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Benefit Booklet 2024
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
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
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
Dental PPO InsurancePlan 5 Advantage – $1,000 | 100% | 80% | 50%Life is full of unexpected smiles, and good oral health helps maintain them. Colonial Life dental insurance helps you pay for routine and costly dental care for you and your family, so you can focus on what’s important.POLICY DETAILSThe policy year maximum benet for this policy is $1,000 per person.Class A, B and C services apply toward the maximum.This policy has a deductible of $50 per person, per policy year for class B and C services.Each covered family member pays a deductible up to a maximum of three members each policy year.The co-insurance for this policy is:NETWORK BENEFITSNetwork providers have agreed to charge discounted rates for covered services. You receive the benet of discounted services and pay only your co-insurance portion and any applicable deductible. Plus, network providers will le your claim for you, so you don’t have to deal with the paperwork. OUT-OF-NETWORK BENEFITSOut-of-network providers haven’t agreed to discounted rates, and their fees may vary signicantly. Your policy’s co-insurance is applied to the lesser of the provider’s charge or a percentage of the customary charge in your area (80th percentile), and may not cover the total costs of dental care. You are responsible for your co-insurance portion, deductible and any remaining balance. CLASS TYPE OF SERVICE INSURANCE PAYSClass A Preventive services 100% Class B Basic services 80%Class C Major services 50%LARGE NATIONAL NETWORK• Save more with 120,000+ unique providers1 • Claims led for members by providers • Easy provider search on ColonialLifeDental.com • In-house recruiting team dedicated to expanding the network IDN8000 - PLAN 5 ADVANTAGE How does this policy pay benets for network and out-of-network care?
THIS POLICY PROVIDES LIMITED BENEFITS. A NETWORK ACCESS PLAN IS AVAILABLE.No benets will be paid for replacement of teeth missing prior to the effective date of coverage.This product is not available in ZIP codes beginning with 025. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy form IDN8000 (including state abbreviations where used, for example: IDN8000-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 1-22 | 527437-31. Network360, December 2021. 2. Member may have one additional periodontal maintenance in place of an additional cleaning. 3. Waiting periods may be waived if takeover applies.4. No waiting period in Maine. Six-month waiting period in Vermont.ColonialLifeDental.comCovered procedures and waiting periodsPREVENTIVE SERVICES (CLASS A): NO WAITING PERIOD• Routine exams and cleanings (twice every 12 months) ‐ One additional cleaning per 12 months if member is in second or third trimester of pregnancy2• X-rays ‐ Bitewing X-rays (up to four lms, once every 12 months)• Children’s services (up to age 14) ‐ Fluoride treatment (once every 12 months) ‐ Sealants (once every 36 months) ‐ Space maintainers (up to age 14, once every 24 months)• Oral cancer screening (for age 40 +, once every 12 months)BASIC SERVICES (CLASS B): NO WAITING PERIOD• Full mouth X-rays (once every ve years)• Fillings• Simple extractions• Emergency treatmentMAJOR SERVICES (CLASS C): 12-MONTH WAITING PERIOD3, 4• Oral surgery (extractions and impacted teeth)• Anesthesia (covered with complex oral surgery)• Inlays and onlays• Crowns• Bridges• Dentures• Repair of crowns, dentures or bridges• Periodontics (gum treatments)• Endodontics (root canals)• Endosteal dental implants (in place of a three-unit bridge)For more information about this dental policy, talk with your benets counselor.Oral wellness is an essential component of our overall health. Based on experience with my own patients, people who actively seek regular dental care have a greater chance to be healthier and happier than people who don’t.Jim Di MarinoDMD, Dental Director for Colonial Life
For more information, talk with your benefits counselor.Individual Dental PPO InsuranceVision RiderIDN8000 – VISION RIDERDental insurance oers an optional vision rider to help pay for eye exams and materials, such as glasses and contact lenses. This coverage can help you maintain healthy vision and overall wellness, as well as provide valuable financial protection for you, your spouse and dependent children.Vision benefitsIN-NETWORKOUT-OF-NETWORKALLOWANCECO-PAYSExam (once per 12 months) $10 $35Materials $25 See belowSTANDARD PLASTIC LENSES (once per 12 months)Single vision Covered by co-pay $25Bifocal Covered by co-pay $40Trifocal Covered by co-pay $50Lenticular $80 allowance $50Progressive $70 allowance $40Polycarbonate lenses (for children to age 19) Covered by co-pay N/AFRAMES1 (once per 12 months)Choose any frame available at provider locations $120 allowance $50CONTACT LENSES2 (once per 12 months) (Includes fit, follow-up and materials) In lieu of eyeglass lenses and frames Elective Up to $120 allowance $100 allowanceMedically necessary Up to $210 allowance $210 allowanceFreedom of choiceYou’ll have access to a national vision network that includes independent optometrists, ophthalmologists and retail stores, including Walmart, Sam’s Club Optical, Costco,3 Pearle Vision and Target. You can search for providers at ColonialLifeVision.com. Additional vision benefit advantages Eye exams and materials (frames, lenses) can be purchased from dierent locations and providers. For example, you could have an eye exam with your favorite eye care professional and order contacts online. Check the network for Value Added and Service Plus providers. They can provide special discounts for extra purchases of lenses and coatings, frames, contact lenses and other products.ColonialLife.com
ColonialLife.com4-19 | 101851-AK-NC1 Eyeglass lenses and frames are paid in lieu of the contact lenses benefit.2 The contact lenses benefit is paid in lieu of eyeglass lenses and frames. Contact lenses consist of three components: materials, exams and fittings. Coverage is for materials and the exam, up to the contact lenses allowance. Fittings may be covered but only up to the amount of any unused contact lenses allowance – aer materials.3 Optometrists at Costco Optical outlets are independent of Costco and may not be in network. To verify that your vision exam will be fully covered aer co-pay, confirm that your doctor is an in-network provider. Special payment and reimbursement terms apply for material purchases at Costco. Additional discounts are not applicable.4 Not a covered benefit. These schedules are subject to change without notice. Added value discounts may not be available in all geographical areas and vary by network. Many providers are not able to oer discounts on “Prestige” frames. Special lens packages that combine numerous lens enhancements at value price points are not covered by these added value programs. Cannot be combined with any other promotions or discounts.5 Some retail chains sell sunglasses in departments outside of their optical shops where discounts do not apply.The policy or its provisions may vary or be unavailable in some states. The policy had exclusions and limitations, which may aect any benefits payable. See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability.Special discounts on material purchases4Providers identified as Value Added or Service Plus in our online provider directory oer the following additional values for our members on vision material purchases. We encourage you to contact your selected provider prior to visiting their location to confirm their continued participation. Not all providers, such as Walmart, Sam’s Club and Costco Optical,³ choose to participate in these special discounts.Value Added providersDISCOUNTS FOR FIRST PAIR OF GLASSESLens options (add-ons for insured purchases):PURCHASE A SECOND PAIR OF GLASSES AND RECEIVE PREFERRED PRICINGLenses:DISCOUNTS ON FRAMES, CONTACT LENSES AND OTHER PRODUCTSService Plus providersRECEIVE UP TO A 20% DISCOUNT FOR THE FOLLOWING ADD-ONS TO INSURED PURCHASES: UV coating Solid tinting/gradient tinting Standard scratch resistance coating UV coating…$15 Solid tinting/gradient tinting…$15 Standard scratch resistance coating…$15 Standard anti-reflective coating…$45 Premium anti-reflective coating…$70 Ultra anti-reflective coating…20% discount Polarized…$75 Transition…$75 Progressive lenses: – Standard…$110 – Premium…$170 – Ultra…member receives a 20% discount Standard polycarbonate …$40 High index (single vision) – 1.56-1.60…$60 – 1.66+…20% discount High index (multi-focal) – 1.56-1.60…$75 – 1.66+…20% discount Single vision plastic lenses…$40 Bifocal plastic lenses…$60 Trifocal lenses…$70 Progressive lenses (standard)…$110 Progressive lenses (premium and ultra)…20% discount Frames – Up to 35% discount Contact Lenses – 5-15% discount, depending on type Other products – 20% discount on non-prescription sunglasses and other ancillary products/solutions Standard anti-reflective coating Premium anti-reflective coating Transition Standard polycarbonateDental plans are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC, and administered by Starmount Life Insurance Company.©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
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
Subsequent diagnosis of a different critical illness4 If you receive a benefit for a specified critical illness and later you are diagnosed with a different specified critical illness the original percentage of the face amount is payable for that particular specified critical illness For more information talk with your Colonial Life benefits counselor Subsequent diagnosis of the same critical illness4 If you receive a benefit for a specified critical illness and later you are diagnosed with the same specified critical illness 25 of the original face amount is payable Critical illness conditions that do not qualify are cancer coronary artery bypass graft surgery disease carcinoma in situ and occupational infectious HIV or occupational infectious hepatitis B C or D Cancer vaccine benefit 50 This benefit is payable if you or your covered family members incur a charge for any FDA approved cancer vaccine while your policy is inforce ColonialLife com Specified Critical Illness Insurance and Critical Illness 1 0 are marketing names of the insurance policy filed as Limited Benefit Health Coverage for Specified Critical Illness In ME and NH the policy is called Limited Benefit Health Coverage for Specified Disease In SC the policy is an Individual Specified Disease policy In VT the policy is an Individual Limited Benefit Insurance policy 1 Please refer to the policy for complete definitions of covered conditions 2 In NH Stroke is referred to as Severe Stroke 3 Benefit for coronary artery disease applicable in lieu of benefit for coronary artery bypass graft surgery when health savings account HSA compliant plan is selected 4 Dates of diagnoses of a covered specified critical illness must be separated by at least 180 days 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 EXCLUSIONS AND LIMITATIONS FOR SPECIFIED CRITICAL ILLNESS We will not pay benefits for a specified critical illness that occurs as a result of a covered person s alcoholism or drug addiction felonies or illegal occupations intoxicants and narcotics pre existing condition psychiatric or psychological condition suicide or self inflicted injuries or war or armed conflict 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 CI 1 0 CI 1 0 PL7 CI 1 0 PL8 or CI 1 0 PL10 including state abbreviations where used for example CI 1 0 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 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 5 23 101825 4
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
Life insurance Term or Whole Life insurance for all phases of your employees lives If you re wondering which life insurance to offer your employees term or whole life The answer is They need both options Term and Whole Life work hand in hand Term and Whole Life insurance work together to provide financial protection for your employees and their loved ones at all phases of life whether they re just starting out raising a family or planning for retirement Term Life offers financial protection and peace of mind for employees and their families during their working years Whole Life provides coverage employees can keep into retirement at competitive rates when they buy it early Young professional Mid career Childhood Retirement Whole life Term life When employees purchase both types of life insurance they have valuable financial protection that can last a lifetime By offering these benefits at work with premiums paid by payroll deduction you provide valuable coverage options for employees without added costs to your bottom line Coverage for spouse and children also provides critical protection for your employees family LIFE INSURANCE
Term Life WHAT IS TERM LIFE Offers financial protection for loved ones during an employee s working years Offers highest amount of life insurance coverage for the lowest premiums KEY BENEFITS Income replacement if the insured passes away Can help pay ongoing expenses for the family such as Mortgage or rent Education Saving for retirement HOW IT WORKS Group Term Life Employer owned Limited portability options Flexible coverage that normally ends at retirement Benefit typically decreases after age 70 Guaranteed issue coverage with no health questions or exams Individual Term Life Employee can continue their coverage if they change jobs or retire The insured chooses a term period of 10 15 20 or 30 years Guaranteed level premiums that do not increase during the selected term period After the term period the insured can end or renew coverage or convert to a whole life policy Whole Life WHAT IS WHOLE LIFE Provides financial protection for loved ones through their retirement KEY BENEFITS Can help with final expenses Can provide a living benefit to help pay for expenses associated with a terminal illness chronic illness or critical illness1 Accumulates cash value at a guaranteed interest rate employees can borrow against this value during times of need2 HOW IT WORKS Guaranteed issue coverage with no health questions or exams Permanent coverage for life with level premiums that can be paid up at age 70 or 100 Death benefit stays the same as long as the employee makes payments How they work together Term Life and Whole Life provide comprehensive life insurance with financial protection during working years and benefits that carry into retirement Together Term Life and Whole Life can help your employees and their loved ones give each other stronger financial security and perhaps some peace of mind after they re gone To learn more talk with your Colonial Life benefits representative ColonialLife com 1 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 2 Accessing the accumulated cash value reduces the death benefit by the amount accessed Cash value will be reduced by any outstanding loans against the policy This information is not intended to be a complete description of the insurance coverage available The policies or their provisions may vary or be unavailable in some states The policies have exclusions and limitations which may affect any benefits payable Applicable to policy forms GTL1 0 P and certificate number GTL1 0 C ICC18 ITL5000 ITL5000 ICC19IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 and ICC19 IWL5000J IWL5000J and applicable state variations For cost and complete details of the 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 FOR BROKERS AND EMPLOYERS 7 21 691150
WHOLE LIFE Accelerated Death Benefit for Long Term Care Services Advances the base plan s death benefit in monthly indemnity payments to help pay for the qualified long term care services needed as a result of the insured s inability to perform at least two of the six activities of daily living ADLs for a period of at least 90 days or the insured s requiring substantial supervision due to severe cognitive impairment A written certification provided by a licensed health care practitioner must be provided The maximum benefit amount is equal to the policy death benefit less any indebtedness Claim payments are made monthly and are a percentage of the death benefit Rates are per thousand tobacco distinct and based on policy face amount and issue age The rider terminates on the first to occur base policy terminates or the date the death benefit is exhausted from long term care benefit payments A 90 day elimination period applies No benefits are payable for care or service received during this time There is a six month pre existing conditions limitation period The rider includes a built in Waiver of Premium due to payments of the long term care benefit which waives any monthly deductions on the policy when long term care benefits are being paid The rider may be added to employee or spouse Whole Life Plus plans It may also be added to a dependent student policy ages 18 26 It may only be added to policies at the point of initial sale The rider cannot be added to existing policies
Deductions per year: 52 These rates were prepared on 9/25/2023 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 FAMILYPreferred with health screening 17-80 $4.88 $6.69 $7.54 $9.34Premier with health screening 17-80 $6.12 $8.38 $9.16 $11.42Individual Disability - ISTD3000 for NC AAA Risk ClassApplicable to policy form Individual DisabilitylOff Job Accident & Off Job Sickness with First Day Hospital3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,500* $1,800* $2,000* $2,300**monthly benefit amount0 days Accident/7 days Sickness 17-49 $6.97 $10.45 $12.54 $13.94 $16.0350-64 $7.96 $11.94 $14.33 $15.92 $18.3165-74 $11.63 $17.45 $20.94 $23.26 $26.75Individual Dental PPO(IDN8000) for NCApplicable to policy form Individual Dental PPO(IDN8000)lwith Vision RiderZip Codes: 270, 271, 272, 273, 274, 275, 276, 277, 278, 280, 281, 282, 283, 284, 285, 286, 287, 288, 289COVERAGE LEVEL INDIVIDUAL INDIVIDUAL ANDSPOUSEINDIVIDUAL ANDCHILDRENINDIVIDUAL ANDFAMILYPlan 5 Advantage - 100/80/50, $1,000 PPO $11.78 $22.73 $28.37 $42.39Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening Benefit, Cancer BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $1.45 $2.19 $1.82 $2.5825-29 $1.91 $2.91 $2.28 $3.3030-34 $2.39 $3.64 $2.76 $4.0435-39 $3.11 $4.75 $3.48 $5.1440-44 $3.73 $5.70 $4.10 $6.0945-49 $4.86 $7.48 $5.25 $7.8450-54 $6.73 $10.34 $7.10 $10.7155-59 $8.28 $12.71 $8.67 $13.1160-64 $10.95 $16.82 $11.35 $17.2165-70 $13.01 $19.98 $13.42 $20.40Moore & Seagle ConstructionPage 1 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening Benefit, Cancer BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$20,000 17-24 $2.39 $3.62 $3.13 $4.4125-29 $3.32 $5.05 $4.05 $5.8430-34 $4.28 $6.53 $5.02 $7.3135-39 $5.72 $8.74 $6.45 $9.5340-44 $6.96 $10.64 $7.70 $11.4245-49 $9.22 $14.19 $10.01 $14.9350-54 $12.96 $19.91 $13.70 $20.6555-59 $16.05 $24.67 $16.84 $25.4560-64 $21.41 $32.88 $22.19 $33.6765-70 $25.52 $39.21 $26.35 $40.04$30,000 17-24 $3.34 $5.05 $4.45 $6.2325-29 $4.72 $7.20 $5.83 $8.3830-34 $6.18 $9.41 $7.28 $10.5935-39 $8.32 $12.74 $9.43 $13.9140-44 $10.19 $15.58 $11.30 $16.7545-49 $13.58 $20.91 $14.76 $22.0150-54 $19.19 $29.49 $20.30 $30.6055-59 $23.83 $36.62 $25.01 $37.8060-64 $31.86 $48.94 $33.04 $50.1265-70 $38.02 $58.43 $39.27 $59.68Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $1.84 $2.81 $2.23 $3.2125-29 $2.60 $3.99 $2.99 $4.3630-34 $3.55 $5.44 $3.94 $5.8435-39 $4.68 $7.18 $5.07 $7.5740-44 $5.85 $9.00 $6.25 $9.3945-49 $7.52 $11.56 $7.91 $11.9350-54 $10.22 $15.69 $10.61 $16.0855-59 $12.98 $19.94 $13.35 $20.3160-64 $16.56 $25.43 $16.95 $25.8265-70 $19.86 $30.51 $20.28 $30.92Moore & Seagle Construction(Continued...)Page 2 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice
Critical Illness 1.0 for NCApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening Benefit, Cancer BenefitTobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$20,000 17-24 $3.18 $4.87 $3.96 $5.6525-29 $4.70 $7.22 $5.48 $7.9630-34 $6.59 $10.13 $7.38 $10.9135-39 $8.85 $13.59 $9.64 $14.3840-44 $11.21 $17.24 $11.99 $18.0245-49 $14.53 $22.36 $15.32 $23.1050-54 $19.93 $30.62 $20.72 $31.4155-59 $25.47 $39.11 $26.21 $39.8560-64 $32.62 $50.10 $33.41 $50.8865-70 $39.22 $60.25 $40.05 $61.08$30,000 17-24 $4.52 $6.92 $5.69 $8.1025-29 $6.80 $10.45 $7.98 $11.5630-34 $9.64 $14.81 $10.82 $15.9935-39 $13.03 $20.01 $14.21 $21.1840-44 $16.56 $25.48 $17.74 $26.6545-49 $21.55 $33.16 $22.72 $34.2750-54 $29.65 $45.55 $30.82 $46.7355-59 $37.95 $58.29 $39.06 $59.4060-64 $48.68 $74.77 $49.86 $75.9465-70 $58.58 $90.00 $59.83 $91.24Term Life (ITL5000) for NCApplicable to policy form ITL5000l20-Year Term Base PlanNon-Tobacco RatesISSUE AGE $10,000 $25,00025 $1.55 $2.4835 $1.77 $3.0545 $2.23 $4.2055 $4.16 $9.0365 $9.46 $14.20Tobacco RatesISSUE AGE $10,000 $25,00025 $2.42 $4.6635 $2.70 $5.3745 $3.66 $7.7855 $7.83 $18.1965 $16.18 $23.92Moore & Seagle Construction(Continued...)Page 3 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice
Important 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.AJ Barringer | AJ.Barringer@ColonialLifeSales.com | (980) 362-8704Moore & Seagle Construction(Continued...)Page 4 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice