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.t { transform-origin: bottom left; z-index: 2; position: absolute; white-space: pre; overflow: visible; line-height: 1.5; } .text-container { white-space: pre; } @supports (-webkit-touch-callout: none) { .text-container { white-space: normal; } } #t1_1_bv-c0ae7fd5-{left:111px;bottom:172px;letter-spacing:0.05px;word-spacing:0.08px;} .s0_1_bv-c0ae7fd5-{font-size:51px;font-family:Barlow-Regular_hc_bv-c0ae7fd5-;color:#FFF;} @font-face { font-family: Barlow-Regular_hc_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_hc_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Voluntary Benefits Booklet Message

.t { transform-origin: bottom left; z-index: 2; position: absolute; white-space: pre; overflow: visible; line-height: 1.5; } .text-container { white-space: pre; } @supports (-webkit-touch-callout: none) { .text-container { white-space: normal; } } #t1_2_bv-c0ae7fd5-{left:87px;bottom:1124px;letter-spacing:-0.32px;word-spacing:0.26px;} #t2_2_bv-c0ae7fd5-{left:72px;bottom:956px;letter-spacing:0.02px;word-spacing:0.08px;} #t3_2_bv-c0ae7fd5-{left:72px;bottom:930px;letter-spacing:0.02px;word-spacing:0.08px;} #t4_2_bv-c0ae7fd5-{left:72px;bottom:905px;letter-spacing:0.04px;word-spacing:0.06px;} #t5_2_bv-c0ae7fd5-{left:72px;bottom:879px;word-spacing:0.1px;} #t6_2_bv-c0ae7fd5-{left:72px;bottom:68px;letter-spacing:-0.3px;word-spacing:0.02px;} #t7_2_bv-c0ae7fd5-{left:72px;bottom:52px;letter-spacing:-0.31px;word-spacing:0.04px;} .s0_2_bv-c0ae7fd5-{font-size:45px;font-family:Barlow-Regular_hc_bv-c0ae7fd5-;color:#FFF;} .s1_2_bv-c0ae7fd5-{font-size:19px;font-family:Barlow-Regular_hc_bv-c0ae7fd5-;color:#354B5B;} .s2_2_bv-c0ae7fd5-{font-size:13px;font-family:Barlow-Regular_hc_bv-c0ae7fd5-;color:#354B5B;} @font-face { font-family: Barlow-Regular_hc_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_hc_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Welcome to Your Voluntary Benefits At , our greatest asset is people like you. We value your hard work and like to do what we can to reward your efforts. That’s why we are pleased to offer you these valuable employee benefits. Please review the information in this booklet to learn about the plans being offered and determine what coverage is right for you. The information contained in this booklet is only a summary of coverage and is not a binding contract. A policy or certificate of coverage will be made available to you that describes the benefits in greater detail. If there are differences between the information in the booklet and the contract, the contract will govern.

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format("woff"); } Group Short Term Disability Insurance If a covered accident or covered sickness prevents you from earning a paycheck, our short term disability insurance can provide a weekly benefit to help you cover your ongoing expenses. hat will be your benefit amountȟ Your weekly benefit will be based on percent of your weekly income at the time you’re disabled, up to a maximum weekly benefit of ______. The elimination period is the number of consecutive days that you’re disabled before benefits are payable due to injury or sickness. Elimination period: 1 Injury days Sickness days >ow lonæ will you receiŒe benefitsȟ Maximum benefit periodȚ weeks qlan choices ȧselected by your emĨloyerȨ: R Off-job only coverage #eductible sources of income Benefits may be offset by deductible sources of income, including if you are receiving or entitled to receive a benefit from workers’ compensation or any state compulsory benefit. 2 >ow much Ĩremium will you Ĩayȟ Your premium may change as you age, as your earnings change and if the rates we offer to your employer change. }o learn more, talk with your Colonial Life benefits counselor. GROUP SHORT TERM DISABILITY INSURANCE 1 4 1 4 52 $1 000 60%

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} 1 VAȚ the elimination period does not apply for disability due to childbirth. 2 Deductible sources of income include benefits received from state disability plans. 'CLUwAZUw U# LATA}}AZUw We will not pay benefits for a disability that is caused by, contributed to by, or occurs as a result of being engaged in an illegal activity; injuring oneself intentionally or attempting or committing suicide, whether sane or not; active participation in a riot, insurrection, or terrorist activity (in FL, this exclusion is for active participation in a riot or insurrection)ț this does not include civil commotion or disorder, injury as an innocent bystander, or injury for self-defense; a disability that occurs while you are incarcerated in a penal or correctional institution or under house arrest or confinementț war or any act of war, whether declared or undeclaredț or loss of professional license, occupational license, or certification. If your coverage includes an occupational exclusion, then we will not pay benefits for a disability that is caused by, contributed to by, or occurs as a result of an occupational injury or sickness; however, we will cover disabilities due to occupational injury or sickness for partners or sole proprietors who cannot be covered by a workers’ compensation law. If your coverage includes a pre-existing condition limitation, then we will not pay benefits for a disability that is a pre- existing condition as defined in this certificate, unless you have satisfied the pre-existing condition limitation period (typically 12 months) shown on the Certificate Schedule on the date you suffer a loss due to a covered accident or covered sickness. A pre-existing condition is an injury or sickness, whether diagnosed or not, for which an insured received medical treatment, consultation, care or services; diagnostic measures were received or recommended to be received; had taken or was prescribed drugs or medication, or symptoms existed, within the three months just prior to the coverage effective date. NDȚ A pre-existing condition is an injury or sickness for which an insured received medical treatment, consultation, care or services; diagnostic measures were received or recommended to be received; had taken or was prescribed drugs or medication, within the three months just prior to the coverage effective date. FOR POLICIES ISSUED OR DELIVERED IN THE COMMONWEALTH OF VIRGINIA: THIS IS AN ECEPTED BENEFITS PZLICY. IT PtZVIDES CZVEtAGE ZNLY FZt THE LIMITED BENEFITS Zt SEtVICES SPECIFIED IN THE PZLICY. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form ICC2ǣ-CLA-GSTDP-1 and certificate form ICC2ǣ-CLA-GSTDC-1 and policy form CLA-GSTDP2ǣ-1 and certificate form CLA-GSTDC2ǣ-1 (including state abbreviations where used). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. An insurance producer may contact you. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2025 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 6-25 | 2293200 ColonialLife.com

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recovery, not how you’re going to pay your bills. Colonial Life Accident Insurance can pay benefits directly to you to use however you like — from medical costs to everyday expenses. Whether you’ve had a fall or a car accident, these benefits can offer financial support when you need it. Our coverage includes: • Benefits payable directly to you • No medical questions to qualify for coverage • Coverage for simple and complex injuries • Benefits payable regardless of other insurance • Worldwide coverage • Works alongside your Health Savings Account (HSA) BENEFITS STORY Milo was working in his yard when he tripped and injured his hand. With Colonial Life accident benefits, Milo was able to pay the annual deductible and co-payments for his health insurance plan without using his savings or taking on debt. MILO’S ACCIDENT BENEFITS Milo went to an urgent care facility and received immediate care. Treatment in a physician’s office or urgent care facility $100 The doctor ordered an X-ray and discovered Milo had fractured his hand. • X-ray • Fracture (hand) $60 $1,200 The doctor also found that Milo had a cut on his hand but did not require stitches. Laceration (no repair) $50 Milo was discharged with a splint. Durable medical equipment $50 Zver the next several weeks, Milo had two follow-up appointments with his doctor. Physician follow-up visits (2 visits) $50 x 2 = $100 Total $1,560 For illustrative purposes only. Benefit amounts may vary and may not cover all expenses. GROUP ACCIDENT (GAC4100) — PREFERRED PLAN 1212757-WA

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Group Accident includes a Benefit Boosterȣ to provide additional financial support for serious accidents. If you have more than Ʉ5,000 in payable benefits for a covered accident, we will give you a Ʉ500 boost to your benefits to help you with whatever expenses you have. ȣPayable once per insured per covered accident BENEFITS STORY Olivia was driving to the store when she got into a car accident. Zlivia’s benefits helped her cover her medical expenses when she was injured in a car accident, helping her to focus on her recovery. OLIVIA’S ACCIDENT BENEFITS Olivia arrived by ambulance at the nearest emergency room and received immediate care. • Ambulance • Emergency department visit • Injury due to auto accident $300 $200 $250 The doctor ordered an X-ray and discovered Olivia had fractured her thigh (femur). He also ordered a CT scan of her head to check for brain injury. • X-ray • Medical imaging • Fracture (thigh) $60 $200 $3,150 Olivia required surgery for her leg. • Surgical repair (thigh fracture) • General anesthesia $3,150 $250 Olivia boarded her pet for two nights after her surgery. Pet boarding (2 days) $20 x 2 = $40 Olivia had eight sessions of physical therapy to help regain the strength in her leg and two follow-up appointments with her doctor. • Therapy services (8 sessions) • Physician follow-up visits (2 visits) $45 x 8 = $360 $50 x 2 = $100 Olivia’s benefits for this accident totaled more than $5,000. Benefit Booster $500 Total $8,560 For illustrative purposes only. Benefit amounts may vary and may not cover all expenses. Benefits are per covered person per covered accident unless stated otherwise Injury benefits • Burns (based on size and degree) ............. $500–$15,000 • wkin ærafts ȧdue to burnsȨ ............................. 50% (payable as a ɦ of the applicable burn benefit) • wkin ærafts ȧnot due to burnsȨ .................... $250–$500 • Concussion ......................................... $375 • ConnectiŒe tissue damaæe ...................... $100–$200 • Eye injury .......................................... $300 • Hearing loss injuries .................................. $120 (maximum once per lifetime per ear per insured) • Anþury due to auto accident 1 .......................... $250 • Anternal inþuries ..................................... $200 • Nnee cartilaæe ȧmeniscusȨ inþury ....................... $150 • Lacerations .................................... $50–$600 • Loss of a diæit Ȱ Ĩartial ......................... $300–$600 • Loss of a diæit ............................... $750–$2,000 • tuĨtured or herniated disc ...................... $150–$300

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wristȚ Ʉ1,200 ɳ hipȚ ɄǢ,150 • wuræical reĨair of fracture ............................ 100% (payable as an additional ɦ of the applicable fractures benefit) • ChiĨ fracture ........................................ 25% (payable as a ɦ of the applicable fractures benefit) Dislocation benefits • Injury .......................................$200–$3,000 Examples: elbowȚ Ʉǣ50 ɳ ankleȚ Ʉ1,200 ɳ hipȚ ɄǢ,000 • wuræical reĨair of dislocation .......................... 100% (payable as an additional ɦ of the applicable dislocations benefit) • AncomĨlete dislocation ................................ 25% (payable as a ɦ of the applicable dislocations benefit) Treatment benefits • ir ambulance ..................................... $1,500 • mbulance ȧæround or waterȨ ......................... $300 • #urable medical eĪuiĨment ...................... $50–$200 • 'meræency dental reĨair ........................ $100–$300 • 'meræency deĨartment .............................. $200 • Family care ................................... ɄǤǟ Ĩer day (maximum of one benefit per day for all Insureds combined, up to a maximum of three days per covered accident, regardless of the number of children) • Anþections to ĨreŒent or limit infection ...................$50 • Lodging ..................................... Ʉǡǟǟ Ĩer day (maximum Ǣ0 days) • Tedical imaæinæ ..................................... $200 • qain manaæement inþections .......................... $100 • qet boardinæ .................................. Ʉǡǟ Ĩer day (maximum of one benefit per day for all insureds combined, up to a maximum of three days per covered accident, regardless of the number of pets that are boarded) • qrosthetic deŒice or artificial limb ............ $1,250–$2,500 • Transfusions........................................ $400 • }ransĨortation ................................ ɄǠǤǟ Ĩer triĨ (maximum 6 one-way trips) • }reatment in a Ĩhysicianȸs oŨce or uræent care facility ... $100 • ȭray or ultrasound ....................................$60 Surgery benefits • nesthesia .................................... $150–$250 • ConnectiŒe tissue suræery...................... $125–$1,600 • Eye surgery ......................................... $300 • General surgery –bdominal, thoracic, or cranial .................... $1,500 –'ŘĨloratory suræery ............................... $225 • Hernia surgery ...................................... $300 • Nnee cartilaæe ȧmeniscusȨ suræery ............... $100–$600 • ZutĨatient suræical facility ............................ $300 • tuĨtured or herniated disc suræery ............. $125–$1,500 Recovery care benefits • tȭhome care ................................ ɄǠǟǟ Ĩer day (maximum 5 days) • Benefit Booster ..................................... $500 • qhysician followȭuĨ Œisits ............................. $50 (maximum 4 days per covered accident) • tehabilitation or subȭacute rehabilitation unit confinement ............................. ɄǠǤǟ Ĩer day (maximum 15 days per covered accident) • }heraĨy serŒices ȧsĨeech, Ĩhysical theraĨy, occuĨational theraĨyȨ ..........................ɄǣǤ Ĩer day (maximum 15 days) Options checked below have been chosen by your employer to enhance your Group Accident Coverage. R Recovery Plus package • BehaŒioral health theraĨy .. . . . . . . . . . . . . . . . . ɄǣǤ Ĩer day (maximum 15 days) • qostȭtraumatic stress disorder ȧq}w#Ȩ .. . . . . . . . . . . $200 • qrescriĨtion druæ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $25 • dditional theraĨy serŒices ȧchiroĨractic, acuĨuncture, alternatiŒe theraĨyȨ . . . . . .$45 (existing therapy services benefit maximum applies to additional therapy services, maximum 15 days)  Gunshot Wound Benefit This benefit can help pay your medical expenses if you receive a non-fatal gunshot wound. It offers you a lump sum for a covered injury regardless of any other insurance you may have and includes on/off-job coverage. • :unshot wound ............................. $_________ This benefit covers a non-fatal gunshot wound from a conventional firearm that reĪuires treatment by a doctor and overnight hospitalization within 24 hours of the injury. If you are shot more than once in a 24-hour period, we can pay benefits only for the first wound.

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HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLE This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs. THIS INSURANCE PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. EXCLUSIONS We will not pay benefits for claims that are caused by, contributed to by, or resulting from elective procedures, felonies or illegal occupations, hazardous avocations, incarceration, racing, semi-professional or professional sports, sickness, suicide or self-inŦicted injuries, war, or armed conŦict. This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GACǣ100-P-WA and certificate form GACǣ100-C-WA. For cost and complete details of coverage, call or write your Colonial Life insurance producer or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FZt EMPLZYEES 7-2ǣ ɳ 1212757-WA ColonialLife.com 1212757-WA

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url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-SemiBold_js_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Wingdings2_jm_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_jm_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Wingdings2_jy_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_jy_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Group Accident Insurance Accidental Death & Dismemberment Benefits These benefits can help pay for expenses related to an accidental death. They can also help pay costs related to recovery and rehabilitation from an accidental dismemberment, including costs that your medical plan doesn’t cover, like co-pays and deductibles. ccidental Death ɪ Dismemberment ȧDɪDȨ benefits Accidental Death and Dismemberment benefits are available to you with Group Accident Insurance coverage, as well as all your covered family members. Talk with your Colonial Life insurance producer about the level of AD&D benefits available to you. Benefits are per covered person per covered accident unless stated otherwise. Economy Basic Preferred Premier   R  Accidental death • Named insured Ʉ25,000 Ʉ25,000 Ʉ50,000 Ʉ50,000 • Spouse Ʉ25,000 Ʉ25,000 Ʉ50,000 Ʉ50,000 • Children Ʉ5,000 Ʉ5,000 Ʉ10,000 Ʉ10,000 Accidental death — Common carrier • Named insured Ʉ100,000 Ʉ100,000 Ʉ200,000 Ʉ200,000 • Spouse Ʉ100,000 Ʉ100,000 Ʉ200,000 Ʉ200,000 • Children Ʉ20,000 Ʉ20,000 Ʉǣ0,000 Ʉǣ0,000 Accidental dismemberment • Both feet Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 • Both hands Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 • Zne foot Ʉ6,000 Ʉ7,500 ɄǨ,000 Ʉ15,000 • One hand Ʉ6,000 Ʉ7,500 ɄǨ,000 Ʉ15,000 • Thumb and index finger of the same hand ɄǢ,000 ɄǢ,750 Ʉǣ,500 Ʉ7,500 Coma (7 or more consecutive days) Ʉ5,000 Ʉ7,500 Ʉ10,000 Ʉ20,000 Home alterations and automobile modifications Ʉ500 Ʉ1,000 Ʉ1,500 Ʉ2,000 GtZUP ACCIDENT (GACǣ100) ȯ AD&D BENEFITS 12ǧǣ100-WA

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Barlow-Regular_jp_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_jp_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-SemiBold_js_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-SemiBold_js_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Wingdings2_jm_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_jm_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Wingdings2_jy_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_jy_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } ccidental Death ɪ Dismemberment benefits ȧcontinuedȨ Economy Basic Preferred Premier   R  Loss of use • Hearing (one ear) Ʉ6,000 Ʉ7,500 ɄǨ,000 Ʉ15,000 • Hearing (both ears) Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 • Sight of one eye Ʉ6,000 Ʉ7,500 ɄǨ,000 Ʉ15,000 • Sight of both eyes Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 • Speech Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 Paralysis • Uniplegia Ʉ6,000 Ʉ7,500 ɄǨ,000 Ʉ15,000 • Hemiplegia Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 • Paraplegia Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 • Triplegia Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 • suadriplegia Ʉ25,000 Ʉ50,000 Ʉ75,000 Ʉ100,000 To learn more, talk with your Colonial Life insurance producer. HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLE This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs. THIS INSURANCE PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. EXCLUSIONS AND LIMITATIONS We will not pay benefits for claims that are caused by, contributed to by, or resulting from elective procedures, felonies or illegal occupations, hašardous avocations,incarceration, racing, semi-professional or professional sports, sickness, suicide or self-inŦicted injuries, war, or armed conŦict. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GACǣ100-P-WA and certificate form GACǣ100-C-WA. For cost and complete details of coverage, call or write your Colonial Life insurance producer or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 202ǣ Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FZt EMPLZYEES 6-2ǣ ɳ 12ǧǣ100-WA ColonialLife.com 12ǧǣ100-WA

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url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_jy_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Group Accident Insurance ccident >osĨital benefits These benefits can help with medical costs related to a hospital stay for a covered accident, including costs that your health insurance may not cover, like co-pays and deductibles. Accident Hospital benefits are available to you with Group Accident Insurance coverage, as well as all your covered family members. Talk with your Colonial Life insurance producer about the level of accident hospital benefits available to you. Benefits are per covered person per covered accident unless stated otherwise. Economy Basic Preferred Premier   R  Hospital Admission $500 $750 Ʉ1,000 Ʉ1,500 Hospital Admission – ICU Ʉ1,250 Ʉ1,500 Ʉ1,750 Ʉ2,500 Hospital Confinement – Daily Stay Max. of Ǣ65 days per insured per covered accident $100 Ʉ200 Ʉ250 ɄǢ50 Hospital ICU Confinement – Daily Stay Max. of 15 days per insured per covered accident Ʉ200 ɄǢ00 $400 Ʉ600 Hospital Sub-Acute ICU Confinement – Daily Stay Max. of Ǣ0 days per insured per covered accident $150 Ʉ250 ɄǢ50 $500 Short Stay Min. of ǧ hours up to 20 hours Ʉ200 Ʉ200 Ʉ200 Ʉ200 To learn more, talk with your Colonial Life insurance producer. GtZUP ACCIDENT (GACǣ100) ȯ ACCIDENT HZSPITAL BENEFITS 12ǧǣ160-WA

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Wingdings2_ks_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_ks_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. | ColonialLife.com | 1-17 | 17075-17 Colonial Life | CHANGE OF BENEFICIARY | Fax: 1-877-828-9430 | Telephone: 1-800-325-4368 Change of Beneficiary Form ñ FAX this direction Fax this form: 1-877-828-9430 Or mail: P.O. Box 1365, Columbia, SC 29202 From: Number of pages: I am changing the following: £ Primary Beneficiary £ Contingent Beneficiary £ Both (If no box is checked, the form will be reviewed only for the beneficiary designations listed.) Insured’s name: First: Middle Initial: Last: SSN: DOB: ____ / ____ / ________ Telephone: Email: Address: City: State: ZIP: Policy number(s): General Information Naming a Minor as a Beneficiary: In some instances, Colonial Life may not be able to pay life insurance proceeds to a minor beneficiary unless a court appointed adult guardian, conservator or custodian has been properly designated for the minor’s property in advance planning documents. When Colonial Life is unable to disperse benefits in such situations, Colonial Life will hold the proceeds (with interest earned on the funds) until the minor reaches the age of majority. If you have questions about the consequences of naming a minor as a beneficiary, feel free to discuss with a legal or estate planning professional. Naming a Trust: Provide the name of the trust, the date the trust was established, and the address of where the trust is held. Naming a Funeral Home: Provide the name, full address, and the owner or authorized personnel of the funeral home. Write “As Interest May Appear” and designate another primary beneficiary to receive any remaining benefits available after the funeral home’s expenses have been paid. Primary beneficiary(ies) All fields must be completed for each beneficiary. Unless otherwise specified, proceeds will be paid in equal shares to surviving beneficiaries. If selecting more than one Primary Beneficiary, the percentages must equal 100%. Attach additional pieces of paper if more space is needed. First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: Contingent beneficiary(ies) If at the time of the insured’s death and all primary beneficiaries are disqualified or die before the insured, proceeds will be paid to the contingent beneficiaries listed in equal shares. If selecting more than one contingent beneficiary, the percentage must equal 100%. Attach additional pieces of paper if more space is needed. First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: Required signature (complete this section in its entirety) ________________________________________________________________________________________________ ______________________________________________ Signature of policy owner Date (MM/DD/YYYY) Print policy owner name: SSN: DOB: ____ /____ / ________ Telephone: Email: Address: City: State: ZIP: Special Notice for Residents of a Community Property State: A spouse or former spouse may have an interest in life insurance proceeds or any accumulated cash value if the policy premiums were paid with community funds. It is your responsibility to consult your legal advisor to 1) ensure that any required consent from a spouse or former spouse has been received and 2) ensure that your spouse or former spouse will not be able to make a claim against any policy values and/or proceeds in the event any policy benefits become payable.

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url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_jm_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Wingdings2_le_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_le_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } For more information, talk with your insurance producer. Group Hospital Indemnity Insurance Plan 2 ColonialLife.com Group Medical Bridge 1 Insurance can help with medical costs associated with a hospital stay that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement................................................................ $1000 per day Maximum of one day per covered person per calendar year Waiver of premium Available aer 30 continuous days of a covered confinement of the named insured R Daily hospital confinement.............................................................. .. .. . $100 per day Maximum of 365 days per covered person per confinement. Re-confinement for the same or related condition within 90 days of discharge is considered a continuation of a previous confinement.  Diagnostic procedure................................................................... $ N/A per day Maximum of one day per covered person per calendar year R Outpatient surgical procedure  Tier 1 ..................................................................................... $500 per day  Tier 2 ..................................................................................... $1000 per day Maximum of $1500 per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedure GMB – PLAN  Diagnostic procedures The following is a list of common diagnostic procedures that may be covered if the diagnostic procedure benefit is selected.  Breast – Biopsy (incisional, needle, stereotactic)  Cardiac – Angiogram – Arteriogram – Thallium stress test – Transesophageal echocardiogram (TEE)  Diagnostic radiology – Computerized tomography scan (CT scan) – Electroencephalogram (EEG) – Magnetic resonance imaging (MRI) – Myelogram – Nuclear medicine test – Positron emission tomography scan (PET scan)  Digestive – Barium enema/lower GI series – Barium swallow/upper GI series – Esophagogastroduodenoscopy (EGD)  Ear, nose, throat, mouth – Laryngoscopy  Gynecological – Amniocentesis – Cervical biopsy – Cone biopsy – Endometrial biopsy  Liver – Biopsy  Lymphatic – Biopsy  Miscellaneous – Bone marrow aspiration/biopsy  Renal – Biopsy  Respiratory – Biopsy – Bronchoscopy – Pulmonary function test (PFT)  Skin – Biopsy – Excision of lesion  Thyroid – Biopsy  Urologic – Cystoscopy – Hysteroscopy – Loop electrosurgical excisional procedure (LEEP) $-WA

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This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. EXCLUSIONS AND LIMITATIONS We will not pay benefits for injuries received in accidents or for sicknesses that occur as a result of a covered person's: Alcohol or Drug Addiction; Dental Procedures; Elective Procedures and Cosmetic Surgery; Felonies or Illegal Occupation; Mental or Nervous Disorders; Pregnancy of a Dependent Child; Suicide or Injuries which any covered person intentionally does to himself; or War. Limitations include: Birth limitations - We will not pay for Hospital Confinement (or Daily Hospital Confinement) due to any covered person giving birth within the first nine (9) months aer the coverage e&ective date of this certificate as a result of a normal pregnancy, including Cesarean. Complications of pregnancy will be covered to the same extent as any other covered sickness. PRE-EXISTING CONDITION LIMITATIONS We will not pay benefits for loss during the first 12 months aer the certificate e&ective date due to a pre-existing condition. A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the certificate e&ective date. This limitation applies to the following benefits, if applicable: Hospital Confinement, Daily Hospital Confinement, Inpatient Mental and Nervous, Rehabilitation Unit Confinement, Specified Critical Illness, Diagnostic Procedure, and Outpatient Surgical Procedure. 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 form GMB7000-P-WA and certificate form GMB7000-C-WA. For cost and complete details of coverage, call or write your Colonial Life insurance producer or the company. The procedures listed below are only a sampling of the procedures that may be covered if the outpatient surgical procedure benefit is selected. Procedures must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, refer to your certificate. Tier 1 outpatient surgical procedures  Breast – Axillary node dissection – Breast capsulotomy – Lumpectomy  Cardiac – Pacemaker insertion  Digestive – Colonoscopy 2 – Fistulotomy – Hemorrhoidectomy – Lysis of adhesions  Ear, nose, throat, mouth – Adenoidectomy – Removal of oral lesions – Myringotomy – Tonsillectomy – Tracheostomy – Tympanotomy  Gynecological – Dilation and curettage (D&C) – Endometrial ablation – Lysis of adhesions  Liver – Paracentesis  Musculoskeletal system – Carpal/cubital repair or release – Foot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair) – Removal of orthopedic hardware – Removal of tendon lesion  Skin – Laparoscopic hernia repair – Skin graing 2 Colonoscopy must result in polyp removal or be recommended by a physician for the purposes of treating or diagnosing a sickness. If a covered family member has a qualified high deductible health plan (HDHP) and actively contributes to a health savings account (HSA), their HSA can be disqualified with this coverage. Tier 2 outpatient surgical procedures  Breast – Breast reconstruction – Breast reduction  Cardiac – Angioplasty – Cardiac catheterization  Digestive – Exploratory laparoscopy – Laparoscopic appendectomy – Laparoscopic cholecystectomy  Ear, nose, throat, mouth – Ethmoidectomy – Mastoidectomy – Septoplasty – Stapedectomy – Tympanoplasty  Eye – Cataract surgery – Corneal surgery (penetrating keratoplasty) – Glaucoma surgery (trabeculectomy) – Vitrectomy  Gynecological – Hysterectomy – Myomectomy  Musculoskeletal system – Arthroscopic knee surgery with meniscectomy (knee cartilage repair) – Arthroscopic shoulder surgery – Clavicle resection – Dislocations (open reduction with internal fixation) – Fracture (open reduction with internal fixation) – Removal or implantation of cartilage – Tendon/ligament repair  Thyroid – Excision of a mass  Urologic – Lithotripsy Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. $-WA 1 Group Medical Bridge is the marketing name for the Limited Benefit Group Hospital Indemnity Insurance policy.

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ColonialLife.com Group Hospital Indemnity Insurance Wellbeing Assistance Standard Benefit THIS INSURANCE PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. WAITING PERIOD Waiting period means the first 30 days following any covered person’s coverage eective date, during which no benefits are payable. 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 form GMB7000-P-WA and certificate form GMB7000-C-WA. For cost and complete details of coverage, call or write your Colonial Life insurance producer or the company. GMB7000 – WELLBEING ASSISTANCE STANDARD BENEFIT | 10-24 | 101730-WA The Group Medical Bridge 1 wellbeing assistance standard benefit can help pay for routine preventive tests you have each year. Wellbeing assistance standard ..................................................... $50 per day Maximum of one day per covered person per calendar year; subject to a 30-day waiting period  Blood test for triglycerides  Bone marrow testing  Breast ultrasound  CA 15-3 (blood test for breast cancer)  CA 125 (blood test for ovarian cancer)  Carotid Doppler  CEA (blood test for colon cancer)  Chest X-ray  Colonoscopy  Echocardiogram (ECHO)  Electrocardiogram (EKG, ECG)  Fasting blood glucose test  Flexible sigmoidoscopy  Hemoccult stool analysis  Mammography  Pap smear  PSA (blood test for prostate cancer)  Serum cholesterol test for HDL and LDL levels  Serum protein electrophoresis (blood test for myeloma)  Skin cancer biopsy  Stress test on a bicycle or treadmill  Thermography  ThinPrep pap test  Virtual colonoscopy Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 1 Group Medical Bridge is the marketing name for the Limited Benefit Group Hospital Indemnity Insurance policy. 101730-WA

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url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/HelveticaLTMM-1_md_bv-c0ae7fd5-.woff") format("woff"); } Group Critical Illness and Cancer Insurance * Plan 2 When life takes an unexpected turn, your focus should be on recovery Ȱ not finances. Colonial Life group critical illness and cancer insurance can provide a lump-sum benefit payable directly to you to use as needed. Coverage amountȚ $1 0 , 000 or $20 , 000 ritical illness and cancer benefits COVERED CONDITION 1 PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Benign brain tumor 100% Coma 100% End stage renal (kidney) failure 100% Heart attack (myocardial infarction) 100% Loss of hearing 100% Loss of sight 100% Loss of speech 100% Major organ failure reĪuiring transplant 100% Occupational infectious HIV or occupational infectious hepatitis B, C or D 100% Permanent paralysis 100% Stroke 100% Sudden cardiac arrest 100% Coronary artery disease 25% COVERED CANCER CONDITION¹ PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Invasive cancer (including all breast cancer) 100% Non-invasive cancer 25% Skin cancer initial diagnosis ............................ $400 per lifetime BENEFITS STORY Preparing for a lifelong journey Rebecca was born with Down syndrome. Her parents’ critical illness and cancer coverage provided a benefit that can help cover expenses related to tebecca’s care and her changing needs. How their coverage helped A hospital stay and treatment for corrective heart surgery Physical therapy to build muscle strength Daycare program For illustrative purposes only. GCI6000 ȯ PLAN 2 387100-1-WA

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other insurance Subsequent diagnosis of a different critical illness 2 If you receive a benefit for a critical illness, and are later diagnosed with a different critical illness, 100ɦ of the coverage amount may be payable for that particular critical illness. Subsequent diagnosis of the same critical illness 2 If you receive a benefit for a critical illness, and are later diagnosed with the same critical illness, 3 25ɦ 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, 25ɦ of the coverage amount is payable if treatment-free for at least 12 months and in complete remission prior to the date of reoccurrenceț excludes non-invasive or skin cancer. Additional covered conditions for dependent children COVERED CONDITION 1 PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Cerebral palsy 100% Cleft lip or palate 100% Cystic fibrosis 100% Down syndrome 100% Spina bifida 100% For more information, talk with your benefits counselor. ȣThe filed product name is Group Critical Illness and Cancer Specified Disease Insurance. 1 Please 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 1ǧ0 days. Ǣ Critical illnesses that do not Īualify 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. }>Aw AUwUtUC' qtZA#'w LATA}'# B'U'FA}w. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benefit, Benefits Payable Upon SubseĪuent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person’s alcoholism or drug addictionț felonies or illegal occupationsț suicide or injuring oneself intentionally, whether sane or notț war or armed conŦictț 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 teoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benefit for a covered person’s invasive cancer or non-invasive cancer thatȚ is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexicoț 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 after the coverage effective date. Pre-existing condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date. This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy forms GCI6000-P-I-WA and GCI6000-P-A-WA and certificate form. GCI6000-C-WA. 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. © 2025 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FZt EMPLZYEES 7-25 | 387100-1-WA ColonialLife.com 387100-1-WA

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url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/HelveticaLTMM-4_n0_bv-c0ae7fd5-.woff") format("woff"); } Group Critical Illness Insurance * >ealth wcreeninæ Benefit The health screening benefit can help reduce the risk of serious illness through early detection of disease or risk factors. >ealth screeninæ benefit...................Ʉ50 Maximum of one test per covered person per calendar yearț subject to a Ǣ0-day waiting period before the benefit is payable. The test must be performed after the waiting period. • Blood test for triglycerides • Bone marrow testing • BRCA1 or BRCA2 testing (genetic test for breast cancer) • Breast ultrasound • CA 15-Ǣ (blood test for breast cancer) • CA 125 (blood test for ovarian cancer) • Carotid Doppler • CEA (blood test for colon cancer) • Chest -ray • Colonoscopy • Echocardiogram (ECHZ) • Electrocardiogram (ENG, 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 colonoscopy For more information, talk with your Colonial Life benefits counselor. ȣThe filed product name is Group Critical Illness and/or Cancer Specified Disease Insurance. Plan 1 includes Critical Illness, Plan 2 includes Critical Illness and Cancer, Plans Ǣ & ǣ only include Cancer. }>Aw AUwUtUC' qtZA#'w LATA}'# B'U'FA}w. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy forms GCI6000-P-I-WA and GCI6000-P-A-WA and certificate form GCI6000-C-WA. 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. © 202ǣ Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. ColonialLife.com GCI6000 ȯ HEALTH SCtEENING BENEFIT FZt EMPLZYEES 2-2ǣ ɳ Ǣǧ7Ǣ07-2-WA Ǣǧ7Ǣ07-2-WA

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Wingdings2_ks_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_ks_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. | ColonialLife.com | 1-17 | 17075-17 Colonial Life | CHANGE OF BENEFICIARY | Fax: 1-877-828-9430 | Telephone: 1-800-325-4368 Change of Beneficiary Form ñ FAX this direction Fax this form: 1-877-828-9430 Or mail: P.O. Box 1365, Columbia, SC 29202 From: Number of pages: I am changing the following: £ Primary Beneficiary £ Contingent Beneficiary £ Both (If no box is checked, the form will be reviewed only for the beneficiary designations listed.) Insured’s name: First: Middle Initial: Last: SSN: DOB: ____ / ____ / ________ Telephone: Email: Address: City: State: ZIP: Policy number(s): General Information Naming a Minor as a Beneficiary: In some instances, Colonial Life may not be able to pay life insurance proceeds to a minor beneficiary unless a court appointed adult guardian, conservator or custodian has been properly designated for the minor’s property in advance planning documents. When Colonial Life is unable to disperse benefits in such situations, Colonial Life will hold the proceeds (with interest earned on the funds) until the minor reaches the age of majority. If you have questions about the consequences of naming a minor as a beneficiary, feel free to discuss with a legal or estate planning professional. Naming a Trust: Provide the name of the trust, the date the trust was established, and the address of where the trust is held. Naming a Funeral Home: Provide the name, full address, and the owner or authorized personnel of the funeral home. Write “As Interest May Appear” and designate another primary beneficiary to receive any remaining benefits available after the funeral home’s expenses have been paid. Primary beneficiary(ies) All fields must be completed for each beneficiary. Unless otherwise specified, proceeds will be paid in equal shares to surviving beneficiaries. If selecting more than one Primary Beneficiary, the percentages must equal 100%. Attach additional pieces of paper if more space is needed. First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: Contingent beneficiary(ies) If at the time of the insured’s death and all primary beneficiaries are disqualified or die before the insured, proceeds will be paid to the contingent beneficiaries listed in equal shares. If selecting more than one contingent beneficiary, the percentage must equal 100%. Attach additional pieces of paper if more space is needed. First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: Required signature (complete this section in its entirety) ________________________________________________________________________________________________ ______________________________________________ Signature of policy owner Date (MM/DD/YYYY) Print policy owner name: SSN: DOB: ____ /____ / ________ Telephone: Email: Address: City: State: ZIP: Special Notice for Residents of a Community Property State: A spouse or former spouse may have an interest in life insurance proceeds or any accumulated cash value if the policy premiums were paid with community funds. It is your responsibility to consult your legal advisor to 1) ensure that any required consent from a spouse or former spouse has been received and 2) ensure that your spouse or former spouse will not be able to make a claim against any policy values and/or proceeds in the event any policy benefits become payable.

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url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/HelveticaLTMM-1_nv_bv-c0ae7fd5-.woff") format("woff"); } @font-face { font-family: HelveticaLTMM-1_o4_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/HelveticaLTMM-1_o4_bv-c0ae7fd5-.woff") format("woff"); } Group Term Life Insurance Voluntary coverage Zur group term life insurance can help increase financial security for your family if something were to happen to you. You can also apply for coverage for your spouse and eligible dependent children without health Īuestions. 1 How much group term coverage do I need? YouȚ $ _____________________ • Available in Ʉ5,000 increments • Minimum of Ʉ10,000 increments to a maximum of five times your salary to Ʉ100,000 Your spouseȚ $ _____________________ • Available in Ʉ5,000 increments • Minimum of Ʉ5,000 to a maximum of Ʉ25, 000 • Spouse coverage cannot exceed your coverage amount 2 Your dependent children (up to age 26)Ț $ _____________________ • Available in Ʉ5,000 increments • Minimum of Ʉ5,000 to a maximum of Ʉ10,000 per dependent child • Each dependent child is covered for the same amount, except children from live birth to six months for whom the death benefit is Ʉ1,000 Why group term life insurance is a good option • Death benefit • Lower premiums • Coverage during high- need years • Benefit payment typically tax-free VZLUNTAtY GtZUP TEtM LIFE

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url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_nn_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-SemiBold_hk_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-SemiBold_hk_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-SemiBold_nt_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-SemiBold_nt_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } dditional benefits and serŒices ķiltȭin aÆÆelerated deatì benefit provides an advance of up to 75ɦ of the death benefit, to a maximum of Ʉ150,000, if diagnosed with a terminal illness. 3 Health Advocate Employee Assistance Program (EAP) provides 2ǣ-hour personal support and referral service, including a medical bill saver service. Face-to- face sessions and video counseling with mental health professionals are available. ǣ • Online: ColonialLife.com/EAP • TelephoneȚ 1-ǧǧǧ-6ǣ5-1772 Life planning services offer financial and legal counseling services, as well as grief support and referral for up to 12 months after a claim. ǣ Get the most out of your coverage Portability: You may be able to continue your coverage if you change jobs or retire. Conversion: After the group term period ends, you may be eligible to convert to a whole life policy without health Īuestions. Waiver of premium: Your premium payments may be eligible for waiver if you become disabled. To learn more, talk with your Colonial Life benefits counselor. 1 Spouse and dependent coverage will not be effective if they are currently totally disabled. Being totally disabled means the inability to perform two or more activities of daily living, being confined to a hospital or similar institution or being unable to attend school outside the home (for a dependent child age 5 up to age 26). In ID, NH and T, the definition of total disability does not include Activities of Daily Living (ADL) reĪuirements. The ability to work does not determine disability. You can pay premiums on insurance for your dependents with no health Īuestions asked. Coverage isn’t effective until the earlier of the date they are no longer totally disabled or two years after the date that coverage would have otherwise become effective for the spouse or dependent child. This provision does not apply to newborn children born while dependent insurance is in effect. 2 The maximum benefit is 50ɦ of your benefit in NE. 3 Terminal illness means an injury or sickness that results in the covered person having a life expectancy of 12 months or less and from which there is no reasonable prospect of recovery. A life expectancy of 2ǣ months or less in IL, NS, MA, T and WA. Accelerated death benefit payments will reduce the amount the policy pays upon the recipient’s death, may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlements and may be taxable. tecipients should consult their tax attorney or advisor before utilišing accelerated benefit payments. ǣ The Employee Assistance Program and Life Planning Services, provided by Health Advocate, are available with Colonial Life & Accident Insurance Company Group Term Life offering. Terms and availability of service are subject to change. The service provider does not provide legal adviceț please consult your attorney for guidance. Services are not valid after coverage terminates. State-mandated limitations for legal services in WA apply. Please contact the company for full details. BENEFIT AGE REDUCTION SCHEDULE When a covered person reaches age 70, but not 75, the amount of insurance will beȚ • 65ɦ of the amount of insurance prior to age 70ț or • 65ɦ of the amount of insurance applied for on or after age 70 but before age 75. When a covered person reaches age 75 or more, the amount of insurance will beȚ • 50ɦ of the amount of insurance prior to the first reductionț or • 50ɦ of the amount of insurance the employee applied for on or after age 75. Znce the benefit reduction schedule begins, there will be no further increases in insurance for a covered person. If the proposed insured is age 70, but not age 75 at the time of enrollment, the amount of insurance applied for will be reduced to 65ɦ. If the proposed insured is age 75 or older at the time of enrollment, the amount applied for will be reduced to 50ɦ. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GTL1.0-P and certificate form GTL1.0-C (including state abbreviations where used, for exampleȚ GTL1.0-P-T and GTL1.0-C-T). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. ColonialLife.com Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2026 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FZt EMPLZYEES Ǣ-26 ɳ 100272-ǧ

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Dismemberment Insurance (AD&D) This coverage can provide benefits for a covered accidental death or dismemberment. Benefits can be used for any purpose, including to help pay costs related to recovery or rehabilitation. hat is my #ɪ# full benefit amountȟ ____________________ The AD&D full benefit amount is eĪual to your group term life insurance death benefit amount. hat is Ĩayable under the #ɪ# benefitȟ If the loss is: % of full amount payable Loss of life 100% Loss or loss of use of both hands or both feet or sight of both eyes 100% Loss or loss of use of one hand and one foot 100% Loss or loss of use of one hand and sight of one eye 100% Loss or loss of use of one foot and sight of one eye 100% Loss of speech and hearing 100% Loss or loss of use of one hand or one foot 50% Loss of sight of one eye 50% Loss of speech or hearing 50% Loss or loss of use of thumb and index finger on the same hand 25% hat other benefits are includedȟ Seatbelts and airbags: Pays a benefit if the cause of death or dismemberment is a car accident and the covered person was using a seatbelt or airbag. Family coŒeraæe AD&D is available to you with your group term life coverage, as well as all your covered family members. }o learn more, talk with your Colonial Life benefits counselor. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GTL1.0-P and certificate form GTL1.0-C (including state abbreviations where used for exampleȚ GTL1.0-P-T and GTL1.0-C-T). 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. © 202ǣ Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. ColonialLife.com GtZUP TEtM LIFE AD&D BENEFIT FZt EMPLZYEES 1-2ǣ ɳ 100265-Ǣ

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src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Medium_os_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-Regular_hc_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_hc_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-Regular_op_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_op_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-SemiBold_ov_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-SemiBold_ov_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Employee assistance and life planning Get support when you need it the most The Employee Assistance Program (EAP) and Life Planning Services from Health Advocate offer a wide range of support that can help you with life’s challenges at home and work. These benefits are available to you with Colonial Life Group Term Life Insurance. More options to get support Health Advocate EAP provides 2ǣ-hour confidential counselingȣ and resources with unlimited phone support, online chat and up to three face-to-face sessions for a variety of personal and work issues, such as: • Stress, anxiety and depression • Substance dependency/addiction • Child care, camps and after-school care • Grief and loss • Special needs services • Identity theft resources • Retirement planning • Staying healthy Expert support on medical expenses Get help in navigating your medical and dental out-of-pocket expenses with Medical Bill Saver®, another Health Advocate EAP resource. Medical Bill Saver can help: • Negotiate out-of-pocket medical and dental costs over $400 • Provide a Savings Results Statement summarizing the outcome • Explain how to maximize your savings and get the most value from your benefits To access EAP, call or go online: Online ColonialLife.com/EAP Telephone 1-888-645-1772 GROUP TERM LIFE INSURANCE

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src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_hc_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-Regular_op_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_op_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-SemiBold_hk_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-SemiBold_hk_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-SemiBold_ov_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-SemiBold_ov_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Life Planning Services Health Advocate Life Planning Services can help ease the burden on families with a terminally ill employee, spouse or designated beneficiary. This service offers financial and legal counseling for up to 12 months, including: • Impartial, confidential consultations • A Life Planning Resource Guide with decisions checklist and basics on settling an estate • Legal and financial counseling on dealing with creditors and financial changes • Tips and downloadable forms relating to wills, estates, survivor benefits and budgeting To access Life Planning Services, call or go online: Online HealthAdvocate.com/members Enter “Colonial Life — Life Planning” in the menu. Telephone 1-800-422-5142 }alk with your Colonial Life benefits counselor to learn more about these valuable services. ȣ The consultants must abide by federal regulations regarding duty to warn of harm to self or others. In these instances, the consultant may be mandated to report a situation to the appropriate authority. The Employee Assistance Program and Life Planning Services provided by Health Advocate are available with Colonial Life & Accident Insurance Company’s group term life offering. Medical Bill Saver is a registered service mark of Health Advocate, Inc. Terms and availability of service are subject to change. The service provider does not provide legal advice; please consult your attorney for guidance. State-mandated limitations for legal services in WA apply. Services are not valid after coverage terminates. Please contact the company for full details. Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 4-24 | 101868-2 ColonialLife.com

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.s1_27_bv-c0ae7fd5-{font-size:16px;font-family:Arial-BoldMT_oz_bv-c0ae7fd5-;color:#000;} .s2_27_bv-c0ae7fd5-{font-size:16px;font-family:ArialMT_ox_bv-c0ae7fd5-;color:#000;} .s3_27_bv-c0ae7fd5-{font-size:16px;font-family:Arial-ItalicMT_p0_bv-c0ae7fd5-;color:#000;} .s4_27_bv-c0ae7fd5-{font-size:16px;font-family:SymbolMT_p5_bv-c0ae7fd5-;color:#000;} @font-face { font-family: Arial-BoldMT_oz_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Arial-BoldMT_oz_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Arial-ItalicMT_p0_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Arial-ItalicMT_p0_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: ArialMT_ox_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/ArialMT_ox_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: SymbolMT_p5_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/SymbolMT_p5_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } GTL 1.0 – DFA 74922 COLONIAL LIFE & ACCIDENT INSURANCE COMPANY REQUIRED DISCLOSURE FORM FOR ACCELERATED DEATH BENEFIT Consequences of This Benefit: Receipt of accelerated death benefits MAY AFFECT MEDICAID AND SUPPLEMENTAL SECURITY INCOME (“SSI”) ELIGIBILITY. The mere fact that you have life coverage and own a certificate with an accelerated death benefit may affect your eligibility for these government programs. In addition, exercising the option to accelerate death benefits and receiving those benefits before you apply for these programs, or while you are receiving government benefits, may affect your initial or continued eligibility. Contact the Medicaid Unit of your local Division of Medical Assistance and the Social Security Administration for more information. Medical condition allowing the Accelerated Death Benefit An Accelerated Death Benefit is a benefit that allows you, the named insured, to be advanced a portion of the death benefit if the covered person is diagnosed with a terminal illness after the coverage effective date. Terminal Illness means an injury or sickness which results in the covered person having a life expectancy of 12 months or less and from which there is no reasonable prospect for recovery. This Disclosure Form highlights some of the information in Policy Form Group Term Life 1.0. It is not an insurance contract. If there are any inconsistencies between this disclosure form and the policy, then the terms and conditions of the actual policy will control. Benefit Amount You may request an amount of up to 75% of the certificate life coverage face amount, but not greater than $150,000. The minimum Accelerated Death Benefit payment is $5,000. The certificate must be in force on the date of payment and must have a life coverage face amount of at least $10,000. The Accelerated Death Benefit amount payable to you is reduced:  first by any due but unpaid premiums; then  by the administrative fee charged by us for Accelerated Death Benefit payments, in the amount in effect at the time of payment, not to exceed $200; then  the remaining sum is discounted for a time period of one year using an interest rate no greater than the greater of: (a) the current yield on 90 day treasury bills; or (b) the current maximum statutory adjustable policy loan interest rate. To File a Claim The Accelerated Death Benefit will be paid to you during the covered person’s lifetime while the certificate is in force, upon receipt of all of the following: 1. a completed Accelerated Death Benefit request form: and 2. proof that the covered person has been diagnosed with a terminal illness. Such proof will include a statement from the covered person’s licensed physician, and any other medical information we deem necessary to confirm the covered person’s health status; and 3. written consent of any irrevocable beneficiary or any assignee, if applicable, agreeing that you may elect the death benefit advance. Benefit Payment We will pay the Accelerated Death Benefit in a lump sum. Upon payment of the Accelerated Death Benefit, the life coverage face amount of the certificate will be reduced by the amount of Accelerated Death Benefit requested by you. Taxability of Benefits The amount paid under this benefit may be taxable. We are not responsible for any tax on or other effects of any benefit paid. As with all tax matters, consult your personal tax advisor to assess the impact of this benefit. Effect on Benefits The death benefit will be reduced if you file for and receive an Accelerated Death Benefit. If an Accelerated Death Benefit is paid, the certificate may not be converted and no new coverage can be added to the certificate.

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and reprinted by Colonial Life & Accident Insurance Company This guide can help you when you shop for life insurance. It discusses how to: • Find a policy that meets your needs and fits your budget. • Decide how much insurance you need. • Make informed decisions when you buy a policy. Before you buy life insurance... Understand what life insurance is Life insurance pays a death benefit if you die while the policy is in effect, in exchange for premiums you pay before your death. You can use the death benefit to protect against financial hardships such as loss of your income, funeral expenses, medical or nursing care expenses, debt repayments, and child care costs after your death. You can get information from content.naic.org/consumer/life-insurance.htm. If you need life insurance, decide how much coverage to buy How much life insurance to buy depends on the financial needs that will continue after your death. Examples include supporting your family, paying for child(ren)’s education, and paying off a mortgage. Some Īuestions you may want to ask about your own needs includeȚ • Does anyone depend on me financiallyȟ • How much of the family income do I provideȟ • How will my family pay my final expenses and repay debts after my deathȟ • Do I want to leave money to charity or familyȟ • If I have life insurance through my employer, is it enough to meet my financial obligationsȟ The answers to these Īuestions can help you decide how much coverage you need. An insurance agent, financial advisor, or insurance company representative can help you evaluate your insurance needs and give you information about available policies. If you already have life insurance, assess your current life insurance policy It’s important to compare your current policy with any new policy you might buy. Neep in mind that you may be able to change your current policy to get benefits you want. Also, know that any changes in your health may impact your ability to get a new policy or the premium you’ll pay. Don’t cancel your current policy until you get the new one. Also, while you may have free or low-cost life insurance through your employer, the death benefit usually is less than you need. And if you leave the employer, you may not be able to take this coverage with you.

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You should choose a policy with features that fit your individual needs. Some things to consider areȚ Term vs. cash value: Term insurance is intended to provide lowercost coverage for a specific period of time (“a term”). If you want coverage for a longer period of time, such as for your lifetime, cash value insurance may be more cost effective. Most term policies don’t build up cash values that you can use in the future. Renewable term vs. nonrenewable term: Most term life insurance coverage can be continued (“renewed”) at the end of the term, even if your health has changed. If you renew a term policy, the new premiums are higher. Ask what the premiums will be before you renew the policy. Also ask if you’ll lose the right to renew the policy at a certain age. A nonrenewable term policy can’t be continued. You’ll have to apply for a new policy if you still want coverage. Whole life vs. universal life: Whole life and universal life insurance are two types of cash value insurance. A key difference between the two is how you pay for the coverage. You typically pay premiums for whole life insurance according to a set schedule. In a universal life policy, you can choose a Ŧexible premium payment pattern as long as you pay enough to keep your policy in force. Variable life vs. non-variable life: The investments you will choose (such as stock and bond funds) in a variable life policy directly impact your cash value. These policies have the greatest potential to build cash value but also the greatest risk of losing cash value. Non-variable life policies often have guaranteed minimums for some features (interest or cash value, for example) but not all. Non-variable life policies also have less potential to build cash value than variable life policies. Be sure you can afford the premium Before you buy a life insurance policy, be sure you can pay the premiums. Can you afford the initial premiumȟ If the premium increases later, will you still be able to afford itȟ The premiums for many life insurance policies are sensitive to changes in the company’s investment earnings, claims costs, and other expenses. If those are worse than expected, you may have to pay a much higher premium. Ask what might be the highest premium you’d have to pay to keep your coverage. Understand the application process You can apply for life insurance through life insurance agents, the mail, and online. In addition to basic information, such as your name, address, employer, job title, and date of birth, you’ll be asked for more personal information. Depending on the type of policy, the insurer may reĪuire you to see a doctor, answer health-related Īuestions, or have a medical professional come to your home or office to assess your health. Usually a policy that doesn’t reĪuire detailed health information will cost more and provide less coverage than one that does. It’s important to tell the truth on the application. The insurance company will check your answers so review the application before you sign. If the insurance company discovers false statements on your application after it issues your policy, it could reduce or cancel your coverage. hoose a beneficiary A beneficiary is the person(s) or organišation(s) you name to receive your life insurance policy’s death benefit. You’ll need to know the Social Security or tax identification number for all beneficiaries. Experts advise you not to name a minor child as a beneficiary. Insurance companies won’t pay a minor. Instead, consider leaving the money to your estate or trust. Evaluate the future of your policy Does your policy have a cash valueȟ In some cash value policies, the values are low in the early years but build later on. In other policies the values build up gradually over the years. Most term policies have no cash value. Ask your insurance agent, financial advisor, or an insurance company representative for an illustration showing future values and benefits. After you buy life insurance... Read your policy carefully After you carefully read your policy, you should be able to answer the following important ĪuestionsȚ • Is your personal information correctȟ • Do premiums or policy values vary from year to yearȟ • What part of the premium or policy value isn’t guaranteedȟ • How will the timing of money paid and received affect any interest the policy might earnȟ

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If you’re not satisfied with your new policy, you can return it for a full refund within a certain period, usually 10 days after you receive it. The review period usually is stated on the first page of the policy. Review your life insurance policy every few years teview your policy with your insurance agent, financial advisor, or an insurance company representative every few years to keep up with changes in your policy and your needs. • Have the premiums or benefits changed since your policy was issuedȟ • Do the death benefits still meet your needsȟ • Do you need more or less coverage after life events, such as birth, adoption, marriage, job change, death, or divorceȟ The insurance company can provide policy statements and illustrations to help with this review. As the policy owner, you can change beneficiaries at no cost. Be sure to review your beneficiaries every few years, especially after major life events that affect your life insurance needs. As part of our state-based system of insurance regulation in the United States, the National Association of Insurance Commissioners (NAIC) provides expertise, data, and analysis for insurance commissioners to effectively regulate the industry and protect consumers. The U.S. standard-setting organišation is governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer reviews, and coordinate regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. For more information, visit www.naic.org. This guide does not endorse any company or policy. Coverage is subject to policy exclusions and limitations that may affect benefits payable. See your benefits counselor for complete details. Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©202ǣ Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 2-2ǣ ɳ 57ǣǣǧ-Ǣ ColonialLife.com

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Wingdings2_ks_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Wingdings2_ks_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. | ColonialLife.com | 1-17 | 17075-17 Colonial Life | CHANGE OF BENEFICIARY | Fax: 1-877-828-9430 | Telephone: 1-800-325-4368 Change of Beneficiary Form ñ FAX this direction Fax this form: 1-877-828-9430 Or mail: P.O. Box 1365, Columbia, SC 29202 From: Number of pages: I am changing the following: £ Primary Beneficiary £ Contingent Beneficiary £ Both (If no box is checked, the form will be reviewed only for the beneficiary designations listed.) Insured’s name: First: Middle Initial: Last: SSN: DOB: ____ / ____ / ________ Telephone: Email: Address: City: State: ZIP: Policy number(s): General Information Naming a Minor as a Beneficiary: In some instances, Colonial Life may not be able to pay life insurance proceeds to a minor beneficiary unless a court appointed adult guardian, conservator or custodian has been properly designated for the minor’s property in advance planning documents. When Colonial Life is unable to disperse benefits in such situations, Colonial Life will hold the proceeds (with interest earned on the funds) until the minor reaches the age of majority. If you have questions about the consequences of naming a minor as a beneficiary, feel free to discuss with a legal or estate planning professional. Naming a Trust: Provide the name of the trust, the date the trust was established, and the address of where the trust is held. Naming a Funeral Home: Provide the name, full address, and the owner or authorized personnel of the funeral home. Write “As Interest May Appear” and designate another primary beneficiary to receive any remaining benefits available after the funeral home’s expenses have been paid. Primary beneficiary(ies) All fields must be completed for each beneficiary. Unless otherwise specified, proceeds will be paid in equal shares to surviving beneficiaries. If selecting more than one Primary Beneficiary, the percentages must equal 100%. Attach additional pieces of paper if more space is needed. First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: Contingent beneficiary(ies) If at the time of the insured’s death and all primary beneficiaries are disqualified or die before the insured, proceeds will be paid to the contingent beneficiaries listed in equal shares. If selecting more than one contingent beneficiary, the percentage must equal 100%. Attach additional pieces of paper if more space is needed. First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: First: Middle initial: Last: Percentage DOB: _____ / _____ / __________ SSN: Telephone: Address: City: State: ZIP: Required signature (complete this section in its entirety) ________________________________________________________________________________________________ ______________________________________________ Signature of policy owner Date (MM/DD/YYYY) Print policy owner name: SSN: DOB: ____ /____ / ________ Telephone: Email: Address: City: State: ZIP: Special Notice for Residents of a Community Property State: A spouse or former spouse may have an interest in life insurance proceeds or any accumulated cash value if the policy premiums were paid with community funds. It is your responsibility to consult your legal advisor to 1) ensure that any required consent from a spouse or former spouse has been received and 2) ensure that your spouse or former spouse will not be able to make a claim against any policy values and/or proceeds in the event any policy benefits become payable.

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src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Bold_q6_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-Regular_q1_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_q1_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: CourierNewPSMT_qg_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/CourierNewPSMT_qg_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: SymbolMT_qb_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/SymbolMT_qb_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Colonial Life Disclosures - Last modified 10/7/2024 Page 1 Account Name: Humane Society of Southwest Washington Date: 6/18/2026 Situs State: WA Vendor: Paylocity – Benefits Enhanced Colonial Life Disclosures, Limitations, and Exclusions By electing coverage, I confirm and agree I have received and read the linked enrollment materials, including statements regarding eligibility for coverage, possible delayed effective dates, benefit provisions, costs, exclusions, limitations, terminations and benefit reductions, offsets and any required outlines of coverage and I acknowledge and agree to them.  Beneficiaries– If not asked or submitted, benefits will be paid to beneficiaries in accordance with the order recorded in the contract. Without a named beneficiary, the beneficiary will automatically be assigned based on the succession listed in the certificate: Spouse, if applicable, your domestic partner who is covered under this certificate as a spouse; children; parents; sisters and brothers; or to your estate. o If you would like to name a beneficiary you may log in to www.coloniallife.com, call the Colonial Life Contact Center at 1-800-325-4368, or complete the beneficiary change form found within the enrollment site.  E-consent – I consent to the electronic delivery of insurance documents, including legally required disclosure and policy documents. I have an email address and an electronic device such as a computer or a smart phone to access the internet and view and retain PDF documents. I can withdraw my consent; update my email address and request, free of charge, a paper copy of any document at any time by contacting Colonial Life & Accident Insurance Company anytime using one of these methods: o Telephone to 800-325-4368 o Paper mail to P.O. Box 100195, Columbia, SC 29202 o Website is: www.coloniallife.com  Eligibility - I confirm I am actively at work at the time of enrollment and working at least 20 hours per week.  Tobacco Rates - If applying for a non-tobacco policy, you attest that you have not used any tobacco products and/or any nicotine delivery system with in the last 12 months. (Use of any nicotine delivery system, including electronic devices, nicotine substitutes, or smoking cessation products, or any electronic device that does not contain nicotine including electronic vaporizers or cigarettes is considered tobacco usage.)

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@font-face { font-family: Calibri_ql_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Calibri_ql_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: CourierNewPSMT_qg_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/CourierNewPSMT_qg_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: SymbolMT_qb_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/SymbolMT_qb_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Colonial Life Disclosures - Last modified 10/7/2024 Page 2 Product Information  Group Critical Illness 6000 o Plan 1, 2, & 3 – If covered by the employee’s plan, spouse and eligible dependent children coverage is 50% of the named insured’s face amount Group Term Life ● When a covered person reaches age 70, but not 75, the amount of insurance will be: o 65% of the amount of insurance prior to age 70; or o 65% of the amount of insurance applied for on or after age 70 but before age 75. ● When a covered person reaches age 75 or more, the amount of insurance will be: o 50% of the amount of insurance prior to the first reduction; or o 50% of the amount of insurance the employee applied for on or after age 75. Once the benefit reduction schedule begins, there will be no further increases in insurance for a covered person. If the proposed insured is age 70, but not age 75 at the time of enrollment, the amount of insurance applied for will be reduced by 35%. If the proposed insured is age 75 or older at the time of enrollment, the amount applied for will be reduced by 50%. Documents and Brochures  You attest to receipt of the following Colonial Life documents within the enrollment site: o Colonial Life Disclosures, Limitations, and Exclusions o Colonial Life Group Accident Brochure o Colonial Life Group Critical Illness Brochure o Colonial Life Group Disability Brochure o Colonial Life Group Medical Bridge Brochure o Colonial Life Voluntary Group Term Life Brochure Voluntary Opt-in Consent Disclosure If you consent, Colonial Life & Accident Insurance Company will transmit documents related to your insurance policy, including legally required disclosures and policy documents, by electronic means, to the extent that electronic transmission is consistent with applicable state and federal law. These documents include, but are not limited to, the entire contract, disclosures, correspondence, guides and notices that are applicable to your coverage. Any document that we send by electronic means, which complies with applicable law, will have the same force and effect as if that document was sent in paper format. Colonial Life & Accident Insurance Company will only transmit documents to you electronically if you consent. Your consent is voluntary. If you have permitted electronic transmissions in the past, that authorization does not obligate the same procedure regarding this policy as well. If you decide that you want to receive documents electronically, Colonial Life & Accident Insurance Company will provide one paper copy per year of any document, at no charge to you, upon request. You can change your mind at any time and have Colonial Life & Accident Insurance Company transmit documents via paper mail by notifying Colonial Life & Accident Insurance Company by any one of these methods listed at the end of this paragraph. If you wish to correct or change the email address Colonial Life & Accident Insurance Company uses to send documents, you can do so any time by notifying Colonial Life & Accident Insurance Company by any one of these methods:  telephone to 800-325-4368, or

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src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Bold_q6_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: Barlow-Regular_q1_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/Barlow-Regular_q1_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } @font-face { font-family: SymbolMT_qb_bv-c0ae7fd5-; src: url("userFiles/a/6/0/6/6/9/0/ElWoHFHngVUOZVG4RMIwYG/fonts/SymbolMT_qb_bv-c0ae7fd5-.woff?_cbt=1787672272") format("woff"); } Colonial Life Disclosures - Last modified 10/7/2024 Page 3  paper mail to P.O. Box 1365, Columbia, SC 29202-1365.  Colonial Life & Accident Insurance Company’s website is: www.coloniallife.com. For purposes of receiving electronic transmission of documents from Colonial Life & Accident Insurance Company, as set forth above, my email address is: test@gmail.com To access the internet and view and retain PDF documents, I have access to an electronic device such as a computer or a smart phone. I consent to receive documents transmitted electronically. Signature: Electronic Signature On File Authorization for Colonial Life & Accident Insurance Company For the purpose of evaluating my application(s) for insurance submitted during the current enrollment and eligibility for benefits under any insurance issued including checking for and resolving any issues that may arise regarding incomplete or incorrect information on my application(s), I hereby authorize the disclosure of the following information about me and, if applicable, my dependents, from the sources listed below to Colonial Life & Accident Insurance Company (Colonial) and its duly authorized representatives. Health information may be disclosed by any health care provider or institution, health plan or health care clearinghouse that has any records or knowledge about me including prescription drug database or pharmacy benefit manager, or ambulance or other medical transport service. Health information may also be disclosed by any insurance company, Medicare or Medicaid agencies or the Medical Information Bureau (MIB). Health information includes my entire medical record but does not include psychotherapy notes. Non-health information including earnings or employment history deemed appropriate by Colonial to evaluate my application may be disclosed by any person or organization that has these records about me, including my employer, employer representative and compensation sources, insurance company, financial institution or governmental entities including departments of public safety and motor vehicle departments. Any information Colonial obtains pursuant to this authorization will be used for the purpose of evaluating my application(s) for insurance or eligibility for benefits. Some information obtained may not be protected by certain federal regulations governing the privacy of health information, but the information is protected by state privacy laws and other applicable laws. Colonial will not re- disclose the information unless permitted or required by those laws. Re-disclosed information may no longer be protected by federal privacy laws. This authorization is valid for two (2) years from its execution and a copy is as valid as the original. A copy will be included with my contract(s) and I or my authorized representative may request access to this information. This authorization may be revoked by me or my authorized representative at any time except to the extent Colonial has relied on the authorization prior to notice of revocation or has a legal right to contest coverage under the contract(s) or the contract itself. If revoked, Colonial may not be able to evaluate my application(s) for insurance or eligibility for benefits as necessary to issue my contract(s). I may revoke this authorization by sending written notice to: Colonial Life & Accident Insurance Company, Underwriting Department, P. O. Box 1365, Columbia, SC 29202. Group Specified Disease Insurance Pretax Disclosure Statement As a participant in my employer’s flexible benefits plan, I have elected to pay my premiums for Colonial Life & Accident Insurance Company’s Group Specified Disease Insurance policy with pretax dollars. I am aware of the tax savings I receive through a flexible benefits plan. While the Internal Revenue Service (IRS) allows me to receive tax savings on my premiums, the IRS also may require me to pay taxes on certain insurance benefits I receive from policies purchased through a flexible benefits plan. I understand that if I receive benefits for an indemnity benefit (lump-sum payment made without regard to actual medical expenses) the IRS may consider the amount of this benefit as taxable income. In making my decision, I understand if I receive more than $600 from all indemnity benefits purchased with pre-tax dollars (comparable to those benefits in my Group Specified Disease Insurance policy) payable by Colonial Life during the calendar year, Colonial Life is required to file a Form 1099 Miscellaneous Income on these amounts. I will receive the Form 1099 to be used in completing my personal tax return, and a copy will be sent to the IRS. A Form 1099 is not required for benefit amounts of $600 or less, although those amounts may still be taxable income to me. Notice to Applicant Regarding Replacement of Accident and Sickness Insurance

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For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy. 1. Health conditions which you may presently have, may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy. 2. Any benefits you have accrued under your present policy may not be payable or transferrable under the new policy. 3. If you are transferring from individual coverage to group coverage, the circumstances under which you may continue your coverage may be limited or no longer available. 4. You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage. 5. If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical/health history. Failure to include all material medical information on an application may provide a basis for the Company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, reread it carefully to be certain that all information has been properly recorded. Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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But when the unexpected happens, it’s reassuring to have coverage that can help protect your pet. Unum Pet Insurance, provided by Nationwide ® , helps your furry family members get the care they need without breaking the bank. Whether you’re looking for broad protection or something more tailored, our pet insurance options are designed to fit your life — and your pet’s needs. Access any licensed vet, anywhere With no networks or pre-approvals required, you can choose any licensed veterinarian, anywhere. Take advantage of our key value-added services, such as the 24/7 VetHelpline ® savings at Petco’s Vetco Total Care clinics and discounts on prescription drugs from select pharmacies like Walmart and Sam’s Club. How it works Visit any vet Submit a claim Receive reimbursement for eligible expenses What can be reimbursed under the policy? Accident 1 • Broken bones • Poisonings • Sprains • Lacerations • Hit by car • Ingested item Example: Poisoning, veterinary bill: $1,035 Plan reimburses: $725 Illness • Ear infections • Vomiting • Hip dysplasia • Allergies • Cancer • Diabetes Example: Cancer, veterinary bill: $2,266 Plan reimburses: $1,586 Wellness • Annual exam • Vaccinations • Fecal test • Deworming • Microchip • Flea control Example: Flea control, veterinary bill: $171 Plan reimburses: $120

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For no extra cost, our pet insurance policyholders get discounts at participating pharmacies while enjoying the effortless conveniences of automatic claims submission. How it works 1. Download a digital pet insurance card 2. Take a prescription to any participating pharmacy, or have the veterinarian call it in 3. Show the pet insurance card at checkout, and pay for the prescription That’s it. The pharmacy will automatically submit your claim for processing, and you will be reimbursed for eligible expenses. VetHelpline When it comes to your pet’s health, no concern is too big or too small. )riendl\, e[Sert adYice Members get unlimited 24/7 video chat guidance from licensed veterinary professionals at no additional cost. Get expert advice on emergency triage, health and wellness, continued care and more — no pet carrier, no car ride, no worries. Download the VetHelpline app from the App Store or Google Play. Members can start using this service once their policy is in effect — there’s no sign up or extra enrollment required. Here’s how coverage works for medical conditions Chew on this: Sofie’s benefit story Sofie, a four-year-old goldendoodle, was brought to the vet after showing symptoms of lethargy, vomiting and loss of appetite. Turns out she’d made a sock her snack, and the vet diagnosed her with a foreign body obstruction. $1,877 reimbursement Veterinary bill: $2,682 Reimbursed: $1,877 Owner’s net cost: $805 Example reflects a Pet Insurance plan with 70% reimbursement and assumes the deductible has been met. For illustrative purposes only. Exotic Pets Owners of birds, reptiles and other exotic pets can get reimbursements on eligible veterinary expenses. Coverage available for: • Amphibians • Birds • Chameleons • Chinchillas • Ferrets • Geckos • Gerbils • Guinea pigs • Hamsters • Iguanas • Lizards • Mice • Rats • Rabbits • Snakes • Tortoises • Turtles • And more Call us at 1-844-208-1105 to learn more about avian and exotic pet coverage.

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No, once you sign up, your policy automatically renews every year. Your renewal period starts 60 days before your current 12-month term ends. You’ll get a policy packet in the mail with the expiration date, and you can make changes to your coverage during this time. Just remember, any changes need to be approved by our underwriting team. Can I make changes to my policy? Absolutely, you can make changes during your policy renewal period. Just keep in mind that any changes need to be approved by our underwriting team. Can I purchase wellness as a standalone coverage? No, we don’t offer wellness coverage on its own. Employees will need to first opt-in to the base coverage. What happens to my pet insurance policies if I leave the company? We’ll reach out to you to update your billing and policy information so your coverage can continue. Will pre-existing conditions be covered? Unum Pet Insurance is guaranteed issue, which means you will receive coverage if you apply; however, pre-existing conditions are not covered. Can I still use my veterinarian? Of course, \ou can Yisit an\ licensed Yet an\where in the world, including specialists and emergency providers. If I have a pet other than a dog or cat, can I enroll? Yes, you can. We offer coverage for birds, rabbits, reptiles and other exotic pets. To enroll, just give us a call at 1-844-208-1105. How do I file a claim? It’s easy. Simply pay your vet bill and then send Nationwide a claim for reimbursement via mail, email or online. • Mail: 1ationwide &laims 'ept, 3O %ox 181, &olumbus, Ohio 181 • Email: submitmyclaim@petinsurance.com • Online: Submit claims at my.petinsurance.com or the Nationwide mobile app. READY TO ENROLL? Ask your employer or Colonial Life representative for your unique enrollment link, or call us directly at 1-844-208-1105. ® unum.com  Example reflects $ccident and Illness coveraJe with 70% reimbursement aIter annual deductible has been Iulȴlled and :ellness /evel  coveraJe.  6ome exclusions may apply. &ertain coveraJes may be excluded due to preexistinJ conditions. 6ee policy documents Ior a complete list oI exclusions and any annual limits that may apply. Plans may not be available in all states. Policy eliJibility may vary. $ll plans reTuire accident coveraJe. $dditional coveraJe Ior Illness +ereditary and &onJenital conditions and wellness are optional. Pet insurance plans are marNeted by 8num Insurance $Jency //& a licensed insurance aJency. For the complete licensinJ inIormation oI 8num Insurance $Jency //& reIer to unum. competinsurancestatelicensinJ. Ȋ8num Pet Insuranceȋ is a marNetinJ name used by 8num Insurance $Jency //&. 8num Insurance $Jency //& is a subsidiary oI 8num *roup and is not a 1ationwide business or aɝliate. Products underwritten by 9eterinary Pet Insurance &ompany &$ &olumbus 2+ 1ational &asualty &ompany all other states &olumbus 2+. $Jency oI 5ecord '90 Insurance $Jency. $ll are subsidiaries oI 1ationwide 0utual Insurance &ompany. 6ubMect to underwritinJ Juidelines review and approval. Products and discounts not available to all persons in all states. Insurance terms deȴnitions and explanations are intended Ior inIormational purposes only and do not in any way replace or modiIy the deȴnitions and inIormation contained in individual insurance contracts policies or declaration paJes which are controllinJ. k 0 8num *roup. $ll riJhts reserved. 8num and &olonial /iIe are reJistered trademarNs and marNetinJ brands oI 8num *roup and its insurinJ subsidiaries. 70 F25 E0P/2<EE6 7 https://unum.petinsurance.com/pet/swhumane

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Our guided question wizard walks you through the process and checks for missing information that could cause delays. Opting for direct deposit can also get approved payments to you up to a week faster than paper check. NEED TO FILE A CLAIM? Here’s what you can do on Colonial Life for Policyholders: Update your personal info & preferences File claims with a simple, guided form Opt for instant alerts by email or text View claim status or policy details anytime Check your claim status by logging into your account at ColonialLife.com/access. You can also sign up for text or email alerts so you know instantly if status changes or more information is needed. For your convenience, you can login anytime with a mobile device to photograph and upload documents with your camera. AFTER YOU FILE: Find out how simple your claims and benefits experience can be by learning more about the Colonial Life for Policyholders portal. Just visit ColonialLife.com to see what this online account administration platform can do for you. LEARN MORE BECOME A MEMBER TODAY: Go to ColonialLife.com/access to register. Click “create an account”, fill out the reĪuired information and click Submit. Enjoy faster service and improved benefits awareness. 1 2 3 THE PORTAL OFFERS YOU: Faster service than calling/emailing Confirmation when a claim has been submitted Simplified bill payment and management Answers to frequently asked questions and live chat assistance if you don’t see what you are looking for. Colonial Life for Policyholders Portal A faster, simpler way to manage your benefits Colonial Life for Policyholders is an online portal created with you in mind. It’s the most convenient and efficient way to file a claim and manage your benefits. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 43233-41 Set up direct deposit for approved payments

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