Return to flip book view
Benefit Booklet - 2024
Learn more online at:ColonialLife.comColonial Life provides benets that employees want for the unexpected moments in life. Whether planning for retirement, growing their families, or saving for college, they know an injury or illness won’t derail their dreams. <b>Kitty Mellone</b>Kmellone@coloniallifenc.com704-907-3944Life is anything but expected. That’s why we’re here.ProductsHospital Confinement Indemnity Insurance (Medical Bridge)Provides benefits to help cover the cost of a hospital stay and other medical procedures for a covered accident or sickness, regardless of what health insurance pays.Accident InsuranceFrom a fall to a car accident, this coverage offers a range of benefits to help cover medical or non-medical related expenses due to a covered accident.Cancer InsuranceProvides benefits for a cancer diagnosis and treatment. Option to add cancer screening benefit.Critical Illness InsuranceProvides lumpsum benefits for a covered critical illness, such as a heart attack or stroke.Term Life InsuranceProvides a predictable way to provide life coverage at more affordable prices during high-need years.Whole Life InsuranceProvides protection for a lifetime. Features guaranteed level premiums and increasing cash values over time. Option to increase coverage on the second, fifth and eighth year of the policy’s anniversary.
Disability InsuranceHow you can protect your incomeIf you become disabled, you could be out of work for a while. Without your income, how would you pay for your everyday living expenses? Fortunately, Colonial Life offers nancial protection options that can help you. What can cause a disability? Many accidents or sicknesses can lead to short term disability claims, including pregnancy and childbirth; injuries from a major accident including dislocations, sprains and fractures; back problems; side effects from medicines or medical procedures; and some mental illnesses. Regardless of your age or health, a disabling sickness or accidental injuries could keep you out of work for weeks or even months.How reliable is your safety net? While many people with disabilities look to workers’ compensation or Social Security Disability Insurance (SSDI) for help, these resources aren’t always reliable. In fact, 68% of workers who apply for SSDI are denied.1 Even if these resources can help, they might not be enough to meet your nancial obligations.How to help yourself You can be better prepared to preserve your way of life with short term disability insurance. Disability insurance features:• Benets payable directly to you in regular payments if you can’t work because of a covered accident or sickness (injury or illness).• Disability benets may be available if you return to work part time. • In most cases, you can keep your coverage even if you change jobs, as long as you pay your premiums when due.Your Colonial Life benets counselor can help you determine the amount of coverage that’s right for you.70%of Americans worry about having enough emergency savings to cover a month’s worth of living expenses.2Nearly25%of 20 year olds can expect to be out of work for at least a year for a disabling condition before they retire.3DISABILITY INSURANCE
Disability Insurance Worksheet You can tailor disability coverage to t your specic needs. Talk with your benets counselor about your expenses and other paid leave benets, such as state paid medical leave, to help determine the coverage that’s right for you.4MONTHLY EXPENSES ROUND TO THE NEAREST HUNDREDRent or mortgage (insurance, minor home repairs) $Transportation (car note, bus fare, insurance, gas, maintenance)$Utilities (cell phone, Wi-Fi, electricity/gas, water) $Food and household necessities (toiletries, cleaning supplies)$Childcare (daycare, after-school care) $Health (medical needs and prescription drugs) $Other (gym/fitness, streaming/cable, extracurricular) $Total monthly expenses (add lines 1-7 together) $Your state’s paid medical leave approximate benefits (if any):Monthly benefit: _____________ Benefit period up to: _____________Talk with your Colonial Life benets counselor to learn more about disability insurance.ColonialLife.com1. Social Security Administration, SSI Annual Statistical Report, 2021.2. Bankrate, Bankrate’s 2023 annual emergency savings report, 2023. 3. Social Security Administration, Disability and Death Probability Tables for Insured Workers, 2022.4. State paid medical leave (PML) benets fall under state-specic program names. For example, in New Jersey, it may be referred to as Temporary Disability Insurance (TDI). Not available in all states.For policies issued or delivered in the Commonwealth of Virginia, THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy forms ISTD3000 and rider form ISTD3000-ADIB (including state abbreviations where used, for example: ISTD3000-TX and ISTD3000-ADIB-TX ), policy form DIS1000 (including state abbreviations where used, for example DIS1000-TX), policy form ED-DIS 1.0 (including state abbreviations where used, for example ED-DIS 1.0-TX), policy form ICC21-DIP3000 and rider form ICC21-DIP3000-R-DIS, policy form GDIS-P and certicate form GDIS-C (including state abbreviations where used, for example: GDIS-P-EE-TX and GDIS-C-EE-TX), and policy form VSTDMP and certicate form VSTDC (including state abbreviations where used, for example VSTDMP-TX and VSTDC-TX). Not applicable in Oregon for policy form ICC21-DIP3000 and rider form ICC21-DIP3000-R-DIS. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. An insurance producer may contact you.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 6-23 | 101165-10
For more information, talk with your benefits counselor.Group Hospital Indemnity InsurancePlan 2ColonialLife.comGroup Medical BridgeSM 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 .......................................... $1,000 / $2,000____per dayMaximum of one day per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered confinement of the named insured£ Daily hospital confinement ................................................................... $_____per dayMaximum of 365 days per covered person per confinement. Re-confinement for the same or related condition within 90 days of discharge is considered a continuation of a previous confinement.£ Diagnostic procedure ........................................................ .......... $_______$500___ per dayMaximum of one day per covered person per calendar year£ Outpatient surgical procedure¾ Tier 1 .................................................................................... $____$500______ per day¾ Tier 2 .................................................................................... $____$1,000_ ___ per dayMaximum of $___$1,500___________ per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedureGMB7000 – PLAN 2Diagnostic procedures - N/AThe 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)
ColonialLife.com8-19 | 101918-1THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONSWe will not pay any benefits for injuries received in accidents or for sicknesses which are caused by, contributed to by or occur as a result of the following exclusions and limitations. (a) alcoholism or drug addiction; (b) dental procedures; (c) elective procedures and cosmetic surgery; (d) felonies or illegal occupations; (e) mental or nervous disorders; (f) pregnancy of a dependent child; (g) suicide or injuries which any covered person intentionally does to himself or herself; (h) war, or (i) giving birth within the first nine months aer the eective date of the certificate. (j) We will not pay benefits for hospital confinementor daily hospital confinement, if included, of a newborn child following his birth unless he is injured or sick. (k) The policy may have additional exclusions and limitations which may aect any benefits payable.PRE-EXISTING CONDITION LIMITATIONS(l) We will not pay benefits for loss during the first 12 months aer the certificate eective date due to a pre-existing condition. (m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the certificate eective date. (n) This limitation applies to the following benefits, if applicable: Hospital Confinement, Daily Hospital Confinement, Inpatient Mental and Nervous, Rehabilitation Unit Confinement, Specified Critical Illness, DiagnosticProcedure, and Outpatient Surgical Procedure.This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy form GMB7000-P and certificate form GMB7000-C (including state abbreviations where applicable, such as policy forms GMB7000-P-AU-TX and GMB7000-P-EE-TX, and certificate forms GMB7000-C-AU-TX and GMB7000-C-EE-TX). Coverage may vary by state and may not be available in all states. This form is not complete without form #101733. Breast– Breast reconstruction– Breast reduction Cardiac– Angioplasty– Cardiac catheterization Digestive– Exploratory laparoscopy– Laparoscopic appendectomy– Laparoscopic cholecystectomy Ear, nose, throat, mouth– Ethmoidectomy– Mastoidectomy– Septoplasty– Stapedectomy– TympanoplastyTier 2 outpatient surgical procedures 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 repairThe 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* – 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 graingKS: "Surgical Procedure" benefit replaces "Outpatient Surgical Procedure." Diagnostic Procedures must be performed in a hospital or an ambulatory surgical center.PA: "Hospital Confinement Admission" benefit replaces the "Hospital Confinement" benefit* 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. Thyroid– Excision of a mass Urologic– LithotripsyUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
Group Hospital Indemnity InsuranceExclusions and LimitationsSTATE-SPECIFIC EXCLUSIONSAK: (a) Replaced by intoxicants and narcotics CA: (k) Additional exclusions include intoxicants and controlled substancesCT: (a) Replaced by intoxication or drug addiction; (d) Replaced by felonies; (f) Exclusion does not applyDE: (a) Exclusion does not apply IL: (a) Replaced by alcoholism, intoxication, or drug addiction; (f) Exclusion does not apply; (g) Exclusion does not applyKS: (a) Replaced by intoxicants and narcotics; (h) Replaced by war or armed conflict; (i) Exclusion does not applyKY: (a) Replaced by intoxicants, narcotics and hallucinogenics LA: (a) Replaced by intoxicants and narcotics MI: (g) Exclusion does not applyMO: (a) Replaced by drug addiction; (d) Replaced by illegal activitiesMS: (a) Replaced by intoxicants and narcoticsNC: (i) Exclusion does not applyND: (a) Exclusion does not apply; (e) Exclusion does not applyNV: (a) Exclusion does not apply OH: (f) Exclusion does not apply; (i) Replaced by 270 daysPA: (a) Replaced by intoxicants and narcotics; (c) Replaced by cosmetic surgery; (e) Replaced by mental, nervous or emotional disorders; (h) Replaced by war or armed conflictSD:(a) Exclusion does not apply TN: (f) Exclusion does not applyTX: (a) Replaced by intoxicants and narcotics VA: (i) Pregnancy resulting from the rape of any covered person, which was reported to the police within seven days following its occurrence, will be covered to the same extent as any other covered accident. The seven-day requirement will be extended to 180 days in the case of an act of rape or incest of a female under 13 years of age.STATE-SPECIFIC PRE-EXISTING CONDITION LIMITATIONSIN, SD, and WY: (m) applies within the six months before the certificate eective date.CA: (m) A pre-existing condition is a sickness or physical condition for which a covered person was diagnosed or treated within 12 months before the coverage eective date.FL: (m) A pre-existing condition is a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within six months before the coverage eective date. Genetic information is not a pre-existing condition in the absence of a diagnosis of the condition related to such information. IL: (m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing by a legally qualified physician or, received medical advice, produced symptoms or had taken medication within 12 months before the coverage eective date.KS: (n) Surgical Procedure replaces Outpatient Surgical Procedure ME: (m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, or received medical advice within 12 months before the coverage eective date.MI: (l) Applies during the first six months aer the certificate eective date (m) applies within the six months before the certificate eective date.MO: (m) A pre-existing condition means having 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 12 months before the coverage eective date of this certificate.NC: (m) A pre-existing condition is those conditions, whether diagnosed or not, for which a covered person received medical advice, diagnosis, care or treatment that was received or recommended within the one-year period immediately preceding the coverage eective date. If you are 65 or older when this certificate is issued, pre-existing conditions will include only conditions specifically eliminated by a rider.ND: (m) A pre-existing condition is a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage eective date.NV: (m) applies within the six months before the certificate eective date. Additionally, pre-existing condition does not include genetic information in the absence of a diagnosis of the condition related to such information.OR: (m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated by a doctor, received advice from a physician or had taken medication prescribed by a doctor within the 12 months period immediately preceding the coverage eective date.PA: (m) A pre-existing condition is a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage eective date. (n) Hospital Confinement Admission replaces Hospital Confinement. CA Lic # (if applicable): _________________This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy form GMB7000-P and certificate form GMB7000-C (including state abbreviations where applicable, such as policy forms GMB7000-P-AU-TX and GMB7000-P-EE-TX, and certificate forms GMB7000-C-AU-TX and GMB7000-C-EE-TX). Coverage may vary by state and may not be available in all states. This form is not complete without base form 101917 or 101918.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2019 Colonial Life & Accident Insurance Company. All rights reserved.Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.GMB7000 – EXCLUSIONS AND LIMITATIONS | 10-18 | 101733-3
For more information, talk with your benefits counselor.ColonialLife.comGroup Hospital Indemnity InsuranceWellbeing Assistance Standard BenefitTHIS POLICY PROVIDES LIMITED BENEFITS. WAITING PERIODWaiting period means the first 30 days following any covered person’s coverage eective date, during which no benefits are payable. This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy forms GMB7000-P and GMB7000-P-TX. Coverage may vary by state and may not be available in all states. ©2016 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.GMB7000 – WELLBEING ASSISTANCE STANDARD BENEFIT | 6-16 | 101730The Group Medical BridgeSM wellbeing assistance standard benefit can help pay for routine preventive tests you have each year.Wellbeing assistance standard....................................................... $__100_______ per dayMaximum 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
Accident 1.0-Premier with Health Screening BenetAccidents happen in places where you and your family spend the most time – at work, in the home and on the playground – and they’re unexpected. How you care for them shouldn’t be. In your lifetime, which of these accidental injuries have happened to you or someone you know?l Sports-related accidental injuryl Broken bonel Burnl Concussionl Lacerationl Back or knee injuriesColonial Life’s Accident Insurance is designed to help you ll some of the gaps caused by increasing deductibles, co-payments and out-of-pocket costs related to an accidental injury. The benet to you is that you may not need to use your savings or secure a loan to pay expenses. Plus you’ll feel better knowing you can have greater nancial security.l Car accidentsl Falls & spillsl Dislocationl Accidental injuries that send you to the Emergency Room, Urgent Care or doctor’s oceWhat additional features are included?l Worldwide coveragel Portablel Compliant with Healthcare Spending Account (HSA) guidelinesWill my accident claim payment be reduced if I have other insurance?You’re paid regardless of any other insurance you may have with other insurance companies, and the benets are paid directly to you (unless you specify otherwise).What if I change employers?If you change jobs or leave your employer, you can take your coverage with you at no additional cost. Your coverage is guaranteed renewable as long as you pay your premiums when they are due or within the grace period. Can my premium change?Colonial Life can change your premium only if we change it on all policies of this kind in the state where your policy was issued. How do I le a claim?Visit coloniallife.com or call our Customer Service Department at 1.800.325.4368 for additional information.Accident Insurance
Your Colonial Life policy also provides benets for the following injuries received as a result of a covered accident.l Burn (based on size and degree) ....................................................................................$1,000 to $12,000l Coma .............................................................................................................................................................$12,500l Concussion .......................................................................................................................................................$150l Emergency Dental Work .................................... $100 Extraction, $400 Crown, Implant, or Denturel Lacerations (based on size) ........................................................................................................... $50 to $800Requires Surgeryl Eye Injury ...........................................................................................................................................................$300l Tendon/Ligament/Rotator Cu .......................................................... $750 - one, $1,500 - two or morel Ruptured Disc ..................................................................................................................................................$750l Torn Knee Cartilage .......................................................................................................................................$750Surgical Carel Surgery (cranial, open abdominal or thoracic) ................................................................................$1,500l Surgery (hernia) ..............................................................................................................................................$150l Surgery (arthroscopic or exploratory) ....................................................................................................$300l Blood/Plasma/Platelets ................................................................................................................................$300Benets listed are for each covered person per covered accident unless otherwise specied.Initial Carel Accident Emergency Treatment........... $200 l Ambulance .......................................$600l X-ray Benet .................................................. $60 l Air Ambulance ............................. $2,000Common Accidental InjuriesDislocations (Separated Joint) Non-Surgical SurgicalHip $9,600 $19,200 Knee (except patella) $4,800 $9,600 Ankle – Bone or Bones of the Foot (other than Toes) $3,840 $7,680 Collarbone (Sternoclavicular) $2,400 $4,800 Lower Jaw, Shoulder, Elbow, Wrist $1,440 $2,880 Bone or Bones of the Hand $1,440 $2,880 Collarbone (Acromioclavicular and Separation) $480 $960 One Toe or Finger $480 $960 Fractures Non-Surgical Surgical Depressed Skull $9,000 $18,000 Non-Depressed Skull $3,600 $7,200 Hip, Thigh $5,400 $10,800 Body of Vertebrae, Pelvis, Leg $2,700 $5,400 Bones of Face or Nose (except mandible or maxilla) $1,260 $2,520 Upper Jaw, Maxilla $1,260 $2,520 Upper Arm between Elbow and Shoulder $1,260 $2,520 Lower Jaw, Mandible, Kneecap, Ankle, Foot $1,080 $2,160 Shoulder Blade, Collarbone, Vertebral Process $1,080 $2,160 Forearm, Wrist, Hand $1,080 $2,160 Rib $900 $1,800 Coccyx $720 $1,440 Finger, Toe $360 $720
Transportation/Lodging AssistanceIf injured, covered person must travel more than 50 miles from residence to receive special treatment and connement in a hospital.l Transportation ............................................................................. $600 per round trip up to 3 round tripsl Lodging (family member or companion) ............................................... $150 per night up to 30 days for a hotel/motel lodging costsAccident Hospital Carel Hospital Admission* ........................................................................................................$2,000 per accidentl. Hospital ICU Admission* ................................................................................................$4,000 per accident* We will pay either the Hospital Admission or Hospital Intensive Care Unit (ICU) Admission, but not both.l Hospital Connement .........................................................$300 per day up to 365 days per accidentl Hospital ICU Connement ...................................................$600 per day up to 15 days per accidentAccident Follow-Up Carel Accident Follow-Up Doctor Visit ..........................................................$50 (up to 4 visits per accident)l Medical Imaging Study ......................................................................................................$300 per accident (limit 1 per covered accident and 1 per calendar year)l Occupational or Physical Therapy ..................................................... $35 per treatment up to 10 daysl Appliances ..........................................................................................$125 (such as wheelchair, crutches)l Prosthetic Devices/Articial Limb ....................................................$750 - one, $1,500 - more than 1l Rehabilitation Unit .................................................$150 per day up to 15 days per covered accident, and 30 days per calendar year. Maximum of 30 days per calendar yearAccidental Dismembermentl Loss of Finger/Toe ............................................................................. $1,250 – one, $2,400 – two or morel Loss or Loss of Use of Hand/Foot/Sight of Eye .................. $12,000 – one, $24,000 – two or moreCatastrophic AccidentFor severe injuries that result in the total and irrecoverable:l Loss of one hand and one foot l Loss of the sight of both eyesl Loss of both hands or both feet l Loss of the hearing of both earsl Loss or loss of use of one arm and one leg or l Loss of the ability to speakl Loss or loss of use of both arms or both legs Named Insured ................ $25,000 Spouse ..............$25,000 Child(ren) .........$12,500365-day elimination period. Amounts reduced for covered persons age 65 and over. Payable once per lifetime for each covered person. Accidental DeathAccidental Death Common Carrierl Named Insured $50,000 $200,000l Spouse $50,000 $200,000l Child(ren) $10,000 $40,000
EXCLUSIONS We will not pay benets for losses that are caused by or are the result of: hazardous avocations; felonies or illegal occupations; racing; semi-professional or professional sports; sickness; suicide or self-inicted injuries; war or armed conict; in addition to the exclusions listed above, we also will not pay the Catastrophic Accident benet for injuries that are caused by or are the result of: birth; intoxication.For cost and complete details, see your Colonial Life benets counselor. Applicable to policy form Accident 1.0-HS-NC. This is not an insurance contract and only the actual policy provisions will control. Health Screening Benet l $50 per covered person per calendar yearProvides a benet if the covered person has one of the health screening tests performed. This benet is payable once per calendar year per person and is subject to a 30-day waiting period.Tests include:l. Blood test for triglyceridesl. Bone marrow testingl. Breast ultrasoundl. CA 15-3 (blood test for breast cancer) l. CA125 (blood test for ovarian cancer) l. Carotid doppler l. CEA (blood test for colon cancer) l. Chest x-ray l. Colonoscopy l. Echocardiogram (ECHO) l. Electrocardiogram (EKG, ECG) l. Fasting blood glucose test l. Flexible sigmoidoscopy l. Hemoccult stool analysisl. Mammographyl. Pap smearl. PSA (blood test for prostate cancer)l. Serum cholesterol test to determine level of HDL and LDL l. Serum protein electrophoresis (blood test for myeloma) l. Stress test on a bicycle or treadmill l. Skin cancer biopsy l. Thermography l. ThinPrep pap test l. Virtual colonoscopy My Coverage Worksheet (For use with your Colonial Life benets counselor) Who will be covered? (check one) Employee Only Spouse Only One Child Only Employee & Spouse One-Parent Family, with Employee One-Parent Family, with Spouse Two-Parent FamilyWhen are covered accident benets available? (check one) On and O -Job Benets O -Job Only BenetsAccident 1.0-Premier with Health Screening BenetColonial Life 1200 Colonial Life BoulevardColumbia, South Carolina 29210coloniallife.com71741-NC©2014 Colonial Life & Accident Insurance Company | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 6-14
Group Critical Illness InsurancePlan 2GCI6000 – PLAN 2 – CRITICAL ILLNESS AND CANCERWhen life takes an unexpected turn, your focus should be on recovery — not finances. Colonial Life’s group critical illness insurance helps relieve financial worries by providing a lump-sum benefit payable directly to you to use as needed.Coverage amount: ____________________________COVERED CRITICAL ILLNESS CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTBenign brain tumor100%Coma100%End stage renal (kidney) failure100%Heart attack (myocardial infarction)100%Loss of hearing100%Loss of sight100%Loss of speech100%Major organ failure requiring transplant100%Occupational infectious HIV or occupational infectious hepatitis B, C, or D100%Permanent paralysis due to a covered accident100%Stroke100%Sudden cardiac arrest100%Coronary artery disease25%COVERED CANCER CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTInvasive cancer (including all breast cancer)100%Non-invasive cancer25%Skin cancer initial diagnosis ............................................................ $400 per lifetimeCritical illness and cancer benefitsSpecial needs daycareA hospital stay and treatment for corrective heart surgeryPhysical therapy to build muscle strengthFor illustrative purposes only.Preparing for a lifelong journeyRebecca was born with Down syndrome. Her parents’ critical illness coverage provided a benefit that can help cover expenses related to Rebecca’s care and her changing needs. HOW THEIR COVERAGE HELPEDThe lump-sum amount from the family coverage benefit helped pay for:
ColonialLife.com5-20 | 3871001. Refer to the certificate for complete definitions of covered conditions. 2. Dates of diagnoses of a covered critical illness must be separated by more than 180 days. 3. Critical illnesses that do not qualify include: coronary artery disease, loss of hearing, loss of sight, loss of speech, and occupational infectious HIV or occupational infectious hepatitis B,C,or D.THIS INSURANCE PROVIDES LIMITED BENEFITSInsureds in MA must be covered by comprehensive health insurance before applying for this coverage.EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benefit, Benefits Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Invasive Cancer (including all Breast Cancer) Benefit, Non-Invasive Cancer Benefit, Benefit Payable Upon Reoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benefit for a covered person’s invasive cancer or non-invasive cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having invasive or non-invasive cancer. No pre-existing condition limitation will be applied for dependent children who are born or adopted while the named insured is covered under the certificate, and who are continuously covered from the date of birth or adoption.PRE-EXISTING CONDITION LIMITATION We will not pay a benefit for a pre-existing condition that occurs during the 12-month period aer the coverage eective date. Pre-existing condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage eective date.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.COVERED CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTCerebral palsy 100%Cle lip or palate 100%Cystic fibrosis 100%Down syndrome 100%Spina bifida 100%KEY BENEFITSAdditional covered conditions for dependent childrenSubsequent diagnosis of a dierent critical illnessIf you receive a benefit for a critical illness, and are later diagnosed with a dierent critical illness, 100% of the coverage amount may be payable for that particular critical illness.Subsequent diagnosis of the same critical illnessIf you receive a benefit for a critical illness, and are later diagnosed with the same critical illness,3 25% of the coverage amount is payable for that critical illness.Reoccurrence of invasive cancer (including all breast cancer)If you receive a benefit for invasive cancer and are later diagnosed with a reoccurrence of invasive cancer, 25% of the coverage amount is payable if treatment-free for at least 12 months and in complete remission prior to the date of reoccurrence; excludes non-invasive or skin cancer.For more information, talk with your benefits counselor.Preparing for the unexpected is simpler than you think. With Colonial Life, youʼll have the support you need to face lifeʼs toughest challenges. Available coverage for spouse and eligible dependent children at 50% of your coverage amount Cover your eligible dependent children at no additional cost Receive coverage regardless of medical history, within specified limits Works alongside your health savings account (HSA) Benefits payable regardless of other insurance
Group Critical Illness InsuranceExclusions and LimitationsSTATE-SPECIFIC EXCLUSIONSAK: Alcoholism or Drug Addiction Exclusion does not applyCO: Suicide exclusion: whether sane or not replaced with while sane CT: Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction; Felonies or Illegal Occupations Exclusion replaced with Felonies; Intoxicants and Narcotics Exclusion does not applyDE: Alcoholism or Drug Addiction Exclusion does not applyIA: Exclusions and Limitations headers renamed to Exclusions and Limitations for Critical Illness Covered Conditions and Critical Illness Cancer Covered ConditionsID: War or Armed Conflict Exclusion replaced with War; Felonies and Illegal Occupations Exclusion replaced with Felonies; Intoxicants and Narcotics Exclusion does not apply; Domestic Partner added to SpouseIL: Alcoholism or Drug Addiction Exclusion replaced with Alcoholism or Substance Abuse DisorderKS: Alcoholism or Drug Addiction Exclusion does not applyKY: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion replaced with Intoxicants, Narcotics and Hallucinogenics.LA: Alcoholism or Drug Addiction Exclusion does not apply; Domestic Partner added to SpouseMA: Exclusions and Limitations headers renamed to Limitations and Exclusions for critical illness and cancerMI: Intoxicants and Narcotics Exclusion does not apply; Suicide Exclusion does not applyMN: Alcoholism or Drug Addiction Exclusion does not apply; Suicide Exclusion does not apply; Felonies and Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs; Intoxicants and Narcotics Exclusion replaced with Narcotic AddictionMS: Alcoholism or Drug Addiction Exclusion does not applyND: Alcoholism or Drug Addiction Exclusion does not applyNV: Intoxicants and Narcotics Exclusion does not apply; Domestic Partner added to SpousePA: Alcoholism or Drug Addiction Exclusion does not apply; Suicide Exclusion: whether sane or not removedSD: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion does not applyTX: Alcoholism or Drug Addiction Exclusion does not apply; Doctor or Physician Relationship added as an additional exclusionUT: Alcoholism or Drug Addiction Exclusion replaced with AlcoholismVT: Alcoholism or Drug Addiction Exclusion does not apply; Intoxicants and Narcotics Exclusion does not apply; Suicide Exclusion: whether sane or not removedSTATE-SPECIFIC PRE-EXISTING CONDITION LIMITATIONSFL: Pre-existing is 6/12; Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within six months before the coverage eective date shown on the Certificate Schedule. Genetic information is not a pre-existing condition in the absence of a diagnosis of the condition related to such information.GA: Pre-existing Condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or a condition for which medical advice or treatment was recommended by or received within 12 months preceding the coverage eective date.ID: Pre-existing is 6 months/12 months; Pre-existing Condition means a sickness or physical condition which caused a covered person to seek medical advice, diagnosis, care or treatment during the six months immediately preceding the coverage eective date shown on the Certificate Schedule.IL: Pre-existing Condition means a sickness or physical condition for which a covered person was diagnosed, treated, had medical testing by a legally qualified physician, received medical advice, produced symptoms or had taken medication within 12 months before the coverage eective date shown on the Schedule of Benefits.IN: Pre-existing is 6 months/12 monthsMA: Pre-existing is 6 months/12 months; Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, or received medical advice within six months before the coverage eective date shown on the Certificate Schedule.ME: Pre-existing is 6 months/6 months; Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, or received medical advice within six months before the coverage eective date shown on the Certificate Schedule.MI: Pre-existing is 6 months/6 monthsNC: Pre-existing Condition means those conditions for which medical advice, diagnosis, care, or treatment was received or recommended within the one-year period immediately preceding the eective date of a covered person. If a covered person is 65 or older when this certificate is issued, pre-existing conditions for that covered person will include only conditions specifically eliminated. NV: Pre-existing is 6 months/12 months; Pre-existing Condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within six months before the coverage eective date. Pre-existing Condition does not include genetic information in the absence of a diagnosis of the condition related to such information.PA: Pre-existing is 90 days/12 months; Pre-existing Condition means a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage eective date shown on the Certificate Schedule.SD: Pre-existing is 6 months/12 monthsTX: Pre-existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage eective date shown on the Certificate Schedule.UT: Pre-existing is 6 months/6 monthsThis information is not intended to be a complete description of the insurance coverage available. The insurance, its name or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. This form is not complete without base form 385403, 387100, 387169, 402383, 402558 or 387238, and rider form 387307, 387381, 387452, 387523, 387594, 387665, 402605 or 402671.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. GCI6000 – EXCLUSIONS AND LIMITATIONS | 8-20 | 388113-1
Group Critical Illness InsuranceWellbeing Assistance BenefitThe wellbeing assistance benefit can help reduce the risk of serious illness through early detection of disease or risk factors.Wellbeing assistance benefit ..........................................................$ 50/ _YR___________ Maximum of one test per covered person per calendar year; subject to a 30-day waiting period before the benefit is payable. The test must be performed aer the waiting period. Blood test for triglycerides Bone marrow testing BRCA1 or BRCA2 testing (genetic test for breast cancer) Breast ultrasound CA 15-3 (blood test for ovarian cancer) CA 125 (blood test for breast cancer) Carotid Doppler CEA (blood test for colon cancer) Chest x-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopyFor more information, talk with your benefits counselor.ColonialLife.comGCI6000 – WELLBEING ASSISTANCE BENEFIT | 5-20 | 387307Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.THIS INSURANCE PROVIDES LIMITED BENEFITS.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.
Term Life InsurancePeace of mind for you and your loved ones You want what’s best for your family, and that includes making sure they’re prepared for the future. With term life insurance from Colonial Life & Accident Insurance Company, you can provide nancial security to help them cover their ongoing living expenses.Advantages of term life insurance Lower cost when compared to cash value life insurance Same benet payout throughout the duration of the policy Several term period options for exibility during high-need years Benet for the beneciary that is typically tax freeBenets and features• Stand-alone spouse policy available whether or not you buy a policy for yourself• Guaranteed premiums that do not increase during the selected term• Ability to convert all or a portion of the benet amount into cash value life insurance• Flexibility to keep the policy if you change jobs or retire• Built-in terminal illness accelerated death benet that provides up to 75% of the policy’s death benet (up to $150,000) if you’re diagnosed with a terminal illness1• Premium savings for face amounts over $250,000 based on your health44% of Americans say their household would face nancial hardship within six months should a wage earner die unexpectedly.LIMRA, 2022 Life Insurance Barometer Study.GAP54% of Americans have life insurance coverage, with an average coverage gap of $200,000.LIMRA, 2021 “Industry Associations Unite to Help Address the Life Insurance Coverage Gap in the United States.”TERM LIFE (ITL5000)
Optional ridersAt an additional cost, you can purchase the following riders for even more nancial protection.Spouse term life riderYour spouse can have up to $50,000 of coverage for a 10-year or 20-year term period.Children’s term life riderYou can purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy — not both.Accidental death benet riderThe beneciary may receive an additional benet if the covered person dies as a result of an accident before age 70. The benet doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benet riderIf a licensed health care practitioner certies that you have a chronic illness, you may receive an advance on all or a portion of the death benet, available in a one-time lump sum or monthly payments.1 A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living.² Premiums are waived during the benet period. Critical illness accelerated death benet riderIf you suffer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benet is payable.1 A subsequent diagnosis benet is included.Waiver of premium benet riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period.3How much coverage do you need? YOU $ _________________Select the term period: 10-year 15-year 20-year 30-year SPOUSE $ _____________Select the term period: 10-year 15-year 20-year 30-yearSelect any optional riders: Spouse term life rider $ _____________ face amount for ______-year term period Children’s term life rider $ _____________ face amount Accidental death benet rider Chronic care accelerated death benet rider Critical illness accelerated death benet rider Waiver of premium benet riderTo learn more, talk with your Colonial Life benets counselor.1. Any payout would reduce the death benet. Benets may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benets. 2. Activities of daily living are bathing, continence, dressing, eating, toileting and transferring. 3. You must resume premium payments once you are no longer disabled.EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage effective date or the date of reinstatement, we will not pay the death benet. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy forms ICC18-ITL5000/ITL5000 and rider forms ICC18-R-ITL5000-STR/R-ITL5000-STR, ICC18-R-ITL5000-CTR/R-ITL5000-CTR, ICC18-R-ITL5000-WP/R-ITL5000-WP, ICC18-R-ITL5000-ACCD/R-ITL5000- ACCD, ICC18-R-ITL5000-CI/R-ITL5000-CI, ICC18-R-ITL5000-CC/R-ITL5000-CC (plus state abbreviations where applicable, for example ITL5000-TX). For cost and complete details of the coverage, call or write your Colonial Life benets counselor or the company.Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 6-22 | 101895-3ColonialLife.com
Your cost will vary based on the level of coverage you select. Whole Life InsuranceYou can’t predict your family’s future, but you can be prepared for it.You like to think that you’ll be there for your family in the years to come. But if something happened to you, would your family have the income they need?It’s not easy to think about such serious circumstances, but it’s important to make sure your family is financially protected. You can gain peace of mind with whole life insurance from Colonial Life.Advantages of whole life insurance Permanent coverage that stays the same throughout the life of the policy Guaranteed level premiums that do not increase because of changes in health or age Access to the policy’s cash value through a policy loan for emergencies Benefit for the beneficiary that is typically tax-freeBenefits and features Two plan options to choose what age your premium payments will end – Paid-Up at Age 70 or Paid-Up at Age 100 Stand-alone spouse policy available whether or not you buy a policy for yourself Flexibility to keep the policy if you change jobs or retire Built-in terminal illness accelerated death benefit that provides up to 75% of the policy’s death benefit (up to $150,000) if you’re diagnosed with a terminal illness Immediate $3,000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses Pays cash surrender value at age 100 (when the policy endows)WHOLE LIFE (IWL5000)HealthAairs.org, End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported, July 2017.Talk with your benefits counselor for information about what level of coverage would work best for you.In the U.S., medical spending in the last 12 months of life is nearly $80,000 per person.$
£ YOU $ ___________________ Select the option:£ Paid-Up at Age 70£ Paid-Up at Age 100£ SPOUSE $ _______________ Select the option:£ Paid-Up at Age 70£ Paid-Up at Age 100EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage eective date or the date of reinstatement, we will not pay the death benefit. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you. Product may vary by state. For costs and complete details of the coverage, call or write your Colonial Life benefits counselor or the company.This brochure is applicable to policy forms ICC19-IWL5000-70/IWL5000-70, ICC19-IWL5000-100/IWL5000-100, ICC19-IWL5000J/IWL5000J and rider forms ICC19-R-IWL5000-STR/R-IWL5000-STR, ICC19-R-IWL5000-CTR/R-IWL5000-CTR, ICC19-R-IWL5000-WP/R-IWL5000-WP, ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD, ICC19-R-IWL5000-CI/R-IWL5000-CI, ICC19-R-IWL5000-CC/R-IWL5000-CC, ICC19-R-IWL5000-GPO/R-IWL5000-GPO and applicable state variations.Additional coverage optionsSpouse term life riderCover your spouse up to a maximum death benefit of $50,000; 10-year and 20-year spouse term riders are available.Juvenile whole life policyYou can purchase a policy while children are young and premiums are low – whether or not you buy a policy on yourself. You may also increase the coverage when the child is 18, 21 and 24 without providing proof of good health. The plan is paid-up at age 70.Children’s term life riderYou may purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy – not both.Accidental death benefit riderThe beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70. The benefit doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benefit riderIf a licensed health care practitioner certifies that you have a chronic illness, you may receive an advance on all or a portion of the death benefit, available in a one-time lump sum or monthly payments. A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living (bathing, continence, dressing, eating, toileting and transferring). Premiums are waived during the benefit period.Critical illness accelerated death benefit riderIf you suer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benefit is payable. A subsequent diagnosis benefit is included.Guaranteed purchase option riderIf you are age 50 or younger when you purchase the policy, you can add the rider, which allows you to purchase additional whole life coverage – without having to answer health questions – at three dierent points in the future. You may purchase up to your initial face amount, not to exceed a total combined maximum of $100,000 for all options.Waiver of premium benefit riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period. Once you are no longer disabled, premium payments will resume.Benefits worksheetFor use with your benefits counselorSelect any optional riders:£ Spouse term life rider $ _____________ face amount for ________-year term period£ Children’s term life rider $ _____________ face amount£ Accidental death benefit rider£ Chronic care accelerated death benefit rider£ Critical illness accelerated death benefit rider£ Guaranteed purchase option rider£ Waiver of premium benefit riderHOW MUCH COVERAGE DO YOU NEED?To learn more, talk with your benefits counselor.ColonialLife.com6-19 | 101935£ DEPENDENT STUDENT $____________£ Paid-Up at Age 70 £ Paid-Up at Age 100 1 Loan should be repaid to protect the policy’s value. 2 Any payout would reduce the death benefit. Benefits may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
Deductions per year: 26 These rates were prepared on 9/18/2024 and are valid for 90 days.Group Disability for NC AA Risk ClassApplicable to policy forms GDIS-P & GDIS-ClOff-Job Accident and Off-Job Sickness with First Day Hospital3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $800* $1,000* $1,200* $1,500* $2,000**monthly benefit amount0 days Accident/7 days Sickness 17-49 $12.04 $15.05 $18.06 $22.57 $30.0950-64 $14.25 $17.82 $21.38 $26.72 $35.6365-74 $20.68 $25.85 $31.02 $38.77 $51.696 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $800* $1,000* $1,200* $1,500* $2,000**monthly benefit amount0 days Accident/7 days Sickness 17-49 $14.73 $18.42 $22.10 $27.62 $36.8350-64 $20.09 $25.11 $30.13 $37.66 $50.2265-74 $31.31 $39.14 $46.97 $58.71 $78.28Group Medical Bridge (GMB7000) for NCAge-BandedApplicable to Policy Forms GMB7000–P & GMB7000-ClWellbeing Assistance: Standard - $100, Outpatient Surgical Procedure: Option 1 - ($500 / $1000 / $1500), DiagnosticProcedure: Option 2 - $500, Medical Treatment Package (Accident / Sickness)HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 2: $100017-49 $15.78 $28.84 $24.25 $37.3250-59 $20.07 $38.38 $28.54 $46.8560-64 $24.26 $47.91 $32.73 $56.3865-99 $31.20 $62.26 $39.95 $71.02HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-49 $20.12 $36.64 $30.44 $46.9650-59 $25.71 $49.55 $36.02 $59.8660-64 $32.15 $64.34 $42.46 $74.6565-99 $42.84 $86.45 $53.52 $97.15Accident 1.0 for NCApplicable to policy forms ACCIDENT 1.0-HS and ACCIDENT1.0-NSlOn/Off-Job Accident CoverageISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYPremier with health screening 17-80 $12.24 $16.76 $18.32 $22.85Page 1 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
Group Critical Illness (GCI6000) for NCApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$5,000 17-24 $2.26 $3.40 $2.26 $3.4025-29 $2.66 $4.00 $2.66 $4.0030-34 $3.07 $4.60 $3.07 $4.6035-39 $3.99 $6.00 $3.99 $6.0040-44 $4.92 $7.39 $4.92 $7.3945-49 $6.44 $9.74 $6.44 $9.7450-54 $7.94 $12.10 $7.94 $12.1055-59 $10.02 $15.26 $10.02 $15.2660-64 $13.18 $20.06 $13.18 $20.0665-69 $15.86 $24.16 $15.86 $24.1670-74 $15.86 $24.16 $15.86 $24.16$10,000 17-24 $3.19 $4.71 $3.19 $4.7125-29 $3.97 $5.91 $3.97 $5.9130-34 $4.80 $7.11 $4.80 $7.1135-39 $6.65 $9.93 $6.65 $9.9340-44 $8.49 $12.70 $8.49 $12.7045-49 $11.54 $17.40 $11.54 $17.4050-54 $14.54 $22.11 $14.54 $22.1155-59 $18.69 $28.43 $18.69 $28.4360-64 $25.02 $38.03 $25.02 $38.0365-69 $30.37 $46.25 $30.37 $46.2570-74 $30.37 $46.25 $30.37 $46.25$15,000 17-24 $4.11 $6.03 $4.11 $6.0325-29 $5.29 $7.83 $5.29 $7.8330-34 $6.53 $9.63 $6.53 $9.6335-39 $9.30 $13.85 $9.30 $13.8540-44 $12.07 $18.00 $12.07 $18.0045-49 $16.64 $25.06 $16.64 $25.0650-54 $21.14 $32.13 $21.14 $32.1355-59 $27.37 $41.61 $27.37 $41.6160-64 $36.86 $56.01 $36.86 $56.0165-69 $44.89 $68.33 $44.89 $68.3370-74 $44.89 $68.33 $44.89 $68.33(Continued...)Page 2 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
Group Critical Illness (GCI6000) for NCApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$20,000 17-24 $5.03 $7.34 $5.03 $7.3425-29 $6.60 $9.74 $6.60 $9.7430-34 $8.26 $12.14 $8.26 $12.1435-39 $11.96 $17.77 $11.96 $17.7740-44 $15.65 $23.31 $15.65 $23.3145-49 $21.74 $32.73 $21.74 $32.7350-54 $27.74 $42.14 $27.74 $42.1455-59 $36.05 $54.79 $36.05 $54.7960-64 $48.69 $73.99 $48.69 $73.9965-69 $59.40 $90.42 $59.40 $90.4270-74 $59.40 $90.42 $59.40 $90.42Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$5,000 17-24 $2.82 $4.18 $2.82 $4.1825-29 $3.46 $5.15 $3.46 $5.1530-34 $4.11 $6.12 $4.11 $6.1235-39 $5.59 $8.33 $5.59 $8.3340-44 $7.06 $10.57 $7.06 $10.5745-49 $9.49 $14.33 $9.49 $14.3350-54 $11.89 $18.10 $11.89 $18.1055-59 $15.21 $23.17 $15.21 $23.1760-64 $20.26 $30.86 $20.26 $30.8665-69 $24.56 $37.39 $24.56 $37.3970-74 $24.56 $37.39 $24.58 $37.41$10,000 17-24 $4.29 $6.28 $4.29 $6.2825-29 $5.59 $8.22 $5.59 $8.2230-34 $6.88 $10.16 $6.88 $10.1635-39 $9.83 $14.59 $9.83 $14.5940-44 $12.79 $19.06 $12.79 $19.0645-49 $17.63 $26.59 $17.63 $26.5950-54 $22.43 $34.11 $22.43 $34.1155-59 $29.08 $44.26 $29.08 $44.2660-64 $39.19 $59.63 $39.19 $59.6365-69 $47.77 $72.70 $47.77 $72.7070-74 $47.77 $72.70 $47.82 $72.74(Continued...)Page 3 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
Group Critical Illness (GCI6000) for NCApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitTobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $5.77 $8.38 $5.77 $8.3825-29 $7.71 $11.29 $7.71 $11.2930-34 $9.65 $14.20 $9.65 $14.2035-39 $14.08 $20.84 $14.08 $20.8440-44 $18.51 $27.56 $18.51 $27.5645-49 $25.78 $38.84 $25.78 $38.8450-54 $32.98 $50.13 $32.98 $50.1355-59 $42.95 $65.36 $42.95 $65.3660-64 $58.11 $88.41 $58.11 $88.4165-69 $70.99 $108.00 $70.99 $108.0070-74 $70.99 $108.00 $71.06 $108.07$20,000 17-24 $7.25 $10.48 $7.25 $10.4825-29 $9.83 $14.36 $9.83 $14.3630-34 $12.42 $18.23 $12.42 $18.2335-39 $18.32 $27.10 $18.32 $27.1040-44 $24.23 $36.05 $24.23 $36.0545-49 $33.92 $51.10 $33.92 $51.1050-54 $43.52 $66.14 $43.52 $66.1455-59 $56.82 $86.45 $56.82 $86.4560-64 $77.03 $117.19 $77.03 $117.1965-69 $94.20 $143.31 $94.20 $143.3170-74 $94.20 $143.31 $94.29 $143.40Term Life (ITL5000) for NCApplicable to policy form ITL5000l20-Year Term Base Plan, Waiver of Premium Benefit, Accidental Death Benefit, Chronic Care Accelerated Death BenefitNon-Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $6.32 $7.58 $10.45 $13.3135 $7.59 $8.33 $11.56 $14.8145 $10.33 $13.90 $19.94 $25.9655 $21.59 $28.43 $41.72 $54.9965 $31.86 $61.87 $91.88 $121.89Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $10.68 $11.12 $15.76 $20.3935 $12.23 $12.50 $17.82 $23.1645 $17.49 $24.83 $36.32 $47.8155 $39.91 $55.99 $83.05 $110.1165 $51.31 $100.78 $150.23 $199.69(Continued...)Page 4 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
Whole Life Plus (IWL5000) for NCApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100, Accelerated Death Benefit for Long-Term Care Services, Accidental Death Benefit,Guaranteed Purchase Option Benefit, Waiver of Premium BenefitNon-Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $12.13 $24.27 $36.40 $48.5435 $16.32 $32.66 $48.98 $65.3145 $25.94 $51.90 $77.85 $103.8055 $42.98 $85.98 $128.96 $171.9565 $71.31 $142.63 $213.95 $285.26Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $20.18 $40.37 $60.55 $80.7435 $24.64 $49.30 $73.93 $98.5845 $37.09 $74.19 $111.28 $148.3755 $62.22 $124.45 $186.68 $248.9165 $101.69 $203.40 $305.10 $406.79Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2024 Colonial Life & Accident Insurance Company"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.Rich Mellone | Richmellone@gmail.com | (704) 907-3997(Continued...)Page 5 of 5Underwritten by Colonial Life & Accident Insurance CompanySee page 5 for Important Notice
In Motion Fitness, Inc. Colonial Interest FormName_______________________________________Job Title__________ Social Security#_________________ Annual Salary _________________________ Address________________________________ City ___________________St. __________Zip_______ Work Phone___________________ Cell Phone________________ Email Address____________________________________________________ Date of Birth (DOB) ____________________ Tobacco________ Non Tobacco________Date of Hire____________________ Beneficiary__________________________________DOB___________Relationship____________ Dependent Information: Spouse________________________________DOB_______________ Relationship____________ Child_________________________________DOB________________Relationship____________ Child_________________________________DOB________________Relationship____________ Child_________________________________DOB________________Relationship____________ ____ Waive Colonial Coverage. I understand that I can only enroll during Annual Enrollment unless I have a qualified event during the year. Signature__________________________________________Date____________ Questions or Assistance Contact: Kitty Mellone 704-907-3944 (D)Complete Form with Rate Sheet & elected coverage’s circled email to Kmellone@coloniallifenc.com
Policyholder Service Guide At Colonial Life our goal is to give you an excellent customer experience that is simple modern and personal Getting started Consider your options The easiest way to manage your business with us is through the My Colonial Life policyholder section of ColonialLife com Whether online or by phone we ll provide the service you need To sign up for the website 1 Visit ColonialLife com 2 Click Register at the top right 3 On the sign up page click Join the Policyholder Website Need ColonialLife com Submit your claim using our eClaims system 3 File health screening wellness and doctor s office visit claims up to 18 months 3 3 Check the status of your claim 3 3 Review print or download a copy of your policy certificate 3 Access claim and service forms 3 3 Access your claim correspondence 3 3 3 Complete a notification for a life claim 3 3 Update your contact information After providing some basic information you ll be ready to go 800 325 4368 Filing claims eClaims With the eClaims feature on ColonialLife com you can file claims online by simply answering a few questions and uploading your supporting documentation You re able to spend less time on paperwork and we re able to process your claim faster With eClaims you can file most claims online including Accident Hospital confinement indemnity Disability Critical illness Cancer Vision You can access eClaims through your computer or mobile device and upload any required supporting documentation Once you re logged in to ColonialLife com visit the Claims Center and select File an Online Claim to get started
Contact us Online ColonialLife com Log in and click on Contact Us to email us Telephone 1 800 325 4368 Contact Center representatives are available Monday through Friday 8 a m to 8 p m ET Information is available 24 7 through our automated phone system Please have your Social Security or policy number ready when you call Hearing impaired customers Customers with a Telecommunications Device for the Deaf TDD should call 803 798 4040 If you do not have a TDD call Voiance Telephone Interpretation Services at 844 495 6105 to reach us Health screening wellness claims The quickest way to receive the applicable benefits for your health screening wellness services is to file online For health screening wellness claims within 18 months of the date you are filing the claim click on File a Wellness Claim Online on the Claims Center page If you do not want to file online you can use the automated customer service center at 1 800 325 4368 For health screening wellness claims over 18 months you ll be directed to print out a paper claim form under the claims and service forms section on the Claims Center page Paper claims If you don t want to file online download the form you need by visiting the Claims Center page on ColonialLife com and clicking on claims and service forms For instructions on how to correctly complete your claim form view the claims videos on the Claims Center page Be sure that you complete all sections of the claim form Also include a diagnosis from your doctor along with copies of any appropriate bills if required Keep a copy of your claim information for your records When we receive information regarding your claim you ll be notified by telephone or email If you select the electronic messaging option you ll receive a call when the claim is processed Claim tips and information When submitting your claim make sure to include all required supporting documentation as this will allow us to process your claim quicker To view correspondence pertaining to your claim visit ColonialLife com Once you log in to your secure account select My Correspondence from the home page Whether you submit your claims online or by paper form you can select optional services that authorize us to Communicate claims information via electronic messaging to your phone number Send claim benefits overnight by deducting a fee from your claim payment Release information to your benefits representative plan administrator or family member You can always check the status of your claim on the My Colonial Life site at ColonialLife com ColonialLife com Applicable to vision rider on the individual dental plan 2016 Colonial Life Accident Insurance Company Columbia SC Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand 4 16 43233 37