoccurrence of invasive cancer including all breast cancer If you receive a benefit for invasive cancer and are later diagnosed with a reoccurrence of invasive cancer 25 of the coverage amount is payable if treatment free for at least 12 months and in complete remission prior to the date of reoccurrence excludes non invasive or skin cancer Additional covered conditions for dependent children COVERED CONDITION1 Cerebral palsy Cleft lip or palate Cystic fibrosis Down syndrome Spina bifida PERCENTAGE OF APPLICABLE COVERAGE AMOUNT 100 100 100 100 100 1 Please refer to the certificate for complete definitions of covered conditions 2 In WA the covered condition is called Permanent Paralysis 3 Dates of diagnoses of a covered critical illness must be separated by more than 180 days 4 Critical illnesses that do not qualify include coronary artery disease loss of hearing loss of sight loss of speech and occupational infectious HIV or occupational infectious hepatitis B C or D The filed product name in FL and VT is Group Critical Illness and Cancer Limited Benefit Insurance THIS INSURANCE PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this insurance EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benefit Benefits Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person s alcoholism or drug addiction felonies or illegal occupations intoxicants and narcotics suicide or injuring oneself intentionally whether sane or not 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 Invasive Cancer including all Breast Cancer Benefit Non Invasive Cancer Benefit Benefit Payable Upon Reoccurrence of Invasive Cancer including all Breast Cancer or Skin Cancer Initial Diagnosis Benefit for a covered person s invasive cancer or non invasive 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 preexisting condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having invasive or non invasive cancer No pre existing condition limitation will be applied for dependent children who are born or adopted while the named insured is covered under the certificate and who are continuously covered from the date of birth or adoption PRE EXISTING CONDITION LIMITATION We will not pay a benefit for a pre existing condition that occurs during the 12 month period after the coverage effective date Pre existing condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C TX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company ColonialLife com 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 11 22 387100 2
Group Critical Illness Insurance Exclusions and limitations State specific exclusions AK Alcoholism or Drug Addiction Exclusion does not apply CA Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics replaced with Intoxicants or Controlled Substances Insureds must be covered by comprehensive health insurance before applying for insurance CO Suicide exclusion whether sane or not replaced with while sane CT Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Felonies Intoxicants and Narcotics Exclusion does not apply DC Alcoholism or Drug Addiction Exclusion does not apply Insureds must be covered by comprehensive health insurance before applying for insurance DE Alcoholism or Drug Addiction Exclusion does not apply GA Insureds must be covered by comprehensive health insurance before applying for insurance IA Exclusions and Limitations headers renamed to Exclusions and Limitations for Critical Illness Covered Conditions and Critical Illness Cancer Covered Conditions ID War or Armed Conflict Exclusion replaced with War Felonies and Illegal Occupations Exclusion replaced with Felonies Intoxicants and Narcotics Exclusion does not apply Domestic Partner added to Spouse IL Alcoholism or Drug Addiction Exclusion replaced with Alcoholism or Substance Abuse Disorder KS Alcoholism or Drug Addiction Exclusion does not apply KY Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion replaced with Intoxicants Narcotics and Hallucinogenics Premium will vary based on the coverage selected and the age of the named insured For attained age rates premiums will increase on the account anniversary date once the named insured reaches the next age band Premium may increase if coverage is ported Waiting Period If included the Wellbeing Assistance Benefit is subject to a 30 day waiting period Waiting period means the first 30 days following each covered person s effective date during which no benefits are payable Termination of the Named Insured s Coverage The coverage on a named insured under the policy will terminate on the earliest of the following dates the date the policy terminates your policyholder cancels the policy and does not offer replacement coverage the end of the grace period following the premium due date and we do not receive the required premium for the named insured the date the named insured is no longer in an eligible class the date the named insured s class is no longer included for insurance or the date the next premium is due after the named insured asks us to end coverage We will provide coverage for a claim for which we are liable under the terms of this certificate if the loss occurs while you are covered LA Alcoholism or Drug Addiction Exclusion does not apply Domestic Partner added to Spouse MA Exclusions and Limitations headers renamed to Limitations and Exclusions for critical illness and cancer Insureds must be covered by comprehensive health insurance before applying for insurance MD Alcoholism or Drug Addiction Exclusion does not apply Felonies or Illegal Occupations Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Prohibited Practitioner Referral added as an additional exclusion for cancer MI Intoxicants and Narcotics Exclusion does not apply Suicide Exclusion does not apply MN Alcoholism or Drug Addiction Exclusion does not apply Suicide Exclusion does not apply Felonies and Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs Intoxicants and Narcotics Exclusion replaced with Narcotic Addiction Insureds must be covered by comprehensive health insurance before applying for insurance MO Alcoholism or Drug Addiction Exclusion replaced with Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Illegal Activities MS Alcoholism or Drug Addiction Exclusion does not apply ND Alcoholism or Drug Addiction Exclusion does not apply NV Intoxicants and Narcotics Exclusion does not apply Domestic Partner added to Spouse PA Alcoholism or Drug Addiction Exclusion does not apply Suicide Exclusion whether sane or not removed SD Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply TX Alcoholism or Drug Addiction Exclusion does not apply Doctor or Physician Relationship added as an additional exclusion UT Alcoholism or Drug Addiction Exclusion replaced with Alcoholism VT Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Suicide Exclusion whether sane or not removed Insureds must be covered by comprehensive health insurance before applying for insurance WA Intoxicants and Narcotics Exclusion does not apply
State specific pre existing condition limitations CA Pre existing Condition means a sickness or physical condition for which a covered person was diagnosed or treated within 12 months before the coverage effective date shown on the Certificate Schedule FL Pre existing is 6 12 Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date shown on the Certificate Schedule Genetic information is not a pre existing condition in the absence of a diagnosis of the condition related to such information GA Pre existing Condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis care or treatment or a condition for which medical advice or treatment was recommended by or received within 12 months preceding the coverage effective date ID Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition which caused a covered person to seek medical advice diagnosis care or treatment during the six months immediately preceding the coverage effective date shown on the Certificate Schedule IL Pre existing Condition means a sickness or physical condition for which a covered person was diagnosed treated had medical testing by a legally qualified physician received medical advice produced symptoms or had taken medication within 12 months before the coverage effective date shown on the Schedule of Benefits IN Pre existing is 6 months 12 months MA Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing or received medical advice within six months before the coverage effective date shown on the Certificate Schedule MD Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within 12 months before the coverage effective date shown on the Certificate Schedule Pre existing condition does not include a condition revealed on the application unless excluded by a signed waiver rider ME Pre existing is 6 months 6 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing or received medical advice within six months before the coverage effective date shown on the Certificate Schedule MI Pre existing is 6 months 6 months NC Pre existing Condition means those conditions for which medical advice diagnosis care or treatment was received or recommended within the one year period immediately preceding the effective date of a covered person If a covered person is 65 or older when this certificate is issued pre existing conditions for that covered person will include only conditions specifically eliminated NV Pre existing is 6 months 12 months Pre existing Condition means a sickness or physical condition for which a covered person was treated had medical testing received medical advice or had taken medication within six months before the coverage effective date Pre existing Condition does not include genetic information in the absence of a diagnosis of the condition related to such information PA Pre existing is 90 days 12 months Pre existing Condition means a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage effective date shown on the Certificate Schedule SD Pre existing is 6 months 12 months TX Pre existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage effective date shown on the Certificate Schedule UT Pre existing is 6 months 6 months WY Pre existing is 6 months 12 months ColonialLife com The filed product name in IA PA and WY is Group Critical Illness Specified Disease Insurance In FL and VT the filed product name is Group Critical Illness Limited Benefit Insurance THIS INSURANCE PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this insurance This information is not intended to be a complete description of the insurance coverage available The insurance its name or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GCI6000 P and certificate form GCI6000 C including state abbreviations where used for example GCI6000 C 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 385403 387100 387169 402383 402558 or 387238 and rider form 387307 387381 387452 387523 387594 387665 402605 or 402671 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 12 22 388113 6
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
Offer 24/7 health care access for your employeesThere’s a simple way to expand your benefits package and giveyour employees better access to medical care. In association with Recuro Health, Colonial Life can help you provide an easier form of doctor visits for your employees — virtual care. This service is available at no direct cost to you or them for the first year following the enrollment.Our service solutionWhile not intended to replace a primary care doctor, Recuro Health gives youremployees 24/7 access to board-certified doctors, where it’s most convenientfor them. With more than 20 million members, Recuro Health is one of thenation’s largest virtual care networks with state-licensed physicians averaging15 years of practice experience.Aer registering, your employees can have a virtual consult to diagnosenon-emergency medical issues over the phone or through secure video on their computer, tablet or the Recuro Health Mobile App. When a medicalcondition calls for a prescription, Recuro Health doctors can send ane-prescription straight to the patient’s local pharmacy of choice (restrictions apply).Improving employee care just got easierMaking Recuro Health part of your overall benefits oering is an easy wayto show your employees you care about their access to medical care. Itcan also help decrease employee absenteeism and increase productivity— while helping lower health care costs for your business. Colonial Lifewill only fund this program for the first year. Following the first year, youhave the opportunity to fund the program at a discounted rate so that youremployees can continue their coverage.To learn more, talk with your Colonial Life representative.10-22 | 101765-4ColonialLife.comHere are some of the commonconditions that can be treated:Recuro Health also oers pediatric care.By accessing, using, or registering with the Recuro Health Application, you agree that you have read andunderstood, and, as a condition to your use of the app, you agree to be bound by, these terms of use. Youdo not have permission to use the Application if you do not agree to these terms of use. The Applicationis intended to facilitate the provision of services to registered users. Recuro Health is the operator of thisApplication and does not provide healthcare services. Recuro’s digital health tools do not provide medicaldiagnosis, advice, or treatment. You should discuss with your physician before making any medical decisions,including starting, stopping or modifying any medication or other treatment or care plan. Services facilitatedthrough the Application can range from health risk assessments, to diagnostic and genomic testing, to visitswith healthcare providers, to prescription of medication by healthcare providers, to other healthcare trackingand navigation tools. The Application enables Healthcare Providers to oer an online telehealth servicethat, when clinically appropriate, allows patients to obtain a limited range of health care from participatingHealthcare Providers. Based on the information you provide, a Healthcare Provider will provide a diagnosisand a treatment plan for you. If you register to receive health care services from Healthcare Providers throughthe Application, we will rely on you to provide accurate and complete information throughout both the clinicalinterview and the registration process, in order to ensure you receive appropriate care.For complete terms & conditions, visit: www.recurohealth.com/terms-conditions/ Allergies Asthma Bronchitis Cold and flu Ear infections Fever Headache Joint aches Respiratory infections Sinus infections Skin infections Urinary tract infectionsInsurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registeredtrademark and marketing brand of Colonial Life & Accident Insurance Company.
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How to File a Claim for Colonial Life Benefits FOR FASTEST RESULTS FILE ONLINE 1 Go to ColonialLife com access to login or register 2 Fill out the required information and click Submit 3 Enjoy streamlined claims management and faster service online DIGITALLY FILE ALL TYPES OF CLAIMS Disability Insurance Accident Hospital Insurance Life Insurance Critical Illness Cancer Insurance Wellness benefits for screening tests Not sure which type of claim to file No problem Just answer a few questions on the portal and we ll help you figure everything out BEFORE YOU FILE Review the appropriate claims checklist at ColonialLife com and have this information handy to make the process go smoothly Proper documentation must be submitted when filing your claim AFTER YOU FILE Check your claim status and manage your claim by logging into your account at ColonialLife com access Live chat is also available 9 a m 5 p m EST OTHER WAYS TO FILE A CLAIM Fax 1 800 880 9325 Mail P O Box 100195 Columbia SC 29202 Colonial Life is committed to providing you our valued customer a market leading claims experience We look forward to serving you on ColonialLife com On the policyholder portal you can View benefit details Here you ll find a copy of your policy to see what s covered and benefit amounts Track your claim Log in anytime to view status or opt in to receive status alerts by email or text so you know instantly if we require additional information Sign up for direct deposit to get approved payments up to a week faster than paper check Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company Columbia SC 2022 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company ADR 1312251
Deductions per year: 24 These rates were prepared on 9/11/2024 based off of 40 eligible lives and are valid for 90 days.Group Accident (GAC4100) for NCApplicable to policy forms GAC4100-P,GAC4100-ClAdditional Benefits: Accident Hospital Benefits Preferred, Wellbeing Assistance Standard - $50On/Off-Job Accident CoverageBENEFIT LEVEL AD&D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE ANDSPOUSEEMPLOYEE ANDDEPENDENTCHILD(REN)EMPLOYEE, SPOUSEAND DEPENDENTCHILD(REN)Premier Not Included 17-99 $7.80 $12.30 $18.20 $22.78Premier Premier 17-99 $9.22 $14.69 $20.19 $25.78Group Disability for NC AAA Risk ClassApplicable to policy forms GDIS-P & GDIS-ClOff-Job Accident and Off-Job Sickness with First Day Hospital3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $800* $1,000* $1,200* $1,400* $1,600**monthly benefit amount0 days Accident/7 days Sickness 17-49 $11.48 $14.35 $17.22 $20.09 $22.9650-64 $13.72 $17.15 $20.58 $24.01 $27.4465-74 $19.92 $24.90 $29.88 $34.86 $39.84Group Critical Illness (GCI6000) for NCApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $100 Benefit, First Diagnosis Building Benefit, Heart Benefits,Progressive Diseases BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$5,000 17-24 $5.62 $8.49 $5.62 $8.4925-29 $6.67 $10.10 $6.67 $10.1030-34 $7.77 $11.68 $7.77 $11.6835-39 $10.03 $15.11 $10.03 $15.1140-44 $12.29 $18.56 $12.29 $18.5645-49 $15.72 $23.88 $15.72 $23.8850-54 $19.12 $29.21 $19.12 $29.2155-59 $22.99 $35.04 $22.99 $35.0460-64 $28.01 $42.65 $28.01 $42.6565-69 $30.91 $47.10 $30.91 $47.1070-74 $30.91 $47.10 $30.91 $47.10GREEN EXTERIOR REMODELINGPage 1 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice
Group Critical Illness (GCI6000) for NCApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $100 Benefit, First Diagnosis Building Benefit, Heart Benefits,Progressive Diseases BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $6.96 $10.43 $6.96 $10.4325-29 $8.51 $12.84 $8.51 $12.8430-34 $10.16 $15.20 $10.16 $15.2035-39 $13.62 $20.46 $13.62 $20.4640-44 $17.08 $25.73 $17.08 $25.7345-49 $22.51 $34.13 $22.51 $34.1350-54 $27.89 $42.53 $27.89 $42.5355-59 $34.51 $52.51 $34.51 $52.5160-64 $43.42 $66.04 $43.42 $66.0465-69 $49.22 $74.94 $49.22 $74.9470-74 $49.22 $74.94 $49.22 $74.94Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$5,000 17-24 $6.95 $10.41 $6.95 $10.4125-29 $8.67 $13.01 $8.67 $13.0130-34 $10.43 $15.59 $10.43 $15.5935-39 $14.10 $21.12 $14.10 $21.1240-44 $17.74 $26.70 $17.74 $26.7045-49 $23.30 $35.33 $23.30 $35.3350-54 $28.84 $43.93 $28.84 $43.9355-59 $35.07 $53.44 $35.07 $53.4460-64 $43.19 $65.76 $43.19 $65.7665-69 $47.84 $72.83 $47.84 $72.8370-74 $47.84 $72.83 $47.87 $72.86$10,000 17-24 $9.07 $13.48 $9.07 $13.4825-29 $11.64 $17.38 $11.64 $17.3830-34 $14.27 $21.23 $14.27 $21.2335-39 $19.92 $29.71 $19.92 $29.7140-44 $25.51 $38.30 $25.51 $38.3045-49 $34.31 $51.95 $34.31 $51.9550-54 $43.10 $65.55 $43.10 $65.5555-59 $53.78 $81.89 $53.78 $81.8960-64 $68.26 $103.83 $68.26 $103.8365-69 $77.56 $117.98 $77.56 $117.9870-74 $77.56 $117.98 $77.61 $118.03GREEN EXTERIOR REMODELING(Continued...)Page 2 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice
Individual Dental 8100 (IDN8100) for NCApplicable to policy form Individual Dental 8100 (IDN8100)lwith Vision Rider - 12 Month Waiting PeriodZip Codes: ALL Zip CodesCOVERAGE LEVEL NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENTCHILD(REN)NAMED INSURED,SPOUSE ANDDEPENDENTCHILD(REN)Standard (MAC 100/80/50) $21.66 $41.18 $50.66 $75.56Group Term Life for NCRate Table G8GApplicable to Policy Forms GTL1.0-P & GTL1.0-CNon-Tobacco RatesISSUE AGE $20,000 $50,000 $75,000 $100,00016-24 $0.89 $2.23 $3.34 $4.4525-29 $1.00 $2.50 $3.75 $5.0030-34 $1.26 $3.15 $4.73 $6.3035-39 $1.67 $4.18 $6.27 $8.3540-44 $2.29 $5.73 $8.59 $11.4545-49 $3.60 $9.00 $13.50 $18.0050-54 $5.44 $13.60 $20.40 $27.2055-59 $8.93 $22.33 $33.49 $44.6560-64 $15.90 $39.75 $59.63 $79.5065-69 $27.90 $69.75 $104.63 $139.5070-74 $32.73 $81.83 $122.74 $163.6575-99 $51.02 $127.55 $191.33 $255.10Tobacco RatesISSUE AGE $20,000 $50,000 $75,000 $100,00016-24 $1.34 $3.35 $5.03 $6.7025-29 $1.51 $3.78 $5.67 $7.5530-34 $1.87 $4.68 $7.02 $9.3535-39 $2.71 $6.78 $10.17 $13.5540-44 $4.04 $10.10 $15.15 $20.2045-49 $6.28 $15.70 $23.55 $31.4050-54 $10.49 $26.23 $39.34 $52.4555-59 $14.84 $37.10 $55.65 $74.2060-64 $24.77 $61.93 $92.89 $123.8565-69 $41.40 $103.50 $155.25 $207.0070-74 $47.27 $118.18 $177.27 $236.3575-99 $65.83 $164.58 $246.87 $329.15Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anGREEN EXTERIOR REMODELING(Continued...)Page 3 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice
Thank you Christina Cobb Benefit Specialist 704 620 2473 Christina Cobb ColonialLifesales com