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Voluntary Benefits Booklet
Hamilton ConstructionChoose the benets that are right for youHamilton Construction is pleased to offer a variety of benets during your upcoming enrollment. You will have the opportunity to speak with a benets counselor during open enrollment to nd out about all of your benefit options.The following Voluntary benefits will be offered during enrollment:Group Hospital Indemnity Insurance provides a benefit for hospital confinement or outpatient surgery to help with deductibles.Group Accident Insurance can provide a benefit for a range of accidental injuries and treatments. You can use the money however you choose.Group Critical Illness Insurance provides a benefit to help you manage the financial impacts of a critical illness.Group Term Life Insurance provides money to your family if you die within a certain time period, or “term.” It can help them with final arrangements, living expenses, tuition and more.Disability Insurance helps replace a portion of your income to help make ends meet if you become disabled from a covered accident or sickness.ColonialLife.comPolicy forms marketed by the company vary by product and are too numerous to list in the advertisement, but a list can be provided upon request. Colonial Life Insurance products are 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. 9-23 | NS-15156
For more information, talk with your benefits counselor.ColonialLife.comGroup Hospital Indemnity InsurancePlan 1 (HSA-Compliant)PA: “Hospital Confinement Admission” benefit replaces the “Hospital Confinement” benefitTHIS INSURANCE PROVIDES LIMITED BENEFITS.Insureds in California must be covered by comprehensive health insurance before applying for Hospital Confinement Indemnity Insurance.EXCLUSIONSWe will not pay any benefits for injuries received in accidents or for sicknesses which are caused by, contributed to by or occur as a result of the following exclusions and limitations. (a) alcoholism or drug addiction; (b) dental procedures; (c) elective procedures and cosmetic surgery; (d) felonies or illegal occupations; (e) mental or nervous disorders; (f) pregnancy of a dependent child; (g) suicide or injuries which any covered person intentionally does to himself or herself; or (h) war. We will not pay benefits for hospital confinement (i) due to giving birth within the first nine months aer the eective 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 aect any benefits payable.PRE-EXISTING CONDITION LIMITATIONS(l) We will not pay benefits for loss during the first 12 months aer the certificate eective date due to a pre-existing condition.(m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the certificateeective date. (n) This limitation applies to the following benefits, if applicable: Hospital Confinement, Daily Hospital Confinement, Inpatient Mental and Nervous, Rehabilitation Unit Confinement and Specified Critical Illness.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 aect any benefits payable. Applicable to policy formGMB7000-P and certificate form GMB7000-C (including state abbreviations where applicable, such as policy forms GMB7000-P-AU-TX and GMB7000-P-EE-TX, and certificate forms GMB7000-C-AU-TX and GMB7000-C-EE-TX). 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 #101733.GMB7000 – PLAN 1 | 6-21 | 101917-2Group Medical BridgeTM insurance can help with medical costs associated with a hospital stay that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement ............................................................... $_______________ per dayMaximum of one day per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered confinement of the named insured£ Daily hospital confinement .................................................................... $100 per dayMaximum of 365 days per covered person per confinement. Re-confinement for the same or related condition within 90 days of discharge is considered a continuation of a previous confinement.Health savings account (HSA) compatibleThis plan is compatible with HSA guidelines and any other HSA plan that a covered family member may participate in. It may also be oered to employees who do not have HSAs.Colonial Life & Accident Insurance Company’s Group Medical Bridge oers an HSA-compatible plan in most states.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.1500.00
For more information, talk with your benefits counselor.Group Accident InsurancePreferred PlanColonialLife.comGAC4000 – PREFERRED PLANNobody expects an accident to happen. But if it does, your main focus should be on recovery, not how you’re going to pay your bills. Colonial Life accident insurance provides benefits directly to you to use however you like – from medical costs to everyday expenses. Whether it's a fall or a car accident, your benefits oer support when you need it.Benefits are per covered person per covered accident unless stated otherwiseAccident emergency treatment ................................................................................................ $150 One visit per covered person per covered accident and Up to four visits per covered person per calendar yearAccident follow-up doctor visit ..................................................................................................$50Up to four visits per covered person per covered accident andUp to 16 visits per covered person per calendar yearAccidental death Accidental deathPer covered person Accidental death common carrier¾ Named insured .....................................................................$50,000 .................. $200,000¾ Spouse ...............................................................................$50,000 .................. $200,000¾ Dependent child(ren) .............................................................. $10,000 ....................$40,000Examples of common carriers are mass transit trains, buses and planesAccidental dismembermentLoss or loss of use¾ One hand, arm, foot, leg or sight of an eye ......................................................................... $9,000¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination ................................ $18,000¾ One finger or one toe ................................................................................................... $1,050¾ Two or more fingers; two or more toes; or any combination ................................................... $2,100Air ambulance .................................................................................................................. $1,500 Transportation to or from a hospital or medical facility Benefits payable directly to the air ambulance service unless bill shows that charges have been paid in fullAmbulance (ground)..............................................................................................................$300 Transportation to or from a hospital or medical facility Benefits payable directly to the ambulance service unless bill shows that charges have been paid in fullAppliance aid in personal locomotion or mobility .........................................................................$100Walking boot, neck brace, back brace, leg brace, cane, crutches, walker and wheelchairBlood/plasma/platelets .........................................................................................................$400 Required during treatment of a covered accidentBurn¾ 2nd-degree burns (covering at least 36% of the body’s surface) ..................................................$1,000¾ 3rd-degree burns (based on size) ......................................................................... $2,000 – $15,000Burn–skin gra ...................................................................................50% of applicable burn benefitAs a result of 2nd-degree or 3rd-degree burns
Catastrophic accidentTotal and irrecoverable loss or loss of use¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination; or¾ Loss of hearing in both ears or loss of ability to speak Subject to a 365-day elimination period; payable once per lifetime per covered person¾ Named insured ..................................................................................................................................................$50,000¾ Spouse ..................................................................................................................................................................$50,000 ¾ Dependent child(ren) .......................................................................................................................................$25,000Coma ...............................................................................................................$10,000Lasting for 14 or more consecutive daysConcussion ............................................................................................................ $375Dislocation (separated joint) Non-surgical Surgical¾ Hip ........................................................................................$3,000 $6,000¾ Knee (except patella) ..................................................................$1,500 $3,000¾ Ankle, bone or bones of the foot (other than toes) ...............................$1,200 $2,400¾ Collarbone (sternoclavicular) ..........................................................$800 $1,600¾ Collarbone (acromioclavicular and separation) ....................................$200 $400¾ Lower jaw ..................................................................................$720 $1,440¾ Shoulder (glenohumeral) ............................................................ $1,200 $2,400¾ Elbow ....................................................................................... $450 $900¾ Wrist ........................................................................................$600 $1,200¾ Bone(s) of the hand, (other than fingers) ............................................. $810 $1,620¾ Finger, toe ..................................................................................$200 $400¾ Incomplete dislocation or dislocation reduction.................................. 25% of the applicable without anesthesia non-surgical amountEmergency dental work ¾ Dental crown or denture ....................................................................................$300 ¾ Dental extraction .............................................................................................$100 Eye injury ..............................................................................................................$300 With surgical repair or removal of a foreign objectFracture (broken bone) Non-surgical Surgical¾ Skull, depressed fracture (except face/nose) ......................................$3,750 $7,500¾ Skull, simple non-depressed fracture (except face/nose) .......................$1,800 $3,600¾ Hip, thigh (femur) ......................................................................$3,150 $6,300¾ Body of vertebrae (excluding vertebral processes) ...............................$2,700 $5,400¾ Pelvis .....................................................................................$2,400 $4,800¾ Leg (tibia and/or fibula) ...............................................................$1,800 $3,600¾ Bones of the face or nose (except mandible or maxilla) ...........................$910 $1,820¾ Upper jaw, maxilla, upper arm between .......................................... $1,050 $2,100 elbow and shoulder¾ Lower jaw, mandible ................................................................. $1,200 $2,400¾ Kneecap, ankle, foot .................................................................. $1,200 $2,400¾ Shoulder blade, collarbone ......................................................... $1,200 $2,400¾ Vertebral processes ......................................................................$630 $1,260¾ Forearm, hand, wrist ................................................................. $1,200 $2,400¾ Rib ..........................................................................................$375 $750¾ Coccyx .....................................................................................$320 $640¾ Finger, toe .................................................................................$200 $400¾ Chip fracture .................................................25% of the applicable non-surgical amountAlex was cleaning out the gutters when he fell. ALEX’S BENEFITS Ambulance $300Emergency room visit $150X-ray $60Hospital admission $1,000Hospital confinement $750Leg fracture (surgical) $3,600Physical therapy $360Appliance (crutches) $100Doctor’s follow-up oice visit $150$6,470EMERGENCY ROOM VISITAlex was taken by ambulance to the nearest emergency room and received immediate care.The doctor ordered an X-ray and discovered Alex had fractured his leg.DIAGNOSTIC PROCEDUREOver the next several weeks, he had three follow-up appointments with his doctor.DOCTORʼS OFFICE VISITAlex had eight sessions of physical therapy to help him regain the strength in his leg.PHYSICAL THERAPYAlex was admitted to the hospital for surgery on his leg. He was confined for three days.HOSPITAL CONFINEMENTFor illustrative purposes only.Benefit amounts may vary and may not cover all expenses. The certificate has exclusions and limitations.ALEXʼS OUT-OF-POCKET EXPENSESWhen Alex totaled up the bills, he had to pay his annual deductible, as well as co-payments for the ambulance, emergency room, hospital, surgery, physical therapy and follow-up visits. Luckily, Alex had accident coverage to help with these expenses.Alex used crutches.APPLIANCE FOR MOBILITY
For more information, talk with your benefits counselor.GAC4000 – PREFERRED PLANHospital admission .............................................................................................................$1,000Per covered person per covered accidentHospital confinement .................................................................................................. $250 per dayUp to 365 days per covered person per covered accidentHospital intensive care unit admission .................................................................................... $1,750 Per covered person per covered accidentHospital intensive care unit confinement ........................................................................ $400 per day Up to 15 days per covered person per covered accident Knee cartilage (torn) ............................................................................................................. $750 Laceration (no repair, without stitches) ..........................................................................................$50 Laceration (repaired by stitches)¾ Total of all lacerations is less than two inches long ...................................................................$150¾ Total of all lacerations is at least two but less than six inches long .................................................$300 ¾ Total of all lacerations is six inches or longer ...........................................................................$600 Lodging (companion) ..................................................................................................$200 per day Up to 30 days per covered person per covered accident Medical imaging study (CT, CAT scan, EEG, MR or MRI) .....................................................................$200 One benefit per covered person per covered accident per calendar yearOccupational or physical therapy .................................................................................... $45 per day Up to 10 days per covered person per covered accident Pain management for epidural anesthesia .................................................................................. $150 Prosthetic device/artificial limb One benefit per covered person per covered accident¾ One ....................................................................................................................... $1,250 ¾ More than one ........................................................................................................... $2,500 Rehabilitation unit confinement ....................................................................................$150 per day Immediately aer a period of hospital confinement due to a covered accident; up to 15 days per covered person per covered accident, not to exceed 30 days per covered person per calendar yearRuptured disc with surgical repair ............................................................................................$900 Surgery¾ Cranial, open abdominal and thoracic .............................................................................. $1,500 ¾ Hernia with surgical repair ...............................................................................................$300Surgery (exploratory and arthroscopic) ....................................................................................... $225Tendon/ligament/rotator cu¾ One with surgical repair .................................................................................................. $900 ¾ Two or more with surgical repair ..................................................................................... $1,800 Transportation for hospital confinement ...................................................................$600 per round tripUp to three round trips for more than 50 miles from home per covered person per covered accidentX-ray ...................................................................................................................................$60
ColonialLife.com2-20 | 101862-1-ORUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be oered to employees who do not have HSAs.THIS CERTIFICATE PROVIDES LIMITED BENEFITS.EXCLUSIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of a covered personʼs felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness, suicide or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we will not pay Catastrophic Accident benefits for injuries a child received during birth, or for injuries that are the result of being intoxicated or under the influence of any narcotics.This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy form GACC1.0-P-OR and certificate form GACC1.0-C-OR. Premium will vary according to the family coverage type.
For more information, talk with your benefits counselor.ColonialLife.comGroup Accident InsuranceHealth Screening BenefitTHIS INSURANCE PROVIDES LIMITED BENEFITS.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be oered to employees who do not have HSAs.The covered person must incur a charge and the certificate must be in force for benefits to be payable. 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 aect any benefits payable. Applicable to policy form GACC1.0-P and certificate form GACC1.0-C (including state abbreviations where used, for example: GACC1.0-C-AL). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.GAC4000 - HEALTH SCREENING | 11-21 | 101865-2This benefit can help pay for routine preventive tests and services.Health screening ................................................................................$_____________Payable once per covered person per calendar year; subject to a 30-day waiting period Blood test for triglycerides Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) Carotid Doppler CEA (blood test for colon cancer) Chest X-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopyUnderwritten 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.50.00
Group Critical Illness InsurancePlan 2GCI6000 – PLAN 2 – CRITICAL ILLNESS AND CANCERWhen life takes an unexpected turn, your focus should be on recovery — not finances. Colonial Life’s group critical illness insurance helps relieve financial worries by providing a lump-sum benefit payable directly to you to use as needed.Coverage amount: ____________________________COVERED CRITICAL ILLNESS CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTBenign brain tumor100%Coma100%End-stage renal (kidney) failure100%Heart attack (myocardial infarction)100%Loss of hearing100%Loss of sight100%Loss of speech100%Major organ failure requiring transplant100%Occupational infectious HIV or occupational infectious hepatitis B, C or D100%Permanent paralysis due to a covered accident100%Stroke100%Sudden cardiac arrest100%Coronary artery disease25%COVERED CANCER CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTInvasive cancer (including all breast cancer)100%Non-invasive cancer25%Skin cancer initial diagnosis ............................................................ $400 per lifetimeCritical illness and cancer benefitsSpecial needs daycareA hospital stay and treatment for corrective heart surgeryPhysical therapy to build muscle strengthFor illustrative purposes only.Preparing for a lifelong journeyRebecca was born with Down syndrome. Her parents’ critical illness coverage provided a benefit that can help cover expenses related to Rebecca’s care and her changing needs. HOW THEIR COVERAGE HELPEDThe lump-sum amount from the family coverage benefit helped pay for:387100-ORelect from $5,000 to $30,000
ColonialLife.com8-20 | 387100-OR1. Refer to the certificate for complete definitions of covered conditions.2. Dates of diagnoses of a covered critical illness must be separated by more than 180 days. 3. 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.THIS INSURANCE PROVIDES LIMITED BENEFITSEXCLUSIONS 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, 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 pre-existing 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 aer the coverage eective date. Pre-existing Condition means a sickness or physical condition for which a covered person was treated by a doctor, received advice from a doctor or had taken medication prescribed by a doctor within a six-month period immediately preceding the coverage eective date shown on the Certificate Schedule.This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GCI6000-P-OR and certificate form GCI6000-C-OR. 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©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.COVERED CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTCerebral palsy 100%Cle lip or palate 100%Cystic fibrosis 100%Down syndrome 100%Spina bifida 100%KEY BENEFITSAdditional covered conditions for dependent childrenSubsequent diagnosis of a dierent critical illnessIf you receive a benefit for a critical illness and are later diagnosed with a dierent critical illness, 100% of the coverage amount may be payable for that particular critical illness.Subsequent diagnosis of the same critical illnessIf you receive a benefit for a critical illness and are later diagnosed with the same critical illness,3 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 six months and in complete remission prior to the date of reoccurrence; excludes non-invasive or skin cancer.For more information, talk with your benefits counselor.Preparing for the unexpected is simpler than you think. With Colonial Life, youʼll have the support you need to face lifeʼs toughest challenges. Available coverage forspouse or domesticpartner and eligibledependent childrenat 50% of yourcoverage amount Cover your eligibledependent children atno additional cost Receive coverageregardless of medicalhistory, withinspecified limits Works alongsideyour health savingsaccount (HSA) Benefits payableregardless of otherinsurance387100-OR
Group Critical Illness InsuranceWellbeing Assistance BenefitThe wellbeing assistance benefit can help reduce the risk of serious illness through early detection of disease or risk factors.Wellbeing assistance benefit ............................................................. $_____________ Maximum of one test per covered person per calendar year; subject to a 30-day waiting period before the benefit is payable. The test must be performed aer the waiting period. Blood test for triglycerides Bone marrow testing BRCA1 or BRCA2 testing (genetic test for breast cancer) Breast ultrasound CA 15-3 (blood test for ovarian cancer) CA 125 (blood test for breast cancer) Carotid Doppler CEA (blood test for colon cancer) Chest x-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopyFor more information, talk with your benefits counselor.ColonialLife.comGCI6000 – WELLBEING ASSISTANCE BENEFIT | 8-20 | 387307-ORUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.THIS INSURANCE PROVIDES LIMITED BENEFITS.This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GCI6000-P-OR and certificate form GCI6000-C-OR. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.387307-OR50.00
Deductions per year: 12Group Medical Bridge (GMB7000) for ORCompositeApplicable to Policy Forms GMB7000–P & GMB7000-ClWithout Wellbeing Assistance, Daily Hospital ConfinementHOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 3: $150017-99 $21.95 $48.40 $30.70 $57.15Group Accident for ORApplicable to policy forms GACC1.0-P & GACC1.0-ClOn/Off-Job Accident Coverage, Health Screening Benefit ($50 Benefit)PreferredISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY17-99 $17.53 $28.64 $31.16 $42.27Group Critical Illness (GCI6000) for ORApplicable 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 - $50 BenefitUni-Tobacco RatesATTAINEDAGENAMED INSURED NAMED INSURED ANDSPOUSE/DOMESTIC PARTNERNAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED,SPOUSE/DOMESTIC PARTNERAND DEPENDENT CHILD(REN)$10,000 17-24 $4.30 $6.60 $4.30 $6.6025-29 $4.80 $7.30 $4.80 $7.3030-34 $5.50 $8.40 $5.50 $8.4035-39 $8.20 $12.40 $8.20 $12.4040-44 $11.30 $17.10 $11.30 $17.1045-49 $16.00 $24.10 $16.00 $24.1050-54 $21.50 $32.40 $21.50 $32.4055-59 $29.40 $44.20 $29.40 $44.2060-64 $39.40 $59.30 $39.40 $59.3065-69 $49.40 $74.30 $49.40 $74.3070-74 $62.90 $94.50 $62.90 $94.50Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2024 Colonial Life & Accident Insurance Company"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.Colonial Life | don.brink@colonial-nw.com | (503) 504-8347Page 1 of 1Underwritten by Colonial Life & Accident Insurance CompanySee page 1 for Important NoticeMonthy Premiums
Group Term Life InsuranceVoluntary coverageOur group term life insurance can help increase nancial security for your family if something were to happen to you. You can also apply for coverage for your spouse and eligible dependent children without health questions.1 How much group term coverage do I need?You:$ _____________________• Available in $1,000 increments• Minimum of $10,000 increments to a maximum of ve times your salary to $500,000Your spouse:$ _____________________• Available in $1,000 increments• Minimum of $5,000 to a maximum of $500,000• Spouse coverage cannot exceed your coverage amount2Your dependent children(up to age 26):$ _____________________• Available in $1,000 increments• Minimum of $1,000 to a maximum of $10,000 per dependent child• Each dependent child is covered for the same amount, except children from live birth to six months for whom the death benet is $1,000Why group term life insurance is a good option• Death benet• Lower premiums• Coverage during high-need years• Benet payment typically tax-freeVOLUNTARY GROUP TERM LIFE
Additional benets and servicesBuilt-in accelerated death benet provides an advance of up to 75% of the death benet, to a maximum of $150,000, if diagnosed with a terminal illness.3Health Advocate Employee Assistance Program (EAP) provides 24-hour personal support and referral service, including a medical bill saver service. Face-to-face sessions and video counseling with mental health professionals are available.4• Online: ColonialLife.com/EAP• Telephone: 1-888-645-1772Life planning services offer nancial and legal counseling services, as well as grief support and referral for up to 12 months after a claim.4Get the most out of your coveragePortability: You may be able to continue your coverage if you change jobs or retire. Conversion: After the group term period ends, you may be eligible to convert to a whole life policy without health questions. Waiver of premium: Your premium payments may be eligible for waiver if you become disabled. To learn more, talk with your Colonial Life benets counselor.1 Spouse and dependent coverage will not be effective if they are currently totally disabled. Being totally disabled means the inability to perform two or more activities of daily living, being conned to a hospital or similar institution, or being unable to attend school outside the home (for a dependent child age 5 up to age 26). In ID, NH and TX, the denition of total disability does not include Activities of Daily Living (ADL) requirements. The ability to work does not determine disability. You can pay premiums on insurance for your dependents with no health questions asked. Coverage isn’t effective until the earlier of the date they are no longer totally disabled or two years after the date that coverage would have otherwise become effective for the spouse or dependent child. This provision does not apply to newborn children born while dependent insurance is in effect.2 The maximum benet is 50% of your benet in NE.3 Terminal illness means an injury or sickness that results in the covered person having a life expectancy of 12 months or less and from which there is no reasonable prospect of recovery. A life expectancy of 24 months or less in IL, KS, MA, TX and WA. Accelerated death benet payments will reduce the amount the policy pays upon the recipient’s death, may adversely affect the recipient’s eligibility for Medicaid or other government benets or entitlements, and may be taxable. Recipients should consult their tax attorney or advisor before utilizing accelerated benet payments.4 The Employee Assistance Program and Life Planning Services, provided by Health Advocate, are available with Colonial Life & Accident Insurance Company Group Term Life offering. Terms and availability of service are subject to change. The service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. State-mandated limitations for legal services in WA apply. Please contact the company for full details.BENEFIT AGE REDUCTION SCHEDULEWhen a covered person reaches age 70, but not 75, the amount of insurance will be:• 65% of the amount of insurance prior to age 70; or• 65% of the amount of insurance applied for on or after age 70 but before age 75.When a covered person reaches age 75 or more, the amount of insurance will be:• 50% of the amount of insurance prior to the rst reduction; or• 50% of the amount of insurance the employee applied for on or after age 75.Once the benet reduction schedule begins, there will be no further increases in insurance for a covered person. If the proposed insured is age 70, but not age 75 at the time of enrollment, the amount of insurance applied for will be reduced by 65%. If the proposed insured is age 75 or older at the time of enrollment, the amount applied for will be reduced by 50%.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GTL1.0-P and certicate form GTL1.0-C (including state abbreviations where used, for example: GTL1.0-P-TX and GTL1.0-C-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.ColonialLife.comUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.FOR EMPLOYEES 3-24 | 100272-7
Group Term Life InsuranceAccidental Death & Dismemberment Insurance (AD&D)This coverage can help pay for expenses related to an accidental death. It can also help pay for costs related to recovery and rehabilitation from an accidental dismemberment.What is my AD&D full benet amount? ____________________The AD&D full benet amount is equal to your group term life insurance death benet amount.What is paid under the AD&D benet?If the loss is: % of full amount paidLoss of life 100%Loss or loss of use of both hands or both feet or sight of both eyes100%Loss or loss of use of one hand and one foot 100%Loss or loss of use of one hand and sight of one eye 100%Loss or loss of use of one foot and sight of one eye 100%Loss of speech and hearing 100%Loss or loss of use of one hand or one foot 50%Loss of sight of one eye 50%Loss of speech or hearing 50%Loss or loss of use of thumb and index nger on the same hand25%What other benets are included? • Seatbelts and airbags • Repatriation (employee only)• Common carrier(employee only)• Disappearance (employee only)Family coverageAD&D is available to you with your group term life coverage, as well as all your covered family members.To learn more, talk with your Colonial Life benets counselor.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy form GTL1.0-P and certicate form GTL1.0-C (including state abbreviations where used, for example: GTL1.0-C-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.© 2023 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 GROUP TERM LIFE AD&D BENEFIT WITH TRAVEL SUITE FOR EMPLOYEES 11-23 | 100267-5
Disability Plus: Individual short-term disability insuranceBase PlanIf you are unable to work due to injury or sickness, disability insurance can provide a monthly benet to help you cover your ongoing expenses. Use this worksheet to see how Colonial Life Disability Plus can help ll gaps so you can focus on recovery.Disability Plus Benets WorksheetTalk with your benets counselor about your expenses to help you determine the Disability Plus benets coverage that’s right for you.MONTHLY EXPENSESRound to the nearest hundredRent or mortgage (insurance, minor home repairs) $Transportation (gas, car, bus, car maintenance and insurance) $Utilities (cell phone, Wi-Fi, electricity/gas, water) $Food and household necessities (toiletries, cleaning supplies) $Childcare (day care, after school care) $Health (medical needs and prescription drugs) $Other (gym/fitness, streaming/cable, extracurricular) $Total monthly expenses (add lines 1–7 together) $DISABILITY PLUS: WHAT’S RIGHT FOR ME?1. How much disability coverage do I need? Monthly benet amount for off-job injury and off-job sickness:$ _________________________Subject to income requirementsIf your plan includes on-job injury/ on-job sickness benets, the on-job benet is 50% of the off-job amount.2. How long do I want benets coverage?Benet period: ____ monthsThe partial disability benet period is three months.3. When would I like my total disability benets to start?After an injury: ________ daysAfter a sickness: ______ daysDISABILITY PLUS (DIP3000) BASE599694-OR
FREQUENTLY ASKED QUESTIONSWhat is the denition of total disability?“Totally disabled” or “total disability” means you are unable to perform the material and substantial duties of your occupation, not working at any occupation, and under the regular and appropriate care of a physician.How does partial disability work?If you are able to return to work part-time, you may still be able to receive 50% of your total disability benet.What is waiver of premium? We will waive your premium payments after 90 consecutive days of a covered disability.What are the age guidelines to qualify for this coverage?Coverage is available from ages 17 to 74.Can I keep my coverage if I change jobs or employers?You can keep your coverage to age 75, even if you change occupations, as long as you pay your premiums when they are due.What happens if I am disabled while traveling outside of the country?If you are totally disabled longer than the elimination period while outside of the United States, Canada, Mexico, Puerto Rico, the Bahama Islands, the Virgin Islands, Bermuda, or Jamaica, you may receive benets for up to the maximum benet period for total disability and partial disability combined, not to exceed 12 months, before you must return to the U.S. to continue receiving benets.For more information, talk with your Colonial Life benets counselor. ColonialLife.comEXCLUSIONS AND LIMITATIONSWe will not pay benets for losses that are caused by, contributed to by, or occur as the result of: aeronautics; aviation; bungee jumping, racing, and sports for wage, compensation, or prot; chemical dependency; cosmetic surgery; felonies; illegal occupations; intoxicants, narcotics or other controlled substances; mental or nervous disorders; suicide or injuries which you intentionally do to yourself; or war, riot, or armed conict. We will not pay for losses due to you giving birth within the rst nine months after the coverage effective date of the policy. We will not pay for loss when the disability is a pre-existing condition as described in the policy.Pre-existing condition means a sickness or physical condition, whether diagnosed or not, for which you were treated, had medical testing, received medical advice, or had taken medication within 12 months before the policy coverage effective date shown on the policy schedule.If we do not pay a claim because the illness is a pre-existing condition, we will provide the insured with the following: a written denial letter; and the information we have documenting the treatment or observation of the pre-existing condition.After this policy has been in force for 12 months from the policy coverage effective date shown on the policy schedule, we will pay benets for any pre-existing condition not excluded by name or specic description if the covered disability began at least 12 months after the policy coverage effective date and the elimination period has been satised.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 ICC21-DIP3000. 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. © 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 3-23 | 599694-OR599694-OR
Filing online means never waiting for mail or dealing with fax machines and complex paper forms . Our guided question wizard walks you through the process and checks for missing information that could cause delays. Opting for direct deposit can also get approved payments to you up to a week faster than paper check. NEED TO FILE A CLAIM?Here’s what you can do on Colonial Life for Policyholders:Update yourpersonal info& preferencesFile claimswith a simple,guided form Opt for instant alerts by email or textView claim statusor policy details anytimeCheck your claim status by logging into your account at ColonialLife.com/access. You can also sign up for text or email alerts so you know instantly if status changes or more information is needed. For your convenience, you can login anytime with a mobile device to photograph and upload documents with your camera.AFTER YOU FILE:Find out how simple your claims and benefits experience can be by learning more about the Colonial Life for Policyholders portal. Just visit ColonialLife.com to see what this online account administration platform can do for you.LEARN MOREBECOME A MEMBER TODAY:Go to ColonialLife.com/access to register.Click “create an account”, fill out the required information and click Submit.Enjoy faster service and improved benefits awareness.123THE PORTALOFFERS YOU:Faster service than calling/emailingConfirmation when a claim has been submittedSimplified bill payment and managementAnswers to frequently asked questions and live chat assistance if you don’t see what you are looking for.Colonial Life for Policyholders PortalA faster, simpler way to manage your benefitsColonial Life for Policyholders is an online portal created with you in mind. It’s the most convenient and ecient way to file a claim and manage your benefits. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.43233-41Set up directdeposit forapproved payments