Hello Autism Clinic Benefit Guide : simplebooklet.com

ELIGIBILITY & ENROLLMENTWho is Eligible and When?If you are a full-time employee (working 30 ormore hours per week), you are eligible to enroll inthe benefits described in this guide. Your spouseor domestic partner and dependent children (upto age 26) are eligible to enroll in these benefitsas well.New Hire EnrollmentNew employees hired after the Annual Open Enrollment period are eligible for benefits on the first day of the month following 60 days of employment. Employees must complete benefit elections within 30 days of the enrollment eligibility date.Mid-Year Change in Status EventGenerally, once you enroll in your benefits, you cannot change your elections until the next open enrollment period. There are, however, some exceptions. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires group health plans[1] to provide a special enrollment opportunity to an employee (or COBRA enrollee) upon the occurrence of specific events. Examples include: Acquisition of new dependent(s) due tomarriage Acquisition of new child dependent(s) due tobirth or adoption (including placement foradoption) Gain eligibility for premium assistancesubsidy under Medicaid or CHIP Loss of other health coverage if due to:• Loss of eligibilityo Death of spouse; divorceo Child loses status (e.g., reaches agelimit)o Employment change (e.g., termination,reduction in hours, unpaid FMLA)• Expiration of COBRA maximum period• Moving out of plan’s service area• Other employer terminates its plan (ordiscontinues employer contributions)• Loss of eligibility under Marketplace policyor individual market policy• Loss of Medicaid or CHIP Coverage

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Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 06/01/2024 - 05/31/2025 : AFA CPOSII 7350 100/50 IntRX CY V23Coverage for: Employee + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.HealthReformPlanSBC.com or by calling 1-888-982-3862. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary/ or call 1-888-982-3862 to request a copy.Important Questions Answers Why This Matters:What is the overall deductible?In-Network: Individual $7,350 / Family $14,700. Out-of-Network: Individual $22,050 / Family $66,150.Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.Are there servicescovered before you meetyour deductible?Yes. Certain office visits, preventive care and urgent care in-network.This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.Are there otherdeductibles for specificservices?No.You don’t have to meet deductibles for specific services.What is the out-of-pocketlimit for this plan?In-Network: Individual $9,100 / Family $18,200. Out-of-Network: Individual $42,050 / Family $126,150.The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.What is not included inthe out-of-pocket limit?Premiums, balance-billing charges, penalties for failure to obtain pre-authorization for services, and health care this plan doesn't cover.Even though you pay these expenses, they don’t count toward the out-of-pocket limit.Will you pay less if youuse a network provider?Yes. See http://www.aetna.com/docfind or call 1-888-982-3862 for a list of in-network providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider's charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.Do you need a referral tosee a specialist?No.You can see the specialist you choose without a referral.081700-050020-162350 Page 1 of 6

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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness$40 copay/visit, deductible does not apply50% coinsuranceNo charge for in-network virtual primary care telemedicine provider visits for certain services.Specialist visit $80 copay/visit 50% coinsuranceNonePreventive care /screening /immunizationNo charge 50% coinsuranceYou may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.If you have a test Diagnostic test (x-ray, blood work) 0% coinsurance 50% coinsuranceNoneImaging (CT/PET scans, MRIs) 0% coinsurance 50% coinsurance NoneIf you need drugs to treat your illness or conditionMore information about prescription drug coverage is available at www.aetna.com/pharmacy-insurance/individuals-familiesPreferred generic drugsTier 1A: $3 copay/ prescription (retail), $6 copay/ prescription (mail order); Tier 1: $10 copay/ prescription (retail), $20 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applyCovers up to a 30 day supply (retail prescription), 31-90 day supply (mail order prescription). Your cost will be higher for choosing Brand over Generics unless prescribed Dispense as Written; cost difference penalty doesn’t apply to overall deductible or out-of-pocket limit. No charge for preferred generic FDA-approved women's contraceptives in-network. No coverage for mail order prescriptions out-of-network. Maintenance drugs- after two retail fills, you are required to fill a 90-day supply at CVS Caremark® Mail Service Pharmacy or CVS Pharmacy.Preferred brand drugs$50 copay/ prescription (retail), $100 copay/ prescription (mail order)50% coinsurance (retail)Non-preferred generic/brand drugs$80 copay/ prescription (retail), $160 copay/ prescription (mail order), deductible does not apply to non-preferred generic drugs50% coinsurance (retail), deductible does not apply to non-preferred generic drugsSpecialty drugsPreferred: 20% coinsurance up to a $250 maximum/ prescription for up to a 30 day supply; Non-preferred: 40% coinsurance up to a $500 Not coveredFirst prescription fill at any retail or specialty pharmacy. Subsequent fills must be through our preferred specialty pharmacy network.081700-050020-162350 Page 2 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)maximum/ prescription for up to a 30 day supplyIf you have outpatient surgeryFacility fee (e.g., ambulatory surgery center)$250 copay/visit 50% coinsuranceNonePhysician/surgeon fees 0% coinsurance 50% coinsurance NoneIf you need immediate medical attentionEmergency room care $500 copay/visit $500 copay/visitCopay waived if admitted. Out-of-network emergency room care cost-share same as in-network. No coverage for non-emergency care.Emergency medical transportation 0% coinsurance 0% coinsuranceOut-of-network cost-share same as in-network.Urgent care$100 copay/visit, deductible does not apply50% coinsurance No coverage for non-urgent use.If you have a hospital stayFacility fee (e.g., hospital room) $500 copay/admission 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.Physician/surgeon fees 0% coinsurance 50% coinsurance NoneIf you need mental health, behavioral health, or substance abuse servicesOutpatient servicesOutpatient office visits: No charge; All other outpatient services: 0% coinsuranceOffice visits and all other outpatient services: 50% coinsuranceNoneInpatient services $500 copay/admission 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If you are pregnantOffice visitsNo charge 50% coinsuranceCost sharing does not apply for preventive services. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).Childbirth/delivery professional services0% coinsurance 50% coinsurance NoneChildbirth/delivery facility services $500 copay/admission 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.081700-050020-162350 Page 3 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you need help recovering or have other special health needsHome health care 0% coinsurance 50% coinsuranceCoverage is limited to 60 visits per year. Out-of-network precertification required or $400 penalty applies per occurrence.Rehabilitation services$80 copay/visit 50% coinsuranceCoverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.Habilitation services 0% coinsurance 50% coinsuranceNoneSkilled nursing care 0% coinsurance 50% coinsuranceCoverage is limited to 60 days per year. Out-of-network precertification required or $400 penalty applies per occurrence.Durable medical equipment 50% coinsurance 50% coinsuranceCoverage is limited to 1 durable medical equipment for same/similar purpose. Excludes repairs for misuse/abuse.Hospice servicesInpatient: $500 copay/admission; Outpatient: 0% coinsurance50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If your child needs dental or eye careChildren's eye exam No charge50% coinsuranceCoverage is limited to 1 exam every 12 months.Children's glasses Not coveredNot coveredNot covered.Children's dental check-up Not covered Not covered Not covered.Excluded Services & Other Covered Services:Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Bariatric surgery• Cosmetic surgery• Dental care (Adult & Child)• Glasses (Child)• Hearing aids• Infertility treatment• Long-term care• Non-emergency care when traveling outside the U.S.• Private-duty nursing• Routine foot care• Weight loss programsOther Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Acupuncture - Coverage is limited to 10 visits per year for in-network only.• Chiropractic care - Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.• Routine eye care (Adult) - Coverage is limited to 1 exam every 12 months.081700-050020-162350 Page 4 of 6

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Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: ● If your group health coverage is subject to ERISA, you may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.● For more information on your rights to continue coverage, contact the plan at 1-888-982-3862.● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.● If your coverage is a church plan, church plans are not covered by the Federal COBRA continuation coverage rules. If the coverage is insured, individuals should contact their State insurance regulator regarding their possible rights to continuation coverage under State law.Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact:● If your group health coverage is subject to ERISA, you may contact Aetna directly by calling the toll-free number on your Medical ID Card, or by calling our general toll free number at 1-888-982-3862. You may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.● Additionally, a consumer assistance program can help you file your appeal. Contact information is at: http://www.aetna.com/individuals-families-health-insurance/rights-resources/complaints-grievances-appeals/index.html.Does this plan provide Minimum Essential Coverage? Yes.Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.Does this plan meet Minimum Value Standards? No. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.To see examples of how this plan might cover costs for a sample medical situation, see the next section.081700-050020-162350 Page 5 of 6

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About these Coverage Examples:This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) ■ The plan’s overall deductible $7,350■ Specialist copayment $80■ Hospital (facility) copayment $500■ Other coinsurance 0%This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)Total Example Cost $12,700In this example, Peg would pay:Cost SharingDeductibles $7,350Copayments $500Coinsurance $0What isn't coveredLimits or exclusions $60The total Peg would pay is $7,910 Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well-controlled condition)■ The plan’s overall deductible $7,350■ Specialist copayment $80■ Hospital (facility) copayment $500■ Other coinsurance 0%This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Diabetic supplies (glucose meter)Total Example Cost $5,600In this example, Joe would pay:Cost SharingDeductibles $3,500Copayments $500Coinsurance $0What isn't coveredLimits or exclusions $20The total Joe would pay is $4,020 Mia’s Simple Fracture (in-network emergency room visit and follow up care)■ The plan’s overall deductible $7,350■ Specialist copayment $80■ Hospital (facility) copayment $500■ Other coinsurance 0%This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray)Durable medical equipment (crutches) Rehabilitation services (physical therapy)Total Example Cost $2,800In this example, Mia would pay:Cost SharingDeductibles $2,800Copayments $0Coinsurance $0What isn't coveredLimits or exclusions $0The total Mia would pay is $2,800Note: These numbers assume the patient does not participate in the plan's wellness program. If you participate in the plan's wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: 1-888-982-3862.The plan would be responsible for the other costs of these EXAMPLE covered services.081700-050020-162350 Page 6 of 6

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Assistive TechnologyPersons using assistive technology may not be able to fully access the following information. For assistance, please call 1-888-982-3862.Smartphone or TabletTo view documents from your smartphone or tablet, the free WinZip app is required. It may be available from your App Store.Non-DiscriminationAetna complies with applicable Federal civil rights laws and does not unlawfully discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, disability, gender identity or sexual orientation.We provide free aids/services to people with disabilities and to people who need language assistance.If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card.If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by contacting: Civil Rights Coordinator, P.O. Box 14462, Lexington, KY 40512 (CA HMO customers: P.O. Box 24030, Fresno, CA 93779), 1-800-648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705), CRCoordinator@aetna.com.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD).Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

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Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 06/01/2024 - 05/31/2025 : AFA CPOSII 5000 80/50 CY V23Coverage for: Employee + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.HealthReformPlanSBC.com or by calling 1-888-982-3862. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary/ or call 1-888-982-3862 to request a copy.Important Questions Answers Why This Matters:What is the overall deductible?In-Network: Individual $5,000 / Family $10,000. Out-of-Network: Individual $10,000 / Family $30,000.Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.Are there servicescovered before you meetyour deductible?Yes. Certain office visits, preventive care, urgent care and prescription drugs in-network.This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.Are there otherdeductibles for specificservices?No.You don’t have to meet deductibles for specific services.What is the out-of-pocketlimit for this plan?In-Network: Individual $7,750 / Family $15,500. Out-of-Network: Individual $25,000 / Family $75,000.The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.What is not included inthe out-of-pocket limit?Premiums, balance-billing charges, penalties for failure to obtain pre-authorization for services, and health care this plan doesn't cover.Even though you pay these expenses, they don’t count toward the out-of-pocket limit.Will you pay less if youuse a network provider?Yes. See http://www.aetna.com/docfind or call 1-888-982-3862 for a list of in-network providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider's charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.Do you need a referral tosee a specialist?No.You can see the specialist you choose without a referral.080700-060020-192370 Page 1 of 6

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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness$40 copay/visit, deductible does not apply50% coinsuranceNo charge for in-network virtual primary care telemedicine provider visits for certain services.Specialist visit$80 copay/visit, deductible does not apply50% coinsuranceNonePreventive care /screening /immunizationNo charge 50% coinsuranceYou may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.If you have a test Diagnostic test (x-ray, blood work) 20% coinsurance 50% coinsuranceNoneImaging (CT/PET scans, MRIs) 20% coinsurance 50% coinsurance NoneIf you need drugs to treat your illness or conditionMore information about prescription drug coverage is available at www.aetna.com/pharmacy-insurance/individuals-familiesPreferred generic drugsTier 1A: $3 copay/ prescription (retail), $6 copay/ prescription (mail order); Tier 1: $10 copay/ prescription (retail), $20 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applyCovers up to a 30 day supply (retail prescription), 31-90 day supply (mail order prescription). Your cost will be higher for choosing Brand over Generics unless prescribed Dispense as Written; cost difference penalty doesn’t apply to out-of-pocket limit. No charge for preferred generic FDA-approved women's contraceptives in-network. No coverage for mail order prescriptions out-of-network. Maintenance drugs- after two retail fills, you are required to fill a 90-day supply at CVS Caremark® Mail Service Pharmacy or CVS Pharmacy.Preferred brand drugs$50 copay/ prescription (retail), $100 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applyNon-preferred generic/brand drugs$80 copay/ prescription (retail), $160 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applySpecialty drugsPreferred: 20% coinsurance up to a $250 maximum/ prescription for up to a 30 day supply; Non-preferred: 40% coinsurance up to a $500 Not coveredFirst prescription fill at any retail or specialty pharmacy. Subsequent fills must be through our preferred specialty pharmacy network.080700-060020-192370 Page 2 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)maximum/ prescription for up to a 30 day supply, deductible does not applyIf you have outpatient surgeryFacility fee (e.g., ambulatory surgery center)20% coinsurance 50% coinsuranceNonePhysician/surgeon fees 20% coinsurance 50% coinsurance NoneIf you need immediate medical attentionEmergency room care20% coinsurance after $300 copay/visit20% coinsurance after $300 copay/visitCopay waived if admitted. Out-of-network emergency room care cost-share same as in-network. No coverage for non-emergency care.Emergency medical transportation 20% coinsurance 20% coinsuranceOut-of-network cost-share same as in-network.Urgent care$75 copay/visit, deductible does not apply50% coinsurance No coverage for non-urgent use.If you have a hospital stayFacility fee (e.g., hospital room) 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.Physician/surgeon fees 20% coinsurance 50% coinsurance NoneIf you need mental health, behavioral health, or substance abuse servicesOutpatient servicesOutpatient office visits: No charge; All other outpatient services: 20% coinsuranceOffice visits and all other outpatient services: 50% coinsuranceNoneInpatient services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If you are pregnantOffice visitsNo charge 50% coinsuranceCost sharing does not apply for preventive services. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).Childbirth/delivery professional services20% coinsurance 50% coinsurance NoneChildbirth/delivery facility services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.080700-060020-192370 Page 3 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you need help recovering or have other special health needsHome health care 20% coinsurance 50% coinsuranceCoverage is limited to 60 visits per year. Out-of-network precertification required or $400 penalty applies per occurrence.Rehabilitation services$80 copay/visit 50% coinsuranceCoverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.Habilitation services 20% coinsurance 50% coinsuranceNoneSkilled nursing care 20% coinsurance 50% coinsuranceCoverage is limited to 60 days per year. Out-of-network precertification required or $400 penalty applies per occurrence.Durable medical equipment 50% coinsurance 50% coinsuranceCoverage is limited to 1 durable medical equipment for same/similar purpose. Excludes repairs for misuse/abuse.Hospice services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If your child needs dental or eye careChildren's eye exam No charge50% coinsuranceCoverage is limited to 1 exam every 12 months.Children's glasses Not coveredNot coveredNot covered.Children's dental check-up Not covered Not covered Not covered.Excluded Services & Other Covered Services:Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Bariatric surgery• Cosmetic surgery• Dental care (Adult & Child)• Glasses (Child)• Hearing aids• Infertility treatment• Long-term care• Non-emergency care when traveling outside the U.S.• Private-duty nursing• Routine foot care• Weight loss programsOther Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Acupuncture - Coverage is limited to 10 visits per year for in-network only.• Chiropractic care - Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.• Routine eye care (Adult) - Coverage is limited to 1 exam every 12 months.080700-060020-192370 Page 4 of 6

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Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: ● If your group health coverage is subject to ERISA, you may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.● For more information on your rights to continue coverage, contact the plan at 1-888-982-3862.● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.● If your coverage is a church plan, church plans are not covered by the Federal COBRA continuation coverage rules. If the coverage is insured, individuals should contact their State insurance regulator regarding their possible rights to continuation coverage under State law.Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact:● If your group health coverage is subject to ERISA, you may contact Aetna directly by calling the toll-free number on your Medical ID Card, or by calling our general toll free number at 1-888-982-3862. You may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.● Additionally, a consumer assistance program can help you file your appeal. Contact information is at: http://www.aetna.com/individuals-families-health-insurance/rights-resources/complaints-grievances-appeals/index.html.Does this plan provide Minimum Essential Coverage? Yes.Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.Does this plan meet Minimum Value Standards? Yes. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.To see examples of how this plan might cover costs for a sample medical situation, see the next section.080700-060020-192370 Page 5 of 6

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About these Coverage Examples:This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) ■ The plan’s overall deductible $5,000■ Specialist copayment $80■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)Total Example Cost $12,700In this example, Peg would pay:Cost SharingDeductibles $5,000Copayments $10Coinsurance $1,300What isn't coveredLimits or exclusions $60The total Peg would pay is $6,370 Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well-controlled condition)■ The plan’s overall deductible $5,000■ Specialist copayment $80■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Diabetic supplies (glucose meter)Total Example Cost $5,600In this example, Joe would pay:Cost SharingDeductibles $100Copayments $1,300Coinsurance $0What isn't coveredLimits or exclusions $20The total Joe would pay is $1,420 Mia’s Simple Fracture (in-network emergency room visit and follow up care)■ The plan’s overall deductible $5,000■ Specialist copayment $80■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray)Durable medical equipment (crutches) Rehabilitation services (physical therapy)Total Example Cost $2,800In this example, Mia would pay:Cost SharingDeductibles $2,300Copayments $200Coinsurance $0What isn't coveredLimits or exclusions $0The total Mia would pay is $2,500Note: These numbers assume the patient does not participate in the plan's wellness program. If you participate in the plan's wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: 1-888-982-3862.The plan would be responsible for the other costs of these EXAMPLE covered services.080700-060020-192370 Page 6 of 6

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Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 06/01/2024 - 05/31/2025 : AFA CPOSII 100/50 $25 $1000D CY V23Coverage for: Employee + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.HealthReformPlanSBC.com or by calling 1-888-982-3862. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary/ or call 1-888-982-3862 to request a copy.Important Questions Answers Why This Matters:What is the overall deductible?$0. Out-of-Network: Individual $5,000 / Family $15,000.Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.Are there servicescovered before you meetyour deductible?No.You will have to meet the deductible before the plan pays for any services.Are there otherdeductibles for specificservices?No.You don’t have to meet deductibles for specific services.What is the out-of-pocketlimit for this plan?In-Network: Individual $6,500 / Family $13,000. Out-of-Network: Individual $15,000 / Family $45,000.The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.What is not included inthe out-of-pocket limit?Premiums, balance-billing charges, penalties for failure to obtain pre-authorization for services, and health care this plan doesn't cover.Even though you pay these expenses, they don’t count toward the out-of-pocket limit.Will you pay less if youuse a network provider?Yes. See http://www.aetna.com/docfind or call 1-888-982-3862 for a list of in-network providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider's charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.Do you need a referral tosee a specialist?No.You can see the specialist you choose without a referral.081700-050020-102347 Page 1 of 6

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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness$25 copay/visit 50% coinsuranceNo charge for in-network virtual primary care telemedicine provider visits for certain services.Specialist visit $100 copay/visit 50% coinsuranceNonePreventive care /screening /immunizationNo charge 50% coinsuranceYou may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.If you have a test Diagnostic test (x-ray, blood work)Lab: $25 copay/visit; X-ray: $75 copay/visit50% coinsuranceNoneImaging (CT/PET scans, MRIs) $500 copay/visit 50% coinsurance NoneIf you need drugs to treat your illness or conditionMore information about prescription drug coverage is available at www.aetna.com/pharmacy-insurance/individuals-familiesPreferred generic drugsTier 1A: $3 copay/ prescription (retail), $6 copay/ prescription (mail order); Tier 1: $10 copay/ prescription (retail), $20 copay/ prescription (mail order)50% coinsurance (retail), deductible does not applyCovers up to a 30 day supply (retail prescription), 31-90 day supply (mail order prescription). Your cost will be higher for choosing Brand over Generics unless prescribed Dispense as Written; cost difference penalty doesn’t apply to out-of-pocket limit. No charge for preferred generic FDA-approved women's contraceptives in-network. No coverage for mail order prescriptions out-of-network. Maintenance drugs- after two retail fills, you are required to fill a 90-day supply at CVS Caremark® Mail Service Pharmacy or CVS Pharmacy.Preferred brand drugs$50 copay/ prescription (retail), $100 copay/ prescription (mail order)50% coinsurance (retail), deductible does not applyNon-preferred generic/brand drugs$80 copay/ prescription (retail), $160 copay/ prescription (mail order)50% coinsurance (retail), deductible does not applySpecialty drugsPreferred: 20% coinsurance up to a $250 maximum/ prescription for up to a 30 day supply; Non-preferred: 40% coinsurance up to a $500 maximum/ prescription for up to a 30 day supplyNot coveredFirst prescription fill at any retail or specialty pharmacy. Subsequent fills must be through our preferred specialty pharmacy network.081700-050020-102347 Page 2 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you have outpatient surgeryFacility fee (e.g., ambulatory surgery center)$500 copay/visit 50% coinsuranceNonePhysician/surgeon fees No charge 50% coinsurance NoneIf you need immediate medical attentionEmergency room care $500 copay/visit$500 copay/visit, deductible does not applyCopay waived if admitted. Out-of-network emergency room care cost-share same as in-network. No coverage for non-emergency care.Emergency medical transportation $500 copay/trip$500 copay/trip, deductible does not applyOut-of-network cost-share same as in-network.Urgent care $75 copay/visit 50% coinsurance No coverage for non-urgent use.If you have a hospital stayFacility fee (e.g., hospital room) $1,000 copay/day, days 1-3 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.Physician/surgeon fees No charge 50% coinsurance NoneIf you need mental health, behavioral health, or substance abuse servicesOutpatient servicesOffice visits and all other outpatient services: No chargeOffice visits and all other outpatient services: 50% coinsuranceNoneInpatient services $1,000 copay/day, days 1-3 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If you are pregnantOffice visitsNo charge 50% coinsuranceCost sharing does not apply for preventive services. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).Childbirth/delivery professional servicesNo charge 50% coinsurance NoneChildbirth/delivery facility services $1,000 copay/day, days 1-3 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.081700-050020-102347 Page 3 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you need help recovering or have other special health needsHome health care $100 copay/visit 50% coinsuranceCoverage is limited to 60 visits per year. Out-of-network precertification required or $400 penalty applies per occurrence.Rehabilitation services$100 copay/visit 50% coinsuranceCoverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.Habilitation services No charge 50% coinsuranceNoneSkilled nursing care $1,000 copay/day, days 1-3 50% coinsuranceCoverage is limited to 60 days per year. Out-of-network precertification required or $400 penalty applies per occurrence.Durable medical equipment 50% coinsurance 50% coinsuranceCoverage is limited to 1 durable medical equipment for same/similar purpose. Excludes repairs for misuse/abuse.Hospice servicesInpatient: $1,000 copay/day, days 1-3; Outpatient: $100 copay/visit50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If your child needs dental or eye careChildren's eye exam No charge50% coinsuranceCoverage is limited to 1 exam every 12 months.Children's glasses Not coveredNot coveredNot covered.Children's dental check-up Not covered Not covered Not covered.Excluded Services & Other Covered Services:Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Bariatric surgery• Cosmetic surgery• Dental care (Adult & Child)• Glasses (Child)• Hearing aids• Infertility treatment• Long-term care• Non-emergency care when traveling outside the U.S.• Private-duty nursing• Routine foot care• Weight loss programs081700-050020-102347 Page 4 of 6

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Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Acupuncture - Coverage is limited to 10 visits per year for in-network only.• Chiropractic care - Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.• Routine eye care (Adult) - Coverage is limited to 1 exam every 12 months.Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: ● If your group health coverage is subject to ERISA, you may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.● For more information on your rights to continue coverage, contact the plan at 1-888-982-3862.● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.● If your coverage is a church plan, church plans are not covered by the Federal COBRA continuation coverage rules. If the coverage is insured, individuals should contact their State insurance regulator regarding their possible rights to continuation coverage under State law.Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact:● If your group health coverage is subject to ERISA, you may contact Aetna directly by calling the toll-free number on your Medical ID Card, or by calling our general toll free number at 1-888-982-3862. You may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.● Additionally, a consumer assistance program can help you file your appeal. Contact information is at: http://www.aetna.com/individuals-families-health-insurance/rights-resources/complaints-grievances-appeals/index.html.Does this plan provide Minimum Essential Coverage? Yes.Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.Does this plan meet Minimum Value Standards? Yes. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.To see examples of how this plan might cover costs for a sample medical situation, see the next section.081700-050020-102347 Page 5 of 6

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About these Coverage Examples:This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) ■ The plan’s overall deductible $0■ Specialist copayment $100■ Hospital (facility) copayment $1,000■ Other copayment $0This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)Total Example Cost $12,700In this example, Peg would pay:Cost SharingDeductibles $0Copayments $2,300Coinsurance $0What isn't coveredLimits or exclusions $60The total Peg would pay is $2,360 Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well-controlled condition)■ The plan’s overall deductible $0■ Specialist copayment $100■ Hospital (facility) copayment $1,000■ Other copayment $0This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Diabetic supplies (glucose meter)Total Example Cost $5,600In this example, Joe would pay:Cost SharingDeductibles $0Copayments $1,300Coinsurance $0What isn't coveredLimits or exclusions $20The total Joe would pay is $1,320 Mia’s Simple Fracture (in-network emergency room visit and follow up care)■ The plan’s overall deductible $0■ Specialist copayment $100■ Hospital (facility) copayment $1,000■ Other copayment $0This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray)Durable medical equipment (crutches) Rehabilitation services (physical therapy)Total Example Cost $2,800In this example, Mia would pay:Cost SharingDeductibles $0Copayments $1,500Coinsurance $0What isn't coveredLimits or exclusions $0The total Mia would pay is $1,500Note: These numbers assume the patient does not participate in the plan's wellness program. If you participate in the plan's wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: 1-888-982-3862.The plan would be responsible for the other costs of these EXAMPLE covered services.081700-050020-102347 Page 6 of 6

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Dental PPO InsurancePlan 4 Premier – $2,000 | 100% | 80% | 50%Life is full of unexpected smiles, and good oral health helps maintain them. Colonial Life dental insurance helps you pay for routine and costly dental care for you and your family, so you can focus on what’s important. POLICY DETAILSThe policy year maximum benet for this policy is $2,000 per person.Class A, B and C services apply toward the maximum.This policy has a deductible of $50 per person, per policy year for class B and C services.Each covered family member pays a deductible up to a maximum of three members each policy year.The co-insurance for this policy is:NETWORK BENEFITSNetwork providers have agreed to charge discounted rates for covered services. You receive the benet of discounted services, and pay only your co-insurance portion and any applicable deductible. Plus, network providers will le your claim for you, so you don’t have to deal with the paperwork. OUT-OF-NETWORK BENEFITSOut-of-network providers haven’t agreed to discounted rates, and their fees may vary signicantly. Your policy’s co-insurance may not cover the total costs of dental care and, in addition to any deductible, you are responsible for any remaining balance. This is referred to as “balance billing” and only happens when you go out of network. CLASS TYPE OF SERVICE INSURANCE PAYSClass A Preventive services 100% Class B Basic services 80%Class C Major services 50%LARGE NATIONAL NETWORK• Save more with 117,000+ unique providers • Claims led for members by providers • Easy provider search on ColonialLifeDental.com • In-house recruiting team dedicated to expanding the network IDN8000 - PLAN 4 PREMIER How does this policy pay benets for network and out-of-network care? 526763-2

Page 27

THIS POLICY PROVIDES LIMITED BENEFITS. This product is not available in ZIP codes beginning with 025. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IDN8000 (including state abbreviations where used, for example: IDN8000-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 4-21 | 526763-21. Member may have one additional periodontal maintenance in place of an additional cleaning. 2. Waiting periods may be waived if takeover applies.3. No waiting period in Maine.ColonialLifeDental.comCovered procedures and waiting periodsPREVENTIVE SERVICES (CLASS A): NO WAITING PERIOD• Routine exams and cleanings (twice every 12 months) ‐ One additional cleaning per 12 months if member is in second or third trimester of pregnancy1• X-rays ‐ Bitewing X-rays (up to four lms, once every 12 months) ‐ Full mouth X-rays (once every ve years)• Children’s services (up to age 14) ‐ Fluoride treatment (once every 12 months) ‐ Sealants (once every 36 months) ‐ Space maintainers (up to age 14, once every 24 months)• Oral cancer screening (for age 40 +, once every 12 months)BASIC SERVICES (CLASS B): NO WAITING PERIOD• Fillings• Simple extractions• Periodontics (gum treatments)• Endodontics (root canals)• Repair of crowns, dentures or bridges• Emergency treatmentMAJOR SERVICES (CLASS C): 12-MONTH WAITING PERIOD2, 3• Oral surgery (extractions and impacted teeth)• Anesthesia (covered with complex oral surgery)• Inlays and onlays• Crowns• Bridges• Dentures• Endosteal implants (in place of a three-unit bridge)For more information about this dental policy, talk with your benets counselor.Oral wellness is an essential component of our overall health. Based on experience with my own patients, people who actively seek regular dental care have a greater chance to be healthier and happier than people who don’t.Jim Di MarinoDMD, Dental Director for Colonial Life526763-2

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Dental PPO InsurancePlan 5 Premier – $1,500 | 100% | 80% | 50%Life is full of unexpected smiles, and good oral health helps maintain them. Colonial Life dental insurance helps you pay for routine and costly dental care for you and your family, so you can focus on what’s important. POLICY DETAILSThe policy year maximum benet for this policy is $1,500 per person.Class A, B and C services apply toward the maximum.This policy has a deductible of $50 per person, per policy year for class B and C services.Each covered family member pays a deductible up to a maximum of three members each policy year.The co-insurance for this policy is:NETWORK BENEFITSNetwork providers have agreed to charge discounted rates for covered services. You receive the benet of discounted services and pay only your co-insurance portion and any applicable deductible. Plus, network providers will le your claim for you, so you don’t have to deal with the paperwork. OUT-OF-NETWORK BENEFITSOut-of-network providers haven’t agreed to discounted rates, and their fees may vary signicantly. Your policy’s co-insurance is applied to the lesser of the provider’s charge or a percentage of the customary charge in your area (90th percentile), and may not cover the total costs of dental care. You are responsible for your co-insurance portion, deductible and any remaining balance. CLASS TYPE OF SERVICE INSURANCE PAYSClass A Preventive services 100% Class B Basic services 80%Class C Major services 50%LARGE NATIONAL NETWORK• Save more with 117,000+ unique providers • Claims led for members by providers • Easy provider search on ColonialLifeDental.com • In-house recruiting team dedicated to expanding the network IDN8000 - PLAN 5 PREMIERHow does this policy pay benets for network and out-of-network care? 527601-1

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THIS POLICY PROVIDES LIMITED BENEFITS. This policy is not available in ZIP codes beginning with 025. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IDN8000 (including state abbreviations where used, for example: IDN8000-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 2-21 | 527601-11. Member may have one additional periodontal maintenance in place of an additional cleaning. 2. Waiting periods may be waived if takeover applies.3. No waiting period in Maine. Six-month waiting period in Vermont.ColonialLifeDental.comCovered procedures and waiting periodsPREVENTIVE SERVICES (CLASS A): NO WAITING PERIOD• Routine exams and cleanings (twice every 12 months) ‐ One additional cleaning per 12 months if member is in second or third trimester of pregnancy1• X-rays ‐ Bitewing x-rays (up to four lms, once every 12 months) ‐ Full mouth x-rays (once every ve years)• Children’s services (up to age 14) ‐ Fluoride treatment (once every 12 months) ‐ Sealants (once every 36 months) ‐ Space maintainers (up to age 14, once every 24 months)• Oral cancer screening (for age 40+, once every 12 months)BASIC SERVICES (CLASS B): NO WAITING PERIOD• Fillings• Simple extractions • Periodontics (gum treatments)• Endodontics (root canals)• Repair of crowns, dentures or bridges• Emergency treatmentMAJOR SERVICES (CLASS C): 12-MONTH WAITING PERIOD2, 3• Oral surgery (extractions and impacted teeth)• Anesthesia (covered with complex oral surgery)• Inlays and onlays• Crowns• Bridges• Dentures• Endosteal dental implants (in place of a three-unit bridge)For more information about this dental policy, talk with your benets counselor.Oral wellness is an essential component of our overall health. Based on experience with my own patients, people who actively seek regular dental care have a greater chance to be healthier and happier than people who don’t.Jim Di MarinoDMD, Dental Director for Colonial Life527601-1

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For more information, talk with yourbenefits counselor.Individual Dental PPO InsuranceVision RiderIDN8000 – VISION RIDERDental insurance o ers an optional vision rider to help pay for eye exams and materials, such as glasses and contact lenses. This coverage can help you maintain healthy vision and overall wellness, as well as provide valuable financial protection for you, your spouse and dependent children.Vision benefitsIN-NETWORKOUT-OF-NETWORKALLOWANCECO-PAYSExam (once per 12 months) $10 Up to $35Materials $25 See belowSTANDARD PLASTIC LENSES (once per 12 months)Single vision Covered by co-pay Up to $25Bifocal Covered by co-pay Up to $40Trifocal Covered by co-pay Up to $50Lenticular $80 allowance Up to $50Progressive $80 allowance Up to $40Polycarbonate lenses (for children to age 19) Covered by co-pay N/AFRAMES1 (once per 12 months)Choose any frame available at provider locations $120 allowance Up to $50CONTACT LENSES2 (once per 12 months) (Includes fit, follow-up and materials) In lieu of eyeglass lenses and frames Elective Up to $120 allowance Up to $100 allowanceMedically necessary Up to $120 allowance Up to $210 allowanceFreedom of choiceYou’ll have access to a national vision network that includes independent optometrists, ophthalmologists and retail stores including Walmart, Sam’s Club Optical, Costco, Pearle Vision and Target. Additional vision benefit advantages  Eye exams and materials (frames, lenses) can be purchased from di erent locations and providers. For example, you could have an eye exam with your favorite eye care professional and order contacts online.  Check the network for Value Added and Service Plus providers. They can provide special discounts for extra purchases of lenses and coatings, frames, contact lenses and other products.ColonialLife.com

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ColonialLife.com1-18 | 101851©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.1 Eyeglass lenses and frames are paid in lieu of the contact lenses benefit.2 The contact lenses benefit is paid in lieu of eyeglass lenses and frames. Contact lenses consist of three components: materials, exams and fittings. Coverage is for materials and the exam, up to the contact lenses allowance. Fittings may be covered but only up to the amount of any unused contact lenses allowance – a er materials.3 Optometrists at Costco Optical outlets are independent of Costco and may not be in network. To verify that your vision exam will be fully covered a er co-pay, confirm that your doctor is an in-network provider. Special payment and reimbursement terms apply for material purchases at Costco. Additional discounts are not applicable.4 Not a covered benefit. These schedules are subject to change without notice. Added value discounts may not be available in all geographical areas and vary by network. Many providers are not able to o er discounts on “Prestige” frames. Special lens packages that combine numerous lens enhancements at value price points are not covered by these added value programs. Cannot be combined with any other promotions or discounts.5 Some retail chains sell sunglasses in departments outside of their optical shops where discounts do not apply.The policy or its provisions may vary or be unavailable in some states. The policy had exclusions and limitations, which may a ect any benefits payable. See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability.Special discounts on material purchases4Providers identified as Value Added or Service Plus in our online provider directory o er the following additional values for our members on vision material purchases. We encourage you to contact your selected provider prior to visiting their location to confirm their continued participation. Not all providers, such as Walmart, Sam’s Club and Costco Optical, choose to participate in these special discounts.Value Added providersDISCOUNTS FOR FIRST PAIR OF GLASSESLens options (add-ons for insured purchases):PURCHASE A SECOND PAIR OF GLASSES AND RECEIVE PREFERRED PRICINGLenses:DISCOUNTS ON FRAMES, CONTACT LENSES AND OTHER PRODUCTSService Plus providersRECEIVE UP TO A 20% DISCOUNT FOR THE FOLLOWING ADD-ONS TO INSURED PURCHASES:  UV coating  Solid tinting/gradient tinting  Standard scratch resistance coating  UV coating…$15  Solid tinting/gradient tinting…$15  Standard scratch resistance coating…$15  Standard anti-reflective coating…$45  Premium anti-reflective coating…$70  Ultra anti-reflective coating…20% discount  Polarized…$75  Transition…$75  Progressive lenses:– Standard…$110– Premium…$170– Ultra…member receives a 20% discount  Standard polycarbonate …$40  High index (single vision)– 1.56-1.60…$60– 1.66+…20% discount  High index (multi-focal)– 1.56-1.60…$75– 1.66+…20% discount  Single vision plastic lenses…$40  Bifocal plastic lenses…$60  Trifocal lenses…$70  Progressive lenses (standard)…$110  Progressive lenses (premium and ultra)…20% discount  Frames – Up to 35% discount  Contact Lenses – 5-15% discount, depending on type  Other products – 20% discount on non-prescription sunglasses and other ancillary products/solutions  Standard anti-reflective coating  Premium anti-reflective coating  Transition  Standard polycarbonate

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For more information, talk with your benefits counselor.Accident InsurancePreferred PlanColonialLife.comIAC4000 – PREFERRED PLANAccident insurance can help with medical or other costs associated with a covered accident or injury that your health insurance may not cover. Coverage options are available for you, your spouse and eligible dependent children. Benefits are per covered person per covered accident unless stated otherwiseAccident emergency treatment ................................................................................................$125 One visit per covered person per covered accidentAccident follow-up treatment (including transportation/telemedicine) ...................................................$55Up to six benefits per covered person per covered accident and up to 12 benefits per covered person per calendar yearAccidental death Accidental deathPer covered person Accidental death common carrier¾ Named insured .....................................................................$40,000 .................. $160,000¾ Spouse ...............................................................................$40,000 .................. $160,000¾ Dependent child(ren) .............................................................. $10,000 ....................$30,000Examples of common carriers are mass transit trains, buses and planesAccidental dismembermentLoss, loss of use or paralysis¾ One hand, arm, foot, leg or sight of an eye ........................................................................$10,000¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination ................................ $20,000Loss or loss of use¾ One finger or one toe ...................................................................................................... $900¾ Two or more fingers; two or more toes; or any combination ................................................... $1,800¾ Partial dismemberment of one finger or toe .........................................................................$450¾ Partial dismemberment of two or more fingers or toes; or any combination ...................................$900Accidental dismemberment due to a catastrophic accidentSubject to a 180-day elimination period; payable once per lifetime per covered person¾ Named insured ........................................................................................................ $25,000¾ Spouse .................................................................................................................. $25,000 ¾ Dependent child(ren) ................................................................................................. $25,000 Accidental injury due to an automobile accident ..........................................................................$250 Requires transportation to a hospital or medical facility by ambulance Payable once per calendar year for all covered persons combinedAir ambulance .................................................................................................................. $2,000 Transportation to or from a hospital or medical facilityAmbulance (ground or water)...................................................................................................$200 Transportation to or from a hospital or medical facilityBlood/plasma/platelets (transfusion) .........................................................................................$300 A transfusion required during treatment of a covered accidentBurn¾ 2nd-degree burns (covering at least 36% of the body’s surface) ..................................................$1,000 ¾ 3rd-degree burns (based on size) ......................................................................... $2,000 – $12,000

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Burn – skin gra .................................................................... 50% of applicable burn benefitAs a result of 2nd-degree or 3rd-degree burnsComa ...............................................................................................................$12,500Lasting for seven or more consecutive daysConcussion ............................................................................................................ $150Dislocation (separated joint) Non-surgical Surgical¾ Hip ........................................................................................$2,250 $4,500¾ Knee (except patella) ..................................................................$1,125 $2,250¾ Ankle, bone or bones of the foot (other than toes) ...............................$1,000 $2,000¾ Collarbone (sternoclavicular) ..........................................................$750 $1,500¾ Collarbone (acromioclavicular and separation) ....................................$500 $1,000¾ Lower jaw, shoulder, elbow, wrist, bone(s) of the hand ............................ $500 $1,000¾ Finger, toe ..................................................................................$100 $200¾ Incomplete dislocation or dislocation reduction.................................. 25% of the applicable without anesthesia non-surgical amountEmergency dental work ¾ Dental crown, denture or implant .........................................................................$300 ¾ Dental extraction .............................................................................................$100 Eye injury ..............................................................................................................$300 With surgical repair or removal of a foreign objectFracture (complete) Non-surgical Surgical¾ Skull, depressed fracture (except face/nose) ......................................$3,000 $6,000¾ Skull, simple non-depressed fracture ..............................................$1,200 $2,400¾ Hip, thigh (femur) ......................................................................$2,200 $4,400¾ Body of vertebrae (excluding vertebral processes), pelvis, leg .................$1,000 $2,000¾ Bones of the face or nose (except mandible or maxilla) ...........................$500 $1,000¾ Upper jaw, maxilla, upper arm between .............................................$450 $900 elbow and shoulder¾ Lower jaw, mandible ....................................................................$375 $750¾ Kneecap, ankle, foot or heel ............................................................$375 $750¾ Shoulder blade ...........................................................................$375 $750¾ Collarbone, vertebral processes ....................................................... $625 $1,250¾ Forearm, hand, wrist ....................................................................$375 $750¾ Rib ..........................................................................................$625 $1,250¾ Coccyx .....................................................................................$250 $500¾ Finger ......................................................................................$325 $650¾ Toe .......................................................................................... $325 $650¾ Chip fracture .................................................25% of the applicable non-surgical amountHearing-loss injuries ................................................................................................$120 Maximum of one benefit for each injured ear per covered person per lifetimeHospital admission ............................................................................................... $1,000 Per covered person per covered accidentHospital confinement .................................................................................... $250 per dayUp to 365 days per covered person per covered accidentHospital sub-acute intensive care unit confinement .............................................. $325 per dayUp to 30 days per covered person per covered accidentIntensive care unit admission .................................................................................. $2,000 Per covered person per covered accidentIntensive care unit confinement ....................................................................... $450 per dayUp to 15 days per covered person per covered accidentJohn was cleaning out the gutters when he fell. EMERGENCY ROOM VISITJohn was admitted to the hospital for surgery on his leg.Over the next several weeks, he had three follow-up appointments with his doctor.John had eight sessions of PT to help him regain the strength in his leg.The doctor ordered an X-ray and discovered John had fractured his leg.John was taken by ambulance to the nearest emergency room and received immediate care.DIAGNOSTIC PROCEDUREHOSPITAL CONFINEMENTDOCTORʼS OFFICE VISITPHYSICAL THERAPYFor illustrative purposes only.Benefit amounts may vary and may not cover all expenses. The policy has exclusions and limitations.JOHN’S BENEFITS Ambulance $200Emergency room visit $125X-ray $30Hospital admission $1,000Hospital confinement $750Leg fracture (surgical) $2,000Physical therapy $280Medical equipment (crutches) $100Doctor’s oice visit $165$4,650JOHNʼS OUT-OF-POCKET EXPENSESWhen John 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, John had accident coverage to help with these expenses.

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For more information, talk with your benefits counselor.IAC4000 – PREFERRED PLANKnee cartilage (torn) .............................................................................................................$650 Laceration (no repair, without stitches) ..........................................................................................$30 Laceration (repaired by stitches)¾ Total of all lacerations is less than two inches long .....................................................................$75¾ Total of all lacerations is at least two but less than six inches long .................................................$275¾ Total of all lacerations is six inches or longer ...........................................................................$600 Lodging (companion) ..................................................................................................$125 per dayUp to 30 days per covered person per covered accident Medical equipment¾ Tier 1 ..........................................................................................................................$30 Arm sling, cane, medical ring cushion, neck brace or wrist/ankle splint¾ Tier 2 ........................................................................................................................$100 Bedside commode, cold therapy system (cryotherapy), crutches, leg brace, shower chair, walker or walking boot¾ Tier 3 ........................................................................................................................$200 Back brace, body jacket, Continuous Passive Movement (CPM), halo, electric scooter, hospital bed (including rental), knee scooter, stair li chair, wheelchairMedical imaging study (CT, CAT scan, EEG, EMG, MR or MRI) ..............................................................$200 One benefit per covered person per covered accident per calendar yearObservation room ..................................................................................................... $150 per day Up to two days per covered person per calendar yearPain management for epidural anesthesia (non-surgical) ................................................................ $100 Post-Traumatic Stress Disorder (PTSD) .......................................................................................$200 Diagnosed from a covered accident with one benefit per covered person per calendar yearProsthetic device/artificial limb¾ One ..........................................................................................................................$750 ¾ More than one ........................................................................................................... $1,500 Repair or replacement¾ Repair .......................................................................................................................$375 ¾ Replacement ...............................................................................................................$750 One repair or replacement per prosthetic device/artificial limb per covered person per lifetimeRehabilitation unit confinement ....................................................................................$150 per day Immediately aer 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 ............................................................................................$750 Surgery¾ Cranial, open abdominal and thoracic .............................................................................. $1,500 ¾ Hernia with surgical repair ...............................................................................................$200Surgery (exploratory and arthroscopic) ....................................................................................... $300 Tendon/ligament/rotator cu¾ One with surgical repair ..................................................................................................$650 ¾ Two or more with surgical repair ..................................................................................... $1,300 Therapy (occupational, physical or speech) ......................................................................... $35 per day Up to 10 days per covered person per covered accidentTransportation for hospital confinement (per round trip) ................................................................$600 Up to 3 round trips for more than 50 miles from home per covered person per covered accidentX-ray ...................................................................................................................................$30

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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 CONDITIONPERCENTAGE 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%Stroke100%Sudden cardiac arrest 100%Coronary artery disease25%COVERED CANCER CONDITIONPERCENTAGE 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:

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ColonialLife.com6-20 | 387100-TX1. 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 BENEFITS.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: doctor or physician relationship; 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 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 aer the coverage eective date. 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 eective date.This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy forms GCI6000-P-EE-TX and GCI6000-P-AU-TX and certificate forms GCI6000-C-EE-TX and GCI6000-C-AU-TX. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©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 CONDITIONPERCENTAGE 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 dierent critical illnessIf you receive a benefit for a critical illness and are later diagnosed with a dierent critical illness, 100% of the coverage amount may be payable for that particular critical illness.Subsequent diagnosis of the same critical illnessIf 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 12 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 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

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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 ............................................................. $100.00Maximum 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 aer 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 | 5-20 | 387307Underwritten 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 or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form 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.

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Disability 1000-TXHow long could you aord to go without a paycheck?Help protect your paycheck with Colonial Life’s short-term disability insurance.You use your paycheck mainly to pay for your home, your car, groceries, medical bills and utilities. What if you couldn’t go to work due to an accident or sickness?Monthly Expenses: $_________________ $_________________ $_________________ $_________________ $_________________ $_________________ Total $_________________My Coverage Worksheet (For use with your Colonial Life Benets Counselor)Short-TermDisability InsuranceHow much coverage do I need? On-Job Accident and On-Job Sickness $________ O-Job Accident and O-Job Sickness $________How long will I receive benets? Total Disability: ___________ months Partial Disability: 3 months* *Partial Disability is 50% of the Total Disability AmountWhen will my benets start? After an Accident: ___________ days After a Sickness: ___________ daysHow much will it cost? Your cost will vary based on the level of coverage you select. What additional features are included?l Waiver of Premiuml Worldwide Coverage

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Will my disability income payment be reduced if I have other insurance?You’re paid regardless of any other insurance you may have with other insurance companies. Benets are paid directly to you (unless you specify otherwise).When am I considered totally disabled?Totally disabled means you are:l Unable to perform the material and substantial duties of your regular occupation;l Not in fact, working at any occupation for wage or prot; andl Under the regular and appropriate care of a doctor, unless the doctor states that continued treatment in the future would be of no benet to you.What if I want to return to work part-time after I am totally disabled?You may be able to return to work part-time and still receive benets. We call this “Partial Disability.” Partially disabled means:l You are unable to perform the material and substantial duties of your regular occupation for 20 hours or more per week;l You are able to work at your regular occupation or any other occupation for less than 20 hours per week;l Your employer will allow you to work for less than 20 hours per week; andl You are under the regular and appropriate care of a doctor.What if I change employers?If you change jobs or leave your employer, you can take your coverage with you at no additional cost. Your coverage is guaranteed renewable to age 70 as long as you continue to pay your premiums when they are due. Here are some What is a pre-existing condition?Pre-existing condition is when you have a sickness or physical condition for which you were treated, received medical advice or had taken medication within 12 months before the eective date of the policy.If you become disabled because of a pre-existing condition, we will not pay for any disability period if it begins during the rst 12 months (6 months if you are age 65 or older on the eective date of the policy) the policy is in force. Can my premium change?You may choose the amount of coverage to meet your needs (subject to your income). You can elect more or less coverage which will change your premium. Colonial Life can change your premium only if we change it on all policies of this kind in the state where your policy was issued. What is a covered accident or a covered sickness?A covered accident is an accident. A covered sickness means an illness, infection, disease or any other abnormal physical condition, not caused by an injury.A covered accident or covered sickness:l Occurs after the eective date of the policy;l Is of a type listed on the Policy Schedule;l Occurs while the policy is in force; andl Is not excluded by name or specic description in the policy. How do I le a claim?Visit coloniallife.com or call our Policyholder Service Center at 1.800.325.4368 for additional information.frequently asked questionsabout Colonial Life’s disability insurance:Colonial Life 1200 Colonial Life BoulevardColumbia, South Carolina 29210coloniallife.com5/11©2011 Colonial Life & Accident Insurance Company.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.Colonial Life and Making benets count are registered service marks of Colonial Life & Accident Insurance Company. EXCLUSIONSWe will not pay benets for losses that are caused by or are the result of: ying; giving birth within the rst nine months after the eective date of the policy; hazardous avocations; felonies and illegal occupation; intoxicants and narcotics; having a pre-existing condition as described and limited by the policy; racing; semi-professional or professional sports; suicide or self-inicted injuries; war or armed conict. For cost and complete details, see your Colonial Life benets counselor. Applicable to policy forms DIS1000-TX and DIS 1000-3M-TX. This is not an insurance contract and only the actual policy provisions will control.59212-10Disability 1000-TX

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Dental PPO Member GuideDental insurance coverage provides valuable protection for both your smile and your wallet. Below is information to help use the plan.USING THE DENTAL & VISION NETWORKS• The name of the dental network is DenteMax Plus /AlwaysCare.1 The name of the vision network, if applicable to your coverage, is First Look.• Find a network provider by visiting ColonialLifeDental.com. DOWNLOAD THE ALWAYSASSIST MOBILE APPAlwaysAssist makes it simple to access your dental and vision benets information. You can:• View benets, claim status, ID cards and more.• Find the app in the App Store or Google Play, or visit the website, ColonialLifeDental.com.• Register using your Social Security number or member ID which can be found on your ID card.Scan this code or go directly to ColonialLifeDental.com to access AlwaysAssist.ID CARDS• ID cards are mailed to your home address within 10 business days of enrolling. • Only the main insured’s name will be listed.• Included with your ID card is a list of the eight nearest network providers, based on your home address.• Vision coverage, if purchased, includes a separate ID card.• Below are samples of ID cards and the mailing envelope they are sent in.CLA OE WIN 9/188485 Goodwood BoulevardBaton Rouge, LA 70806-7878IMPORTANT! Your insurance documents are enclosed. HOW TO USE YOUR DENTAL BENEFITS:  Register and manage your account at AlwaysAssist.com.  Request pre-treatment estimates for all services over $300.  Member Customer Service: (888) 400-9304  Provider Services: (855) 400-9330  Faster claims processing is available for network providers at AlwaysAssist.com. Mail claims to: Dental Claims DepartmentP.O. Box 80139Baton Rouge, LA 70898-013910-18 | NS-15928-1SAMPLEDENTAL ID CardPolicyholder NameMember Claims No: XXXXXXX Cov. Code: DPolicy No: XXXXXXEff. Date: 02/01/2022 Plan: SCANetwork/PPO: DenteMax Plus / AlwaysCareDeductible: $50 per benet year Payor ID: STR01Underwritten by: Colonial Life & Accident Insurance CompanySAMPLE

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CLAIMS• Pre-treatment Estimates: We recommend that your provider submits this when treatment is expected to exceed $300. A claims examiner will review the treatment plan in advance and advise how the plan will pay so you know what your cost will be.• Claim Forms: Most providers will le claims on your behalf, but if you do need to submit your own claim, you can nd the forms you need on ColonialLifeDental.com. CUSTOMER SERVICEOur dental customer service team is available to answer your questions.Monday–Friday 8 a.m.– 8 p.m. ETSaturdays 10 a.m.–4 p.m. ETTheir phone number is 888-400-9304.Need assistance not related to dental? Visit ColonialLife.com 24/7 or call customer service at 800-325-4368.ColonialLifeDental.com1. In Louisiana and Mississippi, the name of the dental network is DenteMax /AlwaysCare.No benets will be paid for replacement of teeth missing prior to the effective date of coverage.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 9-21 | 818100

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Term Life InsuranceHelp protect the people who depend on youIf something happened to you, the last thing your family should have to worry about is financial burdens. Funeral expenses, medical bills and taxes could be just the beginning. How would they cover ongoing living expenses, such as a mortgage, utilities and health care?Plan for the future with term life insurance from Colonial Life & Accident Insurance Company.The advantages of term life insurance  Level death benefit.  Lower cost option compared with cash value insurance.  Coverage for specified periods of time, which can be during high-need years.  Benefit for the beneficiary that is typically free from income tax.Benefits and features  Guaranteed premiums do not increase during the term.  Coverage is guaranteed renewable to age 95 as long as premiums are paid when due.  You can convert it to cash value insurance.  Portability allows you to take it with you if you change jobs or retire.  An accelerated death benefit is included.Your cost will vary based on the level of coverage you select. Talk with your Colonial Life benefits counselor for information about what level of coverage would work best for you.TERM LIFE 1000

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Benefits worksheetFor use with your Colonial Life benefits counselor£ YOU $ __________________ FACE AMOUNTSelect the term period£ 10-year term£ 20-year term£ 30-year term£ SPOUSE $ ______________ FACE AMOUNTSelect the term period£ 10-year term£ 20-year term£ 30-year termSelect any optional riders:£ Spouse term life rider $ _____________ face amount for ________-year term period£ Children’s term life rider $ _____________ face amount£ Waiver of premium benefit rider£ Accidental death benefit riderHOW MUCH COVERAGE DO YOU NEED?To learn more, talk with your Colonial Life benefits counselor.EXCLUSIONS AND LIMITATIONSIf the insured commits suicide within two years (one year in CO and ND) from the coverage eective date, whether he is sane or insane (not applicable in AZ), we will not pay the death benefit. We will terminate this policy and return the premiums paid, without interest. In MO, should death occur as a result of suicide, our company is responsible only for the return of premiums paid when application is made with intent to commit suicide.You will receive a policy summary or illustration (whichever is applicable to your state) when your policy is issued if this policy has exclusions, limitations or reductions of benefits. For costs and complete details, call or write your Colonial Life benefits counselor or the company. This brochure is applicable to policy forms TERM1000, R-TERM1000-ADB, R-TERM1000-CTR, R-TERM1000-STR, R-TERM1000-WAIVER (and applicable state variations, for example: TERM1000-TX, R-TERM1000-ADB-TX-1, R-TERM1000-CTR-TX, R-TERM1000-STR-TX and R-TERM1000-WAIVER-TX-1). See your Colonial Life benefits counselor for additional information specific for your state. This coverage contains limitations and exclusions that may aect benefits payable. Product may vary by state.Cash value policy conversionYou can convert your policy to a Colonial Life cash value life insurance policy any time through age 75 (unless you have used the accelerated death benefit or waiver of premium benefit rider) with no evidence of insurability. Premiums will be based on your age at the time you convert your policy.Accelerated death benefitIf you are diagnosed with a terminal illness, you can request up to 75% of the policy’s death benefit, not to exceed $150,000. We deduct a fee only if you use the benefit, and your death benefit will then be reduced by the amount you receive. In addition, there may be tax consequences for receiving the accelerated benefit; ask your tax advisor for advice. Please refer to your policy for details.Spouse coverage optionsTwo options are available for spouse coverage at an additional cost:1. Spouse term life policy: Oers guaranteed premiums and level death benefits equivalent to those available to you – whether or not you buy a policy for yourself.2. Spouse term life rider: Add a term rider for your spouse to your policy, up to a maximum death benefit of $50,000; 10-year and 20-year are available (20-year rider only available with a 20- or 30-year term policy).Dependent coverageYou may add a children’s term life rider to cover all of your eligible dependent children with up to $10,000 in coverage each for one premium. The children’s term life rider may be added to either the primary or spouse policy, not both.Waiver of premium benefit riderThis rider waives all premiums (for the policy and any riders) if you become totally and permanently disabled before the age of 65. To be considered permanent, your total disability must continue with no interruptions for at least six consecutive months. Premiums waived by this rider do not have to be repaid. This rider is available for the spouse policy as well, subject to home oice approval.Accidental death benefit riderThis rider provides an additional benefit to the beneficiary if the insured dies as a result of an accident before age 70. The benefit doubles if the injury resulting in death occurs while insured is a fare-paying passenger on a public conveyance, such as a commercial aircra or taxicab. An additional seatbelt benefit is also payable.©2016 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 4-16 | 64815-10ColonialLife.com

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Your cost will vary based on the level of coverage you select. Whole Life InsuranceYou can’t predict your family’s future, but you can be prepared for it.You like to think that you’ll be there for your family in the years to come. But if something happened to you, would your family have the income they need?It’s not easy to think about such serious circumstances, but it’s important to make sure your family is financially protected. You can gain peace of mind with whole life insurance from Colonial Life.Advantages of whole life insurance  Permanent coverage that stays the same throughout the life of the policy  Guaranteed level premiums that do not increase because of changes in health or age  Access to the policy’s cash value through a policy loan for emergencies  Benefit for the beneficiary that is typically tax-freeBenefits and features  Two plan options to choose what age your premium payments will end – Paid-Up at Age 70 or Paid-Up at Age 100  Stand-alone spouse policy available whether or not you buy a policy for yourself  Flexibility to keep the policy if you change jobs or retire  Built-in terminal illness accelerated death benefit that provides up to 75% of the policy’s death benefit (up to $150,000) if you’re diagnosed with a terminal illness  Immediate $3,000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses  Pays cash surrender value at age 100 (when the policy endows)WHOLE LIFE (IWL5000)HealthAairs.org, End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported, July 2017.Talk with your benefits counselor for information about what level of coverage would work best for you.In the U.S., medical spending in the last 12 months of life is nearly $80,000 per person.$

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£ YOU $ ___________________ Select the option:£ Paid-Up at Age 70£ Paid-Up at Age 100£ SPOUSE $ _______________ Select the option:£ Paid-Up at Age 70£ Paid-Up at Age 100EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage eective date or the date of reinstatement, we will not pay the death benefit. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you. Product may vary by state. For costs and complete details of the coverage, call or write your Colonial Life benefits counselor or the company.This brochure is applicable to policy forms ICC19-IWL5000-70/IWL5000-70, ICC19-IWL5000-100/IWL5000-100, ICC19-IWL5000J/IWL5000J and rider forms ICC19-R-IWL5000-STR/R-IWL5000-STR, ICC19-R-IWL5000-CTR/R-IWL5000-CTR, ICC19-R-IWL5000-WP/R-IWL5000-WP, ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD, ICC19-R-IWL5000-CI/R-IWL5000-CI, ICC19-R-IWL5000-CC/R-IWL5000-CC, ICC19-R-IWL5000-GPO/R-IWL5000-GPO and applicable state variations.Additional coverage optionsSpouse term life riderCover your spouse up to a maximum death benefit of $50,000; 10-year and 20-year spouse term riders are available.Juvenile whole life policyYou can purchase a policy while children are young and premiums are low – whether or not you buy a policy on yourself. You may also increase the coverage when the child is 18, 21 and 24 without providing proof of good health. The plan is paid-up at age 70.Children’s term life riderYou may purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy – not both.Accidental death benefit riderThe beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70. The benefit doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benefit riderIf a licensed health care practitioner certifies that you have a chronic illness, you may receive an advance on all or a portion of the death benefit, available in a one-time lump sum or monthly payments. A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living (bathing, continence, dressing, eating, toileting and transferring). Premiums are waived during the benefit period.Critical illness accelerated death benefit riderIf you suer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benefit is payable. A subsequent diagnosis benefit is included.Guaranteed purchase option riderIf you are age 50 or younger when you purchase the policy, you can add the rider, which allows you to purchase additional whole life coverage – without having to answer health questions – at three dierent points in the future. You may purchase up to your initial face amount, not to exceed a total combined maximum of $100,000 for all options.Waiver of premium benefit riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period. Once you are no longer disabled, premium payments will resume.Benefits worksheetFor use with your benefits counselorSelect any optional riders:£ Spouse term life rider $ _____________ face amount for ________-year term period£ Children’s term life rider $ _____________ face amount£ Accidental death benefit rider£ Chronic care accelerated death benefit rider£ Critical illness accelerated death benefit rider£ Guaranteed purchase option rider£ Waiver of premium benefit riderHOW MUCH COVERAGE DO YOU NEED?To learn more, talk with your benefits counselor.ColonialLife.com6-19 | 101935£ DEPENDENT STUDENT $____________£ Paid-Up at Age 70 £ Paid-Up at Age 100 1 Loan should be repaid to protect the policy’s value. 2 Any payout would reduce the death benefit. Benefits may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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Deductions per year: 24Individual Dental PPO(IDN8000) for TXApplicable to policy form Individual Dental PPO(IDN8000)Zip Codes: 733, 750, 751, 752, 753, 754, 760, 761, 762, 764, 765, 766, 770, 771, 772, 773, 774, 775, 776, 778, 786,787, 789COVERAGE LEVEL INDIVIDUAL INDIVIDUAL ANDSPOUSEINDIVIDUAL ANDCHILDRENINDIVIDUAL ANDFAMILYPlan 4 Premier - 100/80/50, $2,000 MAC $18.06 $34.11 $42.84 $63.50Plan 5 Premier - 100/80/50, $1,500 PPO $26.34 $50.51 $64.38 $95.60Individual Accident (IAC4000) for TXApplicable to Policy Forms IAC4000lOn/Off-Job Accident CoverageBENEFIT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYPreferred 0-80 $9.48 $13.98 $17.10 $21.38Group Critical Illness (GCI6000) for TXApplicable 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 BenefitUni-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $5.48 $8.28 $5.48 $8.2825-29 $6.43 $9.68 $6.43 $9.6830-34 $7.38 $11.13 $7.38 $11.1335-39 $9.58 $14.38 $9.58 $14.3840-44 $11.78 $17.68 $11.78 $17.6845-49 $15.28 $23.23 $15.28 $23.2350-54 $18.83 $28.73 $18.83 $28.7355-59 $23.73 $36.18 $23.73 $36.1860-64 $31.18 $47.48 $31.18 $47.4865-69 $37.48 $57.13 $37.48 $57.1370-74 $37.48 $57.13 $37.48 $57.13Hello Autism Clinic Hipson BenefitsPage 1 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Group Critical Illness (GCI6000) for TXApplicable 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 BenefitUni-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$20,000 17-24 $7.63 $11.38 $7.63 $11.3825-29 $9.53 $14.18 $9.53 $14.1830-34 $11.43 $17.08 $11.43 $17.0835-39 $15.83 $23.58 $15.83 $23.5840-44 $20.23 $30.18 $20.23 $30.1845-49 $27.23 $41.28 $27.23 $41.2850-54 $34.33 $52.28 $34.33 $52.2855-59 $44.13 $67.18 $44.13 $67.1860-64 $59.03 $89.78 $59.03 $89.7865-69 $71.63 $109.08 $71.63 $109.0870-74 $71.63 $109.08 $71.63 $109.08$30,000 17-24 $9.78 $14.48 $9.78 $14.4825-29 $12.63 $18.68 $12.63 $18.6830-34 $15.48 $23.03 $15.48 $23.0335-39 $22.08 $32.78 $22.08 $32.7840-44 $28.68 $42.68 $28.68 $42.6845-49 $39.18 $59.33 $39.18 $59.3350-54 $49.83 $75.83 $49.83 $75.8355-59 $64.53 $98.18 $64.53 $98.1860-64 $86.88 $132.08 $86.88 $132.0865-69 $105.78 $161.03 $105.78 $161.0370-74 $105.78 $161.03 $105.78 $161.03Disability 1000 for TX A Risk ClassApplicable to policy form DIS1000lOn/Off-Job Accident and Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,500* $2,000* $2,500* $3,000**monthly benefit amount7 days Accident / 7 days Sickness 17-49 $17.75 $26.63 $35.50 $44.38 $53.2550-69 $21.25 $31.88 $42.50 $53.13 $63.756 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,500* $2,000* $2,500* $3,000**monthly benefit amount7 days Accident / 7 days Sickness 17-49 $22.25 $33.38 $44.50 $55.63 $66.7550-69 $29.75 $44.63 $59.50 $74.38 $89.25Hello Autism Clinic Hipson Benefits(Continued...)Page 2 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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12 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,500* $2,000* $2,500* $3,000**monthly benefit amount7 days Accident / 7 days Sickness 17-49 $30.75 $46.13 $61.50 $76.88 $92.2550-69 $38.50 $57.75 $77.00 $96.25 $115.50Term Life (ITL5000) for TXApplicable to policy form ITL5000l10-Year Term Base PlanNon-Tobacco RatesISSUE AGE $10,000 $20,000 $50,00025 $3.32 $4.64 $5.1135 $3.79 $5.58 $5.6345 $4.59 $7.17 $9.3155 $8.09 $14.18 $18.1965 $17.44 $18.54 $43.3375 $45.70 $54.55 $133.37Tobacco RatesISSUE AGE $10,000 $20,000 $50,00025 $5.20 $8.40 $8.8835 $5.76 $9.53 $9.8645 $7.49 $12.98 $20.4655 $16.11 $30.21 $49.0465 $32.83 $37.87 $91.6775 $68.65 $81.28 $200.20Whole Life Plus (IWL5000) for TXApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100Non-Tobacco RatesISSUE AGE $10,000 $15,000 $20,000 $25,00025 $4.60 $6.90 $9.20 $11.5035 $6.26 $9.39 $12.52 $15.6545 $9.94 $14.91 $19.89 $24.8655 $16.23 $24.34 $32.45 $40.5665 $28.88 $43.31 $57.75 $72.19Hello Autism Clinic Hipson Benefits(Continued...)Page 3 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Whole Life Plus (IWL5000) for TXApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100Tobacco RatesISSUE AGE $10,000 $15,000 $20,000 $25,00025 $8.04 $12.05 $16.07 $20.0935 $9.78 $14.66 $19.55 $24.4445 $14.56 $21.83 $29.11 $36.3955 $24.53 $36.80 $49.07 $61.3365 $41.96 $62.94 $83.92 $104.89Important 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.Houston Hamilton |Hello Autism Clinic Hipson Benefits(Continued...)Page 4 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Deductions per year: 24Applicable to policy form Individual Dental PPO(IDN8000)l Vision RiderZip Codes: 733, 750, 751, 752, 753, 754, 760, 761, 762, 764, 765, 766, 770, 771, 772, 773, 774,775, 776, 778, 786, 787, 789COVERAGE LEVEL ISSUE AGE INDIVIDUAL INDIVIDUAL ANDSPOUSEINDIVIDUAL ANDCHILDRENINDIVIDUAL ANDFAMILYVision Rider All Plans17-74 $3.12 $6.18 $6.50 $10.18Important 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.© 2014 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.Houston Hamilton |Page 1 of 1Underwritten by Colonial Life & Accident Insurance CompanySee page 1 for Important Notice

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Getting startedThe easiest way to manage your business with us is through ColonialLife.com. To sign up for the website, click Register at the top right of the home page and follow the instructions. Consider your optionsAt Colonial Life, our goal is to give you an excellent customer experience that is simple, modern and personal. For your convenience, you can choose how you interact with us. For the quickest service, we recommend using our website, which lets you do the following:  Review, print or download a copy of your policy/certificate by clicking on the My Correspondence tab.  Update contact information or add family member profile information for use when filing online claims.  Access service forms to make changes to your policy, such as a beneficiary change.  Submit your claim using our eClaims system.  Check the status of your claim and view claims correspondence.  Access claim forms.Policyholder Service GuideeClaims are quick and easyWith the eClaims feature on ColonialLife.com, you can file most claims online by simply answering a few questions and uploading your supporting documentation. You’re able to spend less time on paperwork, and we’re able to process your claim faster.  From Colonial Life.com, file claims from any device. It’s fast, easy and available 24/7.  Select direct deposit to receive your benefit payment faster.  Easily submit additional documents.Paper claims  If you don’t want to file online, download the form you need by visiting the Claims Center page on ColonialLife.com and clicking on claim and service forms.  You may fax your claim to 1-800-880-9325.  Follow the instructions, tips and videos to complete and submit your claim.ColonialLife.comContact us Online ColonialLife.com Log in and click on Contact UsTelephone 1-800-325-4368Hearing-impaired customers 803-798-4040If you do not have a TDD, call Voiance Telephone Interpretation Services. 844-495-61058-17 | 43233-39Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

Hello Autism Clinic Benefit Guide

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