Return to flip book view

Benefit Booklet 2025

Colonial Life provides benefits that employees want for the unexpected moments in life Whether planning for retirement growing their families or saving for college they know an injury or illness won t derail their dreams For more information Shelley Hartsell 704 883 4838 Shelley Hartsell ColonialLifeSales com Life is anything but expected That s why we re here Plan options Accident insurance Helps offset unexpected medical expenses such as emergency room fees deductibles and copayments that can result from a fracture dislocation or other covered accidental injury Hospital insurance Provides a lump sum benefit for a covered hospital confinement or outpatient surgery to help with copayments and deductibles that are not covered by most major medical plans Cancer Insurance Provides benefits to help with cancer expenses from diagnosis to recovery Benefits may be used to cover non medical expenses such as childcare home health care and transportation and lodging expenses etc Critical illness Supplements your major medical coverage by providing a lump sum benefit you can use to pay the direct and indirect costs related to a covered critical illness and cancer Life insurance Enables you to tailor coverage for your individual needs and helps provide financial security for your family members

Accident Insurance Accidents 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 injury l Broken bone l Burn l Concussion l Laceration l Back or knee injuries l Car accidents l Falls spills l Dislocation l Accidental injuries that send you to the Emergency Room Urgent Care or doctor s office Colonial Life s Accident Insurance is designed to help you fill some of the gaps caused by increasing deductibles co payments and out of pocket costs related to an accidental injury The benefit 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 financial security What additional features are included l Worldwide coverage l Portable l Compliant with Healthcare Spending Account HSA guidelines Will 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 benefits 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 file a claim Visit coloniallife com or call our Customer Service Department at 1 800 325 4368 for additional information Accident 1 0 Premier with Health Screening Benefit

Transportation Lodging Assistance If injured covered person must travel more than 50 miles from residence to receive special treatment and confinement in a hospital l Transportation 600 per round trip up to 3 round trips l Lodging family member or companion 150 per night up to 30 days for a hotel motel lodging costs Accident Hospital Care l Hospital Admission 2 000 per accident l 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 Confinement 300 per day up to 365 days per accident l Hospital ICU Confinement 600 per day up to 15 days per accident Accident Follow Up Care l 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 days l Appliances 125 such as wheelchair crutches l Prosthetic Devices Artificial Limb 750 one 1 500 more than 1 l Rehabilitation Unit 150 per day up to 15 days per covered accident and 30 days per calendar year Maximum of 30 days per calendar year Accidental Dismemberment l Loss of Finger Toe 1 250 one 2 400 two or more l Loss or Loss of Use of Hand Foot Sight of Eye 12 000 one 24 000 two or more Catastrophic Accident For severe injuries that result in the total and irrecoverable l Loss of one hand and one foot l Loss of both hands or both feet l Loss or loss of use of one arm and one leg or l Loss or loss of use of both arms or both legs l Loss of the sight of both eyes l Loss of the hearing of both ears l Loss of the ability to speak Named Insured 25 000 Spouse 25 000 Child ren 12 500 365 day elimination period Amounts reduced for covered persons age 65 and over Payable once per lifetime for each covered person Accidental Death l Named Insured l Spouse l Child ren Accidental Death 50 000 50 000 10 000 Common Carrier 200 000 200 000 40 000

Benefits listed are for each covered person per covered accident unless otherwise specified Initial Care l Accident Emergency Treatment 200 l X ray Benefit 60 l Ambulance 600 l Air Ambulance 2 000 Common Accidental Injuries Dislocations Separated Joint Hip Knee except patella Ankle Bone or Bones of the Foot other than Toes Collarbone Sternoclavicular Lower Jaw Shoulder Elbow Wrist Bone or Bones of the Hand Collarbone Acromioclavicular and Separation One Toe or Finger Non Surgical 9 600 4 800 3 840 2 400 1 440 1 440 480 480 Surgical 19 200 9 600 7 680 4 800 2 880 2 880 960 960 Fractures Depressed Skull Non Depressed Skull Hip Thigh Body of Vertebrae Pelvis Leg Bones of Face or Nose except mandible or maxilla Upper Jaw Maxilla Upper Arm between Elbow and Shoulder Lower Jaw Mandible Kneecap Ankle Foot Shoulder Blade Collarbone Vertebral Process Forearm Wrist Hand Rib Coccyx Finger Toe Non Surgical 9 000 3 600 5 400 2 700 1 260 1 260 1 260 1 080 1 080 1 080 900 720 360 Surgical 18 000 7 200 10 800 5 400 2 520 2 520 2 520 2 160 2 160 2 160 1 800 1 440 720 Your Colonial Life policy also provides benefits for the following injuries received as a result of a covered accident l Burn based on size and degree 1 000 to 12 000 l Coma 12 500 l Concussion 150 l Emergency Dental Work 100 Extraction 400 Crown Implant or Denture l Lacerations based on size 50 to 800 Requires Surgery l Eye Injury 300 l Tendon Ligament Rotator Cuff 750 one 1 500 two or more l Ruptured Disc 750 l Torn Knee Cartilage 750 Surgical Care l Surgery cranial open abdominal or thoracic 1 500 l Surgery hernia 150 l Surgery arthroscopic or exploratory 300 l Blood Plasma Platelets 300

Health Screening Benefit l 50 per covered person per calendar year Provides a benefit if the covered person has one of the health screening tests performed This benefit is payable once per calendar year per person and is subject to a 30 day waiting period Tests include l Blood test for triglycerides l Bone marrow testing l Breast ultrasound l 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 analysis l Mammography l Pap smear l 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 benefits 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 Family When are covered accident benefits available check one On and Off Job Benefits Off Job Only Benefits EXCLUSIONS We will not pay benefits 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 inflicted injuries war or armed conflict in addition to the exclusions listed above we also will not pay the Catastrophic Accident benefit for injuries that are caused by or are the result of birth intoxication For cost and complete details see your Colonial Life benefits counselor Applicable to policy form Accident 1 0 HS NC This is not an insurance contract and only the actual policy provisions will control Accident 1 0 Premier with Health Screening Benefit Colonial Life 1200 Colonial Life Boulevard Columbia South Carolina 29210 coloniallife com 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 71741 NC

For more information, talk with your benefits counselor.Hospital Confinement Indemnity InsurancePlan 2IMB7000 – PLAN 2The surgeries listed below are only a sampling of the surgeries that may be covered. Surgeries must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, please refer to your policy.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 graingOur Individual Medical Bridge Insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement .........................................................................$_______________ Maximum of one benefit per covered person per calendar yearObservation room .................................................................................. $100 per visitMaximum of two visits per covered person per calendar yearRehabilitation unit confinement .................................................................$100 per dayMaximum of 15 days per confinement with a 30-day maximum per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered hospital confinement of the named insuredOutpatient surgical procedure  Tier 1.................................................................................................$_______________  Tier 2.................................................................................................$_______________Maximum of $________________ per covered person per calendar year for all covered outpatient surgical procedures combined15005007501500

ColonialLife.com8-23 | 562911-1  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 Tier 2 outpatient surgical procedures  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 – LithotripsyTHIS POLICY PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this coverage.EXCLUSIONS We will not pay benefits for injuries received in accidents or for sicknesses which are caused by: (a) alcoholism or drug addiction, (b) dental procedures, (c) elective procedures and cosmetic surgery, (d) felonies or illegal occupations, (e) pregnancy of a dependent child, (f) psychiatric or psychological conditions, (g) suicide or injuries which any covered person intentionally does to himself or herself, or (h) war. We will not pay benefits for hospital confinement (i) due to giving birth within the first nine months aer the eective date of the policy or (j) for a newborn who is neither injured nor sick. (k) The policy may have additional exclusions and limitations which may aect any benefits payable.PRE-EXISTING CONDITION LIMITATION(l) We will not pay benefits for loss during the first 12 months aer the eective date due to a pre-existing condition. (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 the 12 months before the eective date of the policy. (n) This limitation applies to the following benefits, if applicable: Hospital Confinement, Daily Hospital Confinement, Enhanced Intensive Care Unit Confinement and Rehabilitation Unit Confinement.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 aect any benefits payable. Applicable to policy form IMB7000 (including state abbreviations where used, for example: IMB7000-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. This form is not complete without form #562973.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.

Cancer Insurance Level 2 benefits INITIAL INTERNAL DIAGNOSIS BENEFIT 5000 Cancer insurance helps provide financial protection through a variety of benefits These benefits are not only for you but also for your covered family members BENEFIT DESCRIPTION BENEFIT AMOUNT Air ambulance 2 000 per trip Transportation to or from a hospital or medical facility max of two trips per confinement Ambulance 250 per trip Transportation to or from a hospital or medical facility max of two trips per confinement Anesthesia Administered during a surgical procedure for cancer treatment General anesthesia 25 of surgical procedures benefit Local anesthesia 30 per procedure Anti nausea medication 40 per day administered or per prescription filled Doctor prescribed medication for radiation or chemotherapy 160 monthly max Blood plasma platelets immunoglobulins 150 per day A transfusion required during cancer treatment 10 000 calendar year max Bone marrow donor screening 50 Testing in connection with being a potential donor once per lifetime Bone marrow or peripheral stem cell donation 500 Receiving another person s bone marrow or stem cells for a transplant once per lifetime Bone marrow or peripheral stem cell transplant 4 000 per transplant Transplant you receive in connection with cancer treatment max of two bone marrow transplant benefits per lifetime Cancer vaccine 50 An FDA approved vaccine for the prevention of cancer once per lifetime BENEFIT DESCRIPTION BENEFIT AMOUNT Companion transportation 0 50 per mile Companion travels by plane train or bus to accompany a covered cancer patient more than 50 miles one way for treatment up to 1 000 per round trip Egg s extraction or harvesting sperm collection and storage Extracted harvested or collected before chemotherapy or radiation once per lifetime Egg s extraction or harvesting sperm collection 700 Egg s or sperm storage cryopreservation 200 Experimental treatment 250 per day Hospital medical or surgical care for cancer 12 500 lifetime max Family care 40 per day Inpatient or outpatient treatment for a covered dependent child 2 000 calendar year max Hair external breast voice box prosthesis 200 per calendar year Prosthesis needed as a direct result of cancer Home health care services1 75 per day Examples include physical therapy occupational therapy speech therapy and audiology prosthesis and orthopedic appliances rental or purchase of durable medical equipment up to 30 days per calendar year or twice the number of days hospital confined whichever is greater Hospice initial or daily care 2 An initial one time benefit and a daily benefit for treatment 15 000 lifetime max for both Initial hospice care once per lifetime 1 000 Daily hospice care 50 per day CANCER ASSIST LEVEL 2

BENEFIT DESCRIPTION BENEFIT AMOUNT Hospital confinement Hospital stay including intensive care required for cancer treatment 30 days or less 150 per day 31 days or more 300 per day Lodging 50 per day Hotel motel expenses when being treated for cancer more than 50 miles from home 70 day calendar year max Medical imaging studies 125 per study Specific studies for cancer treatment 250 calendar year max Outpatient surgical center 200 per day Surgery at an outpatient center for cancer treatment 600 calendar year max Private full time nursing services 75 per day Services while hospital confined other than those regularly furnished by the hospital Prosthetic device artificial limb 1 500 per device or limb A surgical implant needed because of cancer surgery payable one per site 3 000 lifetime max Radiation chemotherapy Weekly benefit max once per week Injected chemotherapy by medical personnel 500 Radiation delivered by medical personnel 500 Monthly chemotherapy benefit max once per month Self injected 200 Pump 200 Topical 200 Oral hormonal 1 24 months 200 Oral hormonal 25 months 100 Oral non hormonal 200 BENEFIT DESCRIPTION BENEFIT AMOUNT Reconstructive surgery3 40 per surgical unit A surgery to reconstruct anatomic defects that result from cancer treatment up to 2 500 per procedure including 25 for general anesthesia Second medical opinion4 200 A second physician s opinion on cancer surgery or treatment once per lifetime Skilled nursing care facility 100 per day Confinement to a covered facility after hospital release up to the number of days paid for hospital confinement Skin cancer initial diagnosis 300 A skin cancer diagnosis while the policy is in force once per lifetime Supportive or protective care drugs and colony stimulating factors 100 per day Doctor prescribed drugs to enhance or modify radiation chemotherapy treatments 800 calendar year max Surgical procedures 50 per surgical unit Inpatient or outpatient surgery for cancer treatment 3 000 max per procedure Transportation 0 50 per mile Travel expenses when being treated for cancer more than 50 miles from home up to 1 000 per round trip Waiver of premium Is available No premiums due if the named insured is disabled longer than 90 consecutive days For more information talk with your Colonial Life benefits counselor ColonialLife com In MD Tobacco cessation benefit available 20 per prescription filled maximum of two 90 day prescriptions per covered person In MT Mammography benefit available 70 for one baseline mammogram for ages 35 39 one mammogram every two years for ages 40 49 one mammogram each year for ages 50 1 In CO Home health care services maximum is up to 60 days per calendar year or twice the number of days hospital confined whichever is greater In WI Home health care services maximum is up to 40 days per calendar year or twice the number of days hospital confined whichever is greater 2 In CO no hospice benefit available 3 In OK Reconstructive surgery is 20 per surgical unit 4 In MD Second medical opinion is 50 maximum of one per covered person per hospital confinement THIS POLICY PROVIDES LIMITED BENEFITS 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 benefits payable Applicable to policy form CanAssist including state abbreviations where used for example CanAssist TX This chart is not complete without form number 1170702 Exclusions Limitations in states CO ID MD MN MO NC OK SC SD VT and 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 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 7 22 101483 4

Cancer Insurance Exclusions and limitations Waiting period All benefits and riders are subject to a 30 day waiting period Waiting period means the first 30 days following the policy s coverage effective date during which no benefits are payable See the following list for state specific variations ID MD MN MO OK SD VA and WA No waiting period Eligibility for cancer benefits We will pay benefits for the treatment of cancer including skin cancer where applicable if the date of diagnosis is after the waiting period the date of diagnosis is while this policy is in force a covered person receives treatment for cancer or skin cancer while this policy is in force and the cancer or treatment is not excluded by name or specific description in this policy If your cancer has a date of diagnosis before the end of the waiting period coverage for that cancer will apply only to losses commencing after this policy has been in force for two years unless it is excluded by name or specific descriptions in this policy If cancer is not pathologically or clinically diagnosed until after you die we will only pay benefits for cancer treatment performed during the 45day period before your death See the following list for state specific variations CO If your cancer has a date of diagnosis before the end of the waiting period coverage for that cancer will apply only to losses commencing after this policy has been in force for one year unless it is excluded by name or specific description in this policy NC If your cancer has a date of diagnosis before the end of the waiting period coverage for that cancer will apply only to losses commencing after the policy has been in force for 12 months unless it is excluded by name or specific description in the policy What is not covered by this policy We will not pay benefits for cancer or skin cancer if the diagnosis or treatment of cancer is received outside of the territorial limits of the United States and its possessions or for other conditions or diseases except losses due directly from cancer See the following list for state specific variations for cancer coverage ID Pre existing condition limitation We will not pay benefits if the diagnosis or treatment of cancer is a pre existing condition unless the covered person has satisfied the six month pre existing condition limitation period shown on the Policy Schedule on the date the covered person is initially diagnosed as having cancer or skin cancer Preexisting condition means having 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 policy coverage effective date of this policy MD Pre existing condition limitation We will not pay benefits if the diagnosis or treatment of cancer is a pre existing condition unless the covered person has satisfied the six month pre existing condition limitation period under your policy on the date the covered person is diagnosed as having cancer or skin cancer Pre existing condition means having 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 your policy effective date We will not pay benefits for cancer or skin cancer Unless the diagnosis and treatment is confirmed and received within the territorial limits of the United States and its possession or For any other conditions or diseases unless the losses due are directly from cancer MN Pre existing condition limitation We will not pay benefits if the diagnosis or treatment of cancer is a pre existing condition unless the covered person has satisfied the six month pre existing condition limitation period shown on the Policy Schedule on the date the covered person is initially diagnosed as having cancer or skin cancer Preexisting condition means having 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 policy coverage effective date of this policy MO Pre existing condition limitation We will not pay benefits if the diagnosis or treatment of cancer is a pre existing condition unless the covered person has satisfied the six month pre existing condition limitation period shown on the Policy Schedule on the date the covered person is initially diagnosed as having cancer or skin cancer Preexisting condition means having 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 policy coverage effective date of this policy OK Pre existing condition limitation We will not pay benefits if the diagnosis or treatment for cancer skin cancer or a specified disease is a pre existing condition unless the covered person has satisfied the six month pre existing condition limitation period under the policy on the date the covered person is initially diagnosed as having cancer skin cancer or a specified disease Pre existing condition means a condition for which the covered person received medical advice was given treatment or treatment was recommended by or received from a doctor within six months immediately preceding the effective date of the policy and which is not excluded by name or specific description in this policy SC We will not pay benefits for cancer or skin cancer If the diagnosis or treatment of cancer is received outside of the territorial limits of the United States and its possessions or For other conditions or diseases except losses due directly from cancer aggravated by cancer or resulting from cancer or treatment of cancer CANCER ASSIST EXCLUSIONS AND LIMITATIONS

SD Pre existing condition limitation We will not pay benefits if the diagnosis or treatment for cancer skin cancer or a specified disease is a pre existing condition unless the covered person has satisfied the six month pre existing condition limitation period under your policy on the date the covered person is diagnosed as having cancer skin cancer or a specified disease Pre existing condition means having 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 your policy effective date VA Pre existing condition limitation We will not pay benefits for the diagnosis of internal cancer or skin cancer that is a pre existing condition nor will we pay benefits for the treatment of internal cancer or skin cancer that is a pre existing condition unless the covered person has satisfied the six month pre existing condition limitation period on the policy Pre existing condition means a condition for which a covered person was diagnosed prior to the effective date of the policy and for which medical advice or treatment was recommended by or received from a doctor within six months immediately preceding the effective date of the policy VT We will not pay benefits for cancer or skin cancer If the diagnosis or treatment of cancer is received outside of the territorial limits of the United States and its possessions unless the diagnosis is confirmed within the territorial limits of the United States or its possessions by a licensed physician or For other conditions or diseases except losses due directly from cancer WA Pre existing condition limitation We will not pay benefits if the diagnosis or treatment for cancer skin cancer or a specified disease is a pre existing condition unless the covered person has satisfied the six month pre existing condition limitation period under the policy on the date the covered person is initially diagnosed as having cancer skin cancer or a specified disease Pre existing condition means having 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 policy effective date Eligibility for specified disease hospital confinement rider We will pay this benefit each day a covered person incurs a charge and is confined to a hospital for treatment of a specified disease if the date of diagnosis of the specified disease is after the waiting period the date of diagnosis of the specified disease is while the rider is in force a covered person is confined to a hospital for treatment of a specified disease while this rider is in force and the specified disease is not excluded by name or specific description in this rider If your specified disease has a date of diagnosis before the end of the waiting period coverage for that specified disease will apply only to hospital confinements commencing after this rider has been in force for two years unless the specified disease is excluded by name or specific description in this rider See the following list for state specific variations for this rider MA If your specified disease has a date of diagnosis during the waiting period coverage for that specified disease will apply only to hospital confinements commencing after this rider has been in force for six months unless the specified disease is excluded by name or specific description in this rider If your specified disease has a date of diagnosis during the waiting period you may choose to cancel your policy and receive a refund of all premiums paid or select a six month delay in the payment of benefits for the specified disease which was diagnosed during the waiting period CO If your specified disease has a date of diagnosis before the end of the waiting period coverage for that specified disease will apply only to hospital confinements commencing after this rider has been in force for one year unless the specified disease is excluded by name or specific description in this rider NC If your specified disease has a date of diagnosis before the end of the waiting period coverage for that specified disease will apply only to hospital confinements commencing after this rider has been in force for 12 months unless the specified disease is excluded by name or specific description in this rider NH If your specified disease has a date of diagnosis before the end of the waiting period coverage for that specified disease will apply only to hospital confinements commencing after this rider has been in force for six months unless the specified disease is excluded by name or specific description in this rider ID MD MN MO OK SD and VA Pre existing condition limitation If a covered person s specified disease is a pre existing condition coverage for that specified disease will only apply to hospital confinements commencing after this rider has been in force for six months unless the specified disease is excluded by name or specific description in this rider Guaranteed renewable The policy is guaranteed renewable as long as you pay the premiums when they are due or within the grace period Your premium can be changed only if we change it on all policies of this kind in force in the state where the policy was issued The filed product name in most states is Specified Disease Insurance In FL and VT the filed product name is Limited Benefit Insurance THIS POLICY PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this insurance This information is not intended to be a complete description of the insurance coverage available The policy or its provisions may vary or be unavailable in some states The policy has exclusions and limitations which may affect any benefits payable Applicable to policy form CanAssist and rider forms R CanAssistIndx R CanAssistProg and R CanAssistSpDis including state abbreviations where applicable for example CanAssist 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 101478 101481 101482 101483 101484 101485 101486 or 101547 ColonialLife com 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 1 23 1170702 1

Cancer Insurance Wellness Benefits1 Part one Cancer wellness health screening Provided when one of the tests listed below is performed after the waiting period and while the policy is in force Payable once per calendar year per covered person CANCER WELLNESS TESTS2 Bone marrow testing Breast ultrasound CA 15 3 blood test for breast cancer CA 125 blood test for ovarian cancer CEA blood test for colon cancer Chest X ray Colonoscopy Flexible sigmoidoscopy Hemoccult stool analysis Mammography3 Pap smear PSA blood test for prostate cancer Serum protein electrophoresis blood test for myeloma Skin biopsy Thermography ThinPrep Pap test4 Virtual colonoscopy HEALTH SCREENING TESTS Blood test for triglycerides Carotid Doppler Echocardiogram ECHO Electrocardiogram EKG ECG Fasting blood glucose test Serum cholesterol test for HDL and LDL levels Stress test on a bicycle or treadmill Part two Cancer wellness additional invasive diagnostic test or surgical procedure Provided when a doctor performs a diagnostic test or surgical procedure after the waiting period as the result of an abnormal result from one of the covered cancer wellness tests in part one We will pay the benefit regardless of the test results Payable once per calendar year per covered person To encourage early detection our cancer insurance offers benefits for wellness and health screening tests For more information talk with your Colonial Life benefits counselor CANCER ASSIST WELLNESS

Specified Critical Illness Insurance If you re diagnosed with a covered critical illness or cancer specified critical illness insurance from Colonial Life can help with your expenses so you can concentrate on what s most important your treatment care and recovery Face amount ___1_0_k_ _2_0_k_ _3_0_k__ Critical illness benefit FOR THE DIAGNOSIS OF THIS COVERED CRITICAL ILLNESS CONDITION THIS PERCENTAGE OF THE FACE AMOUNT IS PAYABLE Cancer 100 Heart attack myocardial infarction 100 Stroke2 100 End stage renal kidney failure 100 Major organ failure 100 Permanent paralysis due to a covered accident 100 Coma 100 Blindness 100 Occupational infectious HIV or occupational infectious hepatitis B C or D 100 Coronary artery bypass graft surgery disease3 25 Carcinoma in situ 25 The maximum benefit amount for this policy is 3x the face amount for the named insured for all covered persons combined The policy will terminate when the maximum benefit amount for specified critical illness has been paid CRITICAL ILLNESS 1 0 WITH CANCER AND SUBSEQUENT DIAGNOSIS

Specified Critical Illness Insurance Exclusions limitations and additional disclosures State specific variations on exclusions AK Alcoholism or Drug Addiction Exclusion does not apply CT Alcoholism or Drug Addiction Exclusion replaced with Intoxication or Drug Addiction Felonies or Illegal Occupations replaced with Felonies DE Alcoholism or Drug Addiction Exclusion does not apply FL Alcoholism or Drug Addiction Exclusion does not apply Psychiatric or Psychological Condition Exclusion does not apply ID Alcoholism or Drug Addiction Exclusion does not apply Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional Disorders IN Accidents or Sicknesses Occurring While the Policy is not In Force Exclusion added KY Alcoholism or Drug Addiction Exclusion does not apply Hallucinogenics added to Intoxicants and Narcotics Exclusion MD Alcoholism or Drug Addiction Exclusion does not apply Felonies or Illegal Occupations Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Suicide or Self Inflicted Injuries Exclusion replaced with Self Destruction or Self Inflicted Injuries MO Alcoholism or Drug Addiction Exclusion replaced with Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Illegal Activities NH Intoxicants and Narcotics exclusion does not apply NJ Alcoholism or Drug Addiction replaced with Drug Addiction Felonies or Illegal Occupations Exclusion replaced with Felonies or Illegal Jobs Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional Disease or Disorder OR Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Suicide or Self Inflicted Injuries Exclusion does not apply Felonies or Illegal Occupations Exclusion replaced with Felonies SC Alcoholism or Drug Addiction Exclusion does not apply Psychiatric or Psychological Condition Exclusion replaced with Mental or Emotional Disorders SD Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply TX Alcoholism or Drug Addiction Exclusion does not apply UT Alcoholism or Drug Addiction Exclusion replaced with Alcoholism VT Alcoholism or Drug Addiction Exclusion does not apply Intoxicants and Narcotics Exclusion does not apply Psychiatric or Psychological Condition Exclusion does not apply War or Armed Conflict Exclusion replaced with War State specific pre existing condition limitations FL 12 12 Pre existing Condition means having a sickness or physical condition that during the 12 months immediately preceding the Policy Coverage Effective Date of this policy had manifested itself in such a manner as would cause an ordinarily prudent person to seek medical advice diagnosis care or treatment or for which medical advice diagnosis care or treatment was recommended or received IA 12 12 Pre existing Condition means having a condition for which medical advice or treatment or medication was recommended by a physician or received from a physician within 12 months preceding the Policy Coverage Effective Date of the covered person s policy MD 12 12 Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken medication within 12 months before the Policy Coverage Effective Date of this policy A condition admitted or disclosed on the application will be covered unless the disease or condition is excluded by name or specific description effective on the date of loss NC 12 12 Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken medication within 12 months before the Policy Coverage Effective Date of this policy If a covered person is 65 or older when this policy is issued pre existing conditions for that covered person will include only conditions specifically eliminated by rider NH 6 6 Pre existing condition means having a sickness or physical condition for which any covered person was diagnosed treated had medical testing or received medical advice within 6 months before the Policy Coverage Effective Date of this policy NJ 6 6 Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken medication within six months before the Policy Coverage Effective Date of this policy NV 6 12 Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing received medical advice or had taken medication within six months before the Policy Coverage Effective Date of this policy

Critical Illness Insurance Health Screening Benefit The optional health screening benefit can help you reduce the risk of serious illness through early detection Health screening benefit __50 00_____________ Maximum of one screening test per covered person per calendar year Blood test for triglycerides Pap smear Bone marrow testing PSA blood test for prostate cancer Breast ultrasound Serum cholesterol test for HDL and LDL levels 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 For more information talk with your benefits counselor Fasting blood glucose test Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy Flexible sigmoidoscopy Hemoccult stool analysis Mammography ColonialLife com THIS POLICY INSURANCE PROVIDES LIMITED BENEFITS Insureds in GA MA MN and VT must be covered by comprehensive health insurance before applying for critical illness or cancer insurance This information is not intended to be a complete description of the insurance coverage available The policy insurance or its provisions may vary or be unavailable in some states The policy insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form CI 1 0 P and GCC1 0 P and certificate form GCC1 0 C including state abbreviations where used for example CI 1 0 P TX GCC1 0 P TX and GCC1 0 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 2021 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GROUP CRITICAL CARE CRITICAL ILLNESS 1 0 HEALTH SCREENING BENEFIT 5 21 100355 4

In the U S medical spending in the last 12 months of life is nearly 80 000 per person HealthAffairs org End Of Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported July 2017 Your cost will vary based on the level of coverage you select Talk with your benefits counselor for information about what level of coverage would work best for you Whole Life Insurance You 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 emergencies1 Benefit for the beneficiary that is typically tax free Benefits 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 illness2 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

Term Life Insurance Peace of mind for you and your loved ones You want what s best for your family and that includes making sure they re prepared for the future With term life insurance from Colonial Life Accident Insurance Company you can provide financial security to help them cover their ongoing living expenses Advantages of term life insurance Lower cost when compared to cash value life insurance Same benefit payout throughout the duration of the policy Several term period options for flexibility during high need years 44 of Americans say their household would face financial hardship within six months should a wage earner die unexpectedly LIMRA 2022 Life Insurance Barometer Study Benefit for the beneficiary that is typically tax free Benefits and features Stand alone spouse policy available whether or not you buy a policy for yourself GA P Guaranteed premiums that do not increase during the selected term Ability to convert all or a portion of the benefit amount into cash value life insurance Flexibility to keep the policy if you change jobs or retire Built in terminal illness accelerated death benefit that provides up to 75 of the policy s death benefit up to 150 000 if you re diagnosed with a terminal illness1 Premium savings for face amounts over 250 000 based on your health 54 of Americans have life insurance coverage with an average coverage gap of 200 000 LIMRA 2021 Industry Associations Unite to Help Address the Life Insurance Coverage Gap in the United States TERM LIFE ITL5000

How to File a Claim for Colonial Life Benefits FOR FASTEST RESULTS FILE ONLINE 1 Go to ColonialLife com access to login or register 2 Fill out the required information and click Submit 3 Enjoy streamlined claims management and faster service online DIGITALLY FILE ALL TYPES OF CLAIMS Disability Insurance Accident Hospital Insurance Life Insurance Critical Illness Cancer Insurance Wellness benefits for screening tests Not sure which type of claim to file No problem Just answer a few questions on the portal and we ll help you figure everything out BEFORE YOU FILE Review the appropriate claims checklist at ColonialLife com and have this information handy to make the process go smoothly Proper documentation must be submitted when filing your claim AFTER YOU FILE Check your claim status and manage your claim by logging into your account at ColonialLife com access Live chat is also available 9 a m 5 p m EST OTHER WAYS TO FILE A CLAIM Fax 1 800 880 9325 Mail P O Box 100195 Columbia SC 29202 Colonial Life is committed to providing you our valued customer a market leading claims experience We look forward to serving you on ColonialLife com On the policyholder portal you can View benefit details Here you ll find a copy of your policy to see what s covered and benefit amounts Track your claim Log in anytime to view status or opt in to receive status alerts by email or text so you know instantly if we require additional information Sign up for direct deposit to get approved payments up to a week faster than paper check Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company Columbia SC 2022 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company ADR 1312251

Deductions per year: 24 These rates were prepared on 12/8/2023 and are valid for 90 days.Accident 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 $13.26 $18.16 $19.85 $24.75Individual Medical Bridge for NCApplicable to policy form Individual Medical Bridgel$1500 Hospital Confinement Benefit and Outpatient Surgical Procedure Benefit with a calendar year maximum of $1500,$50 Health Screening Benefit. Enhanced Intensive Care Unit Confinement benefitISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENTCHILDRENEMPLOYEE, SPOUSE ANDDEPENDENT CHILDREN17-49 $16.15 $30.46 $20.68 $34.9950-59 $21.41 $40.41 $25.93 $44.9460-64 $27.33 $51.66 $31.85 $56.1865-75 $38.51 $72.81 $43.48 $77.78Cancer Assist for NCApplicable to policy form CanAssistlwith Specified Disease Benefit, Progressive Payment Benefit, $100 Health Screening Benefit$5,000 Initial Diagnosis BenefitCOVERAGE LEVEL ISSUE AGE NAMED INSURED EMPLOYEE AND SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYLevel 2 17-75 $19.11 $32.59 $19.51 $32.99Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $2.28 $3.45 $2.28 $3.4525-29 $2.63 $4.05 $2.63 $4.0530-34 $3.03 $4.70 $3.03 $4.7035-39 $4.23 $6.50 $4.23 $6.5040-44 $5.03 $7.70 $5.03 $7.7045-49 $6.53 $10.00 $6.53 $10.0050-54 $8.33 $12.80 $8.33 $12.8055-59 $10.28 $15.75 $10.28 $15.7560-64 $12.73 $19.55 $12.73 $19.5565-70 $15.43 $23.70 $15.43 $23.70Jewish Federation of Greater CharlottePage 1 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice

Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$20,000 17-24 $3.48 $5.25 $3.48 $5.2525-29 $4.18 $6.45 $4.18 $6.4530-34 $4.98 $7.75 $4.98 $7.7535-39 $7.38 $11.35 $7.38 $11.3540-44 $8.98 $13.75 $8.98 $13.7545-49 $11.98 $18.35 $11.98 $18.3550-54 $15.58 $23.95 $15.58 $23.9555-59 $19.48 $29.85 $19.48 $29.8560-64 $24.38 $37.45 $24.38 $37.4565-70 $29.78 $45.75 $29.78 $45.75$30,000 17-24 $4.68 $7.05 $4.68 $7.0525-29 $5.73 $8.85 $5.73 $8.8530-34 $6.93 $10.80 $6.93 $10.8035-39 $10.53 $16.20 $10.53 $16.2040-44 $12.93 $19.80 $12.93 $19.8045-49 $17.43 $26.70 $17.43 $26.7050-54 $22.83 $35.10 $22.83 $35.1055-59 $28.68 $43.95 $28.68 $43.9560-64 $36.03 $55.35 $36.03 $55.3565-70 $44.13 $67.80 $44.13 $67.80Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $2.78 $4.25 $2.78 $4.2525-29 $3.43 $5.25 $3.43 $5.2530-34 $4.28 $6.60 $4.28 $6.6035-39 $5.93 $9.10 $5.93 $9.1040-44 $7.68 $11.80 $7.68 $11.8045-49 $9.88 $15.15 $9.88 $15.1550-54 $12.43 $19.05 $12.43 $19.0555-59 $15.78 $24.25 $15.78 $24.2560-64 $18.98 $29.15 $18.98 $29.1565-70 $23.23 $35.70 $23.23 $35.70Jewish Federation of Greater Charlotte(Continued...)Page 2 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice

Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening BenefitTobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$20,000 17-24 $4.48 $6.85 $4.48 $6.8525-29 $5.78 $8.85 $5.78 $8.8530-34 $7.48 $11.55 $7.48 $11.5535-39 $10.78 $16.55 $10.78 $16.5540-44 $14.28 $21.95 $14.28 $21.9545-49 $18.68 $28.65 $18.68 $28.6550-54 $23.78 $36.45 $23.78 $36.4555-59 $30.48 $46.85 $30.48 $46.8560-64 $36.88 $56.65 $36.88 $56.6565-70 $45.38 $69.75 $45.38 $69.75$30,000 17-24 $6.18 $9.45 $6.18 $9.4525-29 $8.13 $12.45 $8.13 $12.4530-34 $10.68 $16.50 $10.68 $16.5035-39 $15.63 $24.00 $15.63 $24.0040-44 $20.88 $32.10 $20.88 $32.1045-49 $27.48 $42.15 $27.48 $42.1550-54 $35.13 $53.85 $35.13 $53.8555-59 $45.18 $69.45 $45.18 $69.4560-64 $54.78 $84.15 $54.78 $84.1565-70 $67.53 $103.80 $67.53 $103.80Whole 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 ServicesNon-Tobacco RatesISSUE AGE $10,000 $20,000 $30,00018 $9.20 $18.40 $27.5819 $9.22 $18.42 $27.6420 $9.24 $18.46 $27.6821 $9.26 $18.52 $27.7622 $9.28 $18.56 $27.8223 $9.30 $18.60 $27.8824 $9.32 $18.66 $27.9825 $9.40 $18.78 $28.1826 $9.54 $19.08 $28.6027 $9.76 $19.52 $29.26Jewish Federation of Greater Charlotte(Continued...)Page 3 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 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 ServicesNon-Tobacco RatesISSUE AGE $10,000 $20,000 $30,00028 $10.04 $20.08 $30.1029 $10.36 $20.72 $31.0830 $10.72 $21.44 $32.1631 $11.10 $22.20 $33.2832 $11.48 $22.98 $34.4633 $11.92 $23.82 $35.7234 $12.38 $24.72 $37.0835 $12.84 $25.70 $38.5436 $13.36 $26.72 $40.0837 $13.92 $27.84 $41.7638 $14.54 $29.06 $43.5839 $15.20 $30.38 $45.5840 $15.94 $31.84 $47.7441 $16.72 $33.44 $50.1242 $17.56 $35.12 $52.6843 $18.46 $36.94 $55.3844 $19.42 $38.84 $58.2645 $20.40 $40.84 $61.2446 $21.46 $42.92 $64.3647 $22.52 $45.04 $67.5448 $23.62 $47.20 $70.8049 $24.74 $49.46 $74.1850 $25.92 $51.82 $77.7251 $27.22 $54.42 $81.6452 $28.64 $57.24 $85.8653 $30.18 $60.34 $90.5254 $31.84 $63.72 $95.5655 $33.68 $67.32 $100.9856 $35.68 $71.36 $107.0457 $37.84 $75.64 $113.4658 $40.08 $80.14 $120.2259 $42.50 $85.00 $127.4860 $45.06 $90.12 $135.1861 $47.86 $95.72 $143.5462 $50.84 $101.66 $152.48Jewish Federation of Greater Charlotte(Continued...)Page 4 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 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 ServicesNon-Tobacco RatesISSUE AGE $10,000 $20,000 $30,00063 $54.00 $107.98 $161.9864 $57.38 $114.78 $172.1665 $61.02 $122.02 $183.0266 $65.06 $130.08 $195.1467 $69.38 $138.72 $208.0868 $73.96 $147.92 $221.9069 $78.92 $157.84 $236.7670 $84.30 $168.60 $252.8871 $84.58 $169.16 $253.7472 $90.80 $181.60 $272.4073 $97.86 $195.70 $293.5474 $105.86 $211.72 $317.6075 $114.96 $229.92 $344.8676 $125.22 $250.44 $375.6677 $136.76 $273.52 $410.2678 $149.64 $299.28 $448.9279 $163.94 $327.90 $491.84Tobacco RatesISSUE AGE $10,000 $20,000 $30,00018 $13.88 $27.74 $41.6019 $14.28 $28.54 $42.8020 $14.66 $29.30 $43.9621 $15.04 $30.06 $45.0822 $15.38 $30.76 $46.1223 $15.70 $31.40 $47.0824 $16.00 $32.00 $47.9825 $16.28 $32.52 $48.7826 $16.52 $33.00 $49.5027 $16.74 $33.50 $50.2428 $16.98 $33.96 $50.9229 $17.24 $34.46 $51.6830 $17.54 $35.04 $52.5631 $17.86 $35.76 $53.6232 $18.28 $36.56 $54.84Jewish Federation of Greater Charlotte(Continued...)Page 5 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 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 ServicesTobacco RatesISSUE AGE $10,000 $20,000 $30,00033 $18.78 $37.52 $56.2834 $19.30 $38.60 $57.8835 $19.90 $39.78 $59.6636 $20.54 $41.04 $61.5637 $21.22 $42.42 $63.6038 $21.94 $43.88 $65.8239 $22.72 $45.46 $68.1840 $23.60 $47.18 $70.7641 $24.56 $49.10 $73.6442 $25.66 $51.30 $76.9243 $26.86 $53.74 $80.5844 $28.22 $56.42 $84.6245 $29.66 $59.30 $88.9246 $31.16 $62.30 $93.4647 $32.70 $65.36 $98.0648 $34.26 $68.50 $102.7449 $35.88 $71.74 $107.6050 $37.58 $75.16 $112.7451 $39.54 $79.06 $118.5852 $41.78 $83.54 $125.3053 $44.38 $88.74 $133.1054 $47.26 $94.52 $141.7655 $50.34 $100.68 $151.0056 $53.56 $107.12 $160.6857 $56.78 $113.54 $170.3258 $60.00 $120.02 $180.0059 $63.22 $126.44 $189.6660 $66.54 $133.04 $199.5461 $70.08 $140.14 $210.2462 $73.96 $147.90 $221.8663 $78.16 $156.30 $234.4464 $82.64 $165.28 $247.9065 $87.34 $174.70 $262.0266 $92.36 $184.72 $277.0667 $97.52 $195.00 $292.50Jewish Federation of Greater Charlotte(Continued...)Page 6 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 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 ServicesTobacco RatesISSUE AGE $10,000 $20,000 $30,00068 $102.82 $205.62 $308.4269 $108.32 $216.64 $324.9470 $114.24 $228.44 $342.6871 $115.04 $230.06 $345.1072 $122.42 $244.82 $367.2473 $130.84 $261.66 $392.4874 $140.08 $280.16 $420.2475 $150.10 $300.20 $450.2876 $160.82 $321.62 $482.4477 $172.16 $344.32 $516.4878 $184.08 $368.16 $552.2479 $196.50 $392.98 $589.48Important 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.© 2023 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.Shelley Hartsell | Shelley.Hartsell@ColonialLifeSales.com | (704) 883-4838Jewish Federation of Greater Charlotte(Continued...)Page 7 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice

Thank you Colonial Life Voluntary Benefits Please contact Shelley Hartsell Benefits Specialist 704 883 4838 Shelley Hartsell ColonialLifeSales com