NorthernPiedmontCounselingBenefitBooklet : simplebooklet.com

Northern Piedmont Counseling 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 Life is anything but expected That s why we re here Products Accident Insurance From a fall to a car accident this coverage offers a range of benefits to help cover medical or non medical related expenses due to a covered accident Hospital Confinement Indemnity Insurance Medical Bridge Provides benefits to help cover the cost of a hospital stay and other medical procedures Disability Insurance Provides financial protection to cover income loss from a covered disability Critical Illness Insurance Provides lumpsum benefits for a covered critical illness such as a heart attack or stroke Dental Insurance Dental insurance provides benefits for a variety of procedures from routine cleanings to more advanced procedures Learn more online at ColonialLife com BROKER EMPLOYER 2 23 NS 1017472

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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

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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

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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

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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

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For more information talk with your benefits counselor Hospital Confinement Indemnity Insurance Plan 2 Our Individual Medical BridgeSM 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 ____3__0_0_0_______ Maximum of one benefit per covered person per calendar year Observation room 100 per visit Maximum of two visits per covered person per calendar year Rehabilitation unit confinement 100 per day Maximum of 15 days per confinement with a 30 day maximum per covered person per calendar year Waiver of premium Available a er 30 continuous days of a covered hospital confinement of the named insured Outpatient surgical procedure Tier 1 ____5_0__0________ Tier 2 ____7_5__0________ Maximum of _____1_5__0_0_______ per covered person per calendar year for all covered outpatient surgical procedures combined The 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 ing IMB7000 PLAN 2

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Tier 2 outpatient surgical procedures Breast Breast reconstruction Breast reduction Cardiac Angioplasty Cardiac catheterization Digestive Exploratory laparoscopy Laparoscopic appendectomy Laparoscopic cholecystectomy Ear nose throat mouth Ethmoidectomy Mastoidectomy Septoplasty Stapedectomy Tympanoplasty Eye Cataract surgery Corneal surgery penetrating keratoplasty Glaucoma surgery trabeculectomy Vitrectomy Gynecological Hysterectomy Myomectomy Musculoskeletal system Arthroscopic knee surgery with meniscectomy knee cartilage repair Arthroscopic shoulder surgery Clavicle resection Dislocations open reduction with internal fixation Fracture open reduction with internal fixation Removal or implantation of cartilage Tendon ligament repair Thyroid Excision of a mass Urologic Lithotripsy ColonialLife com THIS POLICY PROVIDES LIMITED BENEFITS 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 preexisting 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 insurance 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 2021 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 1 21 562911

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Hospital Confinement Indemnity Insurance Exclusions and Limitations STATE SPECIFIC EXCLUSIONS AK a Replaced by intoxicants and narcotics CA a Replaced by intoxicants or controlled substances c Replaced by cosmetic surgery CT a Replaced by intoxication or drug addiction d Replaced by felonies e Exclusion does not apply DE a Exclusion does not apply IL a Replaced by alcoholism intoxication or drug addiction e Exclusion does not apply g Exclusion does not apply KS a Replaced by intoxicants and narcotics f Exclusion does not apply h Replaced by war or armed conflict i Exclusion does not apply j or requires necessary care and treatment of medically diagnosed congenital defects birth abnormalities or routine and necessary immunizations KY a Replaced by intoxicants narcotics and hallucinogenics LA a Replaced by intoxicants and narcotics MI g Exclusion does not apply MN a Replaced by narcotic addiction e Exclusion does not apply g Exclusion does not apply MO a Replaced by drug addiction NC i Exclusion does not apply OR a Exclusion does not apply d Replaced by felony i Replace nine months with six months SC f Replaced by mental or emotional disorders SD a Exclusion does not apply TN a Replaced by intoxicants and narcotics e Exclusion does not apply TX a Replaced by intoxicants and narcotics WA a Only sicknesses caused by alcoholism or drug addiction are excluded not accidents STATE SPECIFIC PRE EXISTING CONDITION LIMITATIONS NV WY m applies within the six months before the policy e ective date CT m Pre existing Condition means having a sickness or physical condition for which any covered person was treated received medical advice or had taken medication within 12 months before the e ective date of this policy FL m Pre existing Condition means any covered person having a sickness or physical condition that during the 12 months immediately preceding the e ective 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 Routine follow up care during the 12 months immediately preceding the e ective date of this policy to determine whether a breast cancer has recurred in a covered person who has been previously determined to be free of breast cancer does not constitute medical advice diagnosis care or treatment for purposes of determining pre existing conditions unless evidence of breast cancer is found during or as a result of the follow up care GA m 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 prescription medication within 12 months before the e ective date of this policy IL m Pre existing Condition means having a sickness or physical condition for which any covered person was diagnosed treated had medical testing by a legally qualified physician or received medical advice or had taken medication within 12 months prior to the e ective date of this policy ME m Pre existing Condition means having a sickness or physical condition for which any covered person was treated had medical testing or received medical advice within 12 months before the e ective date of this policy NC m Pre existing Condition means having those conditions whether diagnosed or not for which any covered person received medical advice diagnosis care or treatment was received or recommended within one year period immediately preceding the e ective date of this policy If you are 65 or older when this policy is issued pre existing conditions will include only conditions specifically eliminated by rider OR Pre existing Condition means having a sickness or physical condition for which any covered person was diagnosed received treatment care or medical advice within the 6 month period immediately preceding the e ective date of this policy Insureds in California Oregon and South Dakota must be covered by comprehensive health insurance before applying for hospital indemnity insurance This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may 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 base form 562880 562911 or 562942 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 IMB7000 EXCLUSIONS AND LIMITATIONS 3 22 562973 1

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Specified Critical Illness Insurance For more information talk with your benefits counselor ColonialLife com 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 15K 25K 50 Critical illness benefit For the diagnosis of this covered critical illness condition 1 Cancer Heart attack myocardial infarction Stroke End stage renal kidney failure Major organ failure Permanent paralysis due to a covered accident Coma Blindness Occupational infectious HIV or occupational infectious hepatitis B C or D Coronary artery bypass graft surgery disease2 Carcinoma in situ This percentage of the face amount is payable 100 100 100 100 100 100 100 100 100 25 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 Subsequent diagnosis of a different critical illness3 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 Subsequent diagnosis of the same critical illness3 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 2 carcinoma in situ and occupational infectious HIV or occupational infectious hepatitis B C or D CRITICAL ILLNESS 1 0 WITH CANCER AND SUBSEQUENT DIAGNOSIS

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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

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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 1 Please refer to the policy for complete definitions of covered conditions 2 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 3 Dates of diagnoses of a covered specified critical illness must be separated by at least 180 days THIS POLICY PROVIDES LIMITED BENEFITS 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 is not an insurance contract and only the actual policy provisions will control 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 The policy or its provisions may vary or be unavailable in some states Please see your Colonial Life benefits counselor for details Underwritten by Colonial Life Accident Insurance Company Columbia SC 2019 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 4 19 101825 1

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Dental Insurance Plan 3 1 500 100 80 50 For more information talk with your benefits counselor ColonialLife com Dental insurance from Colonial Life can help preserve your smile with easy to use coverage that promotes overall wellness Benefits can help with a variety of dental costs from routine cleanings to more advanced procedures Coverage is available for you your spouse and dependent children Plan details The benefit year maximum for this plan is 1 500 per person Class A B and C services apply toward the benefit year maximum This plan has a deductible of 50 per person Families only pay the deductible for a maximum of three people Applies only to class B and C services The co insurance for this plan is CLASS Class A Class B Class C TYPE OF SERVICE Preventive services Basic services Major services INSURANCE PAYS 100 80 50 Network Our national dental network offers more than 323 000 access points 1 Members may choose any dentist but may receive additional savings by choosing an in network dentist Plus services not covered by this plan may also still be eligible for in network savings 2 Out of network benefits are paid at the network negotiated rate 3 To locate a participating dentist access the provider search at ColonialLifeDental com See reverse for covered procedures and waiting periods IDN8000 PLAN 3

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ColonialLife com Covered procedures and waiting periods Preventive 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 pregnancy4 X rays Bitewing X rays up to four films 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 Adjunctive pre diagnostic oral cancer screening for age 40 or older once every 12 months Basic services Class B No waiting period Full mouth panoramic X rays once every five years Simple restorative services fillings Simple extractions Emergency treatment Major services Class C 12 month waiting period Oral surgery extractions and impacted teeth Anesthesia subject to review covered with complex oral surgery Repair of crown denture or bridge Periodontics gum treatments Endodontics root canals Inlays and onlays Crowns Bridges Dentures Endosteal implants in lieu of an approved three unit bridge 1 Internal data 2017 Access points are sites where network dentists see patients Some dentists may be available at more than one access point 2 Not an insured benefit 3 If you visit an out of network dentist you may be billed for remaining amounts over the benefit amount paid up to the billed charge 4 Member may have one additional periodontal maintenance in lieu of an additional cleaning Periodontal maintenance is a major service and subject to a 12 month waiting period 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 See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability 2018 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company Underwritten by Colonial Life Accident Insurance Company Columbia SC 4 18 101838 1

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Dental PPO Member Guide Dental insurance coverage provides valuable protection for both your smile and your wallet Below is information to help use the plan USING THE DENTAL VISION NETWORKS The name of the dental network is DenteMax Plus AlwaysCare 1 The name of the vision network if applicable to your coverage is First Look Find a network provider by visiting ColonialLifeDental com ID CARDS ID cards are mailed to your home address within 10 business days of enrolling Only the main insured s name will be listed Included with your ID card is a list of the eight nearest network providers based on your home address Vision coverage if purchased includes a separate ID card Below are samples of ID cards and the mailing envelope they are sent in 8485 Goodwood Boulevard Baton Rouge LA 70806 7878 DOWNLOAD THE ALWAYSASSIST MOBILE APP AlwaysAssist makes it simple to access your dental and vision benefits information You can View benefits claim status ID cards and more Find the app in the App Store or Google Play or visit the website ColonialLifeDental com Register using your Social Security number or member ID which can be found on your ID card IMPORTANT Your insurance documents are enclosed CLA OE WIN 9 18 DENTAL ID Card E L P M SA Policyholder Name Member Claims No XXXXXXX Cov Code D Policy No XXXXXX Eff Date 02 01 2022 Plan SCA Network PPO DenteMax Plus AlwaysCare Deductible 50 per benefit year Payor ID STR01 Underwritten by Colonial Life Accident Insurance Company HOW TO USE YOUR DENTAL BENEFITS Scan this code or go directly to ColonialLifeDental com to access AlwaysAssist E L P AM Register and manage your account at AlwaysAssist com Request pre treatment estimates for all services over 300 Member Customer Service 888 400 9304 Provider Services 855 400 9330 Faster claims processing is available for network providers at AlwaysAssist com S Mail claims to Dental Claims Department P O Box 80139 Baton Rouge LA 70898 0139 10 18 NS 15928 1

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Individual Dental PPO Insurance Vision Rider For more information talk with your benefits counselor ColonialLife com Dental insurance offers 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 benefits IN NETWORK OUT OF NETWORK ALLOWANCE CO PAYS Exam once per 12 months 10 35 Materials 25 See below STANDARD PLASTIC LENSES1 once per 12 months Single vision Covered by co pay 25 Bifocal Covered by co pay 40 Trifocal Covered by co pay 50 Lenticular 80 allowance 50 Progressive 70 allowance 40 Polycarbonate lenses for children to age 19 Covered by co pay N A FRAMES1 once per 12 months Choose any frame available at provider locations 120 allowance 50 CONTACT LENSES2 once per 12 months Includes fit follow up and materials In lieu of eyeglass lenses and frames Elective Up to 120 allowance 100 allowance Medically necessary Up to 210 allowance 210 allowance Freedom of choice You 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 different 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 IDN8000 VISION RIDER

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Special discounts on material purchases4 Providers identified as Value Added or Service Plus in our online provider directory offer the following additional values for our members on vision material purchases We encourage you to contact your selected provider prior to visiting their location to confirm their continued participation Not all providers such as Walmart Sam s Club and Costco Optical choose to participate in these special discounts Value Added providers DISCOUNTS FOR FIRST PAIR OF GLASSES Lens options add ons for insured purchases 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 U ltra 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 PURCHASE A SECOND PAIR OF GLASSES AND RECEIVE PREFERRED PRICING Lenses Single vision plastic lenses 40 Bifocal plastic lenses 60 Trifocal lenses 70 Progressive lenses standard 110 Progressive lenses premium and ultra 20 discount DISCOUNTS ON FRAMES CONTACT LENSES AND OTHER PRODUCTS 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 solutions5 Service Plus providers RECEIVE UP TO A 20 DISCOUNT FOR THE FOLLOWING ADD ONS TO INSURED PURCHASES UV coating Solid tinting gradient tinting Standard scratch resistance coating Standard anti reflective coating Premium anti reflective coating Transition Standard polycarbonate ColonialLife com 1 Eyeglass lenses and frames are paid in lieu of the contact lenses benefit 2 The contact lenses benefit is paid in lieu of eyeglass lenses and frames Contact lenses consist of three components materials exams and fittings Coverage is for materials and the exam up to the contact lenses allowance Fittings may be covered but only up to the amount of any unused contact lenses allowance after 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 after 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 offer 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 affect any benefits payable See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability Dental 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 4 19 101851 AK NC

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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

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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

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Deductions per year 12 Accident 1 0 for NC l On Off Job Accident Coverage Premier with health screening These rates were prepared on 8 30 2023 and are valid for 90 days Applicable to policy forms ACCIDENT 1 0 HS and ACCIDENT 1 0 NS ISSUE AGE 17 80 NAMED INSURED 26 51 EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY 36 32 39 70 49 50 Individual Medical Bridge for NC Applicable to policy form Individual Medical Bridge l 3000 Hospital Confinement Benefit and Outpatient Surgical Procedure Benefit with a calendar year maximum of 1500 Enhanced Intensive Care Unit Confinement benefit ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENT CHILDREN EMPLOYEE SPOUSE AND DEPENDENT CHILDREN 17 49 50 59 60 64 65 75 50 10 68 25 90 45 130 65 95 05 129 80 171 80 247 80 68 15 86 30 108 50 150 50 113 10 147 85 189 85 267 65 Individual Disability ISTD3000 for NC A Risk Class l Off Job Accident Off Job Sickness with First Day Hospital 3 Month Benefit Period ELIMINATION PERIOD ISSUE AGE 1 500 0 days Accident 7 days Sickness monthly benefit amount 17 49 50 64 65 74 55 65 68 10 98 70 2 000 74 20 90 80 131 60 Applicable to policy form Individual Disability 2 500 92 75 113 50 164 50 3 000 111 30 136 20 197 40 Individual Dental PPO IDN8000 for NC l with Vision Rider Applicable to policy form Individual Dental PPO IDN8000 Zip Codes 270 271 272 273 274 275 276 277 278 280 281 282 283 284 285 286 287 288 289 COVERAGE LEVEL INDIVIDUAL INDIVIDUAL AND SPOUSE INDIVIDUAL AND CHILDREN Plan 3 100 80 50 1 500 MAC 42 30 80 78 99 60 INDIVIDUAL AND FAMILY 148 70 Page 1 of 4 Underwritten by Colonial Life Accident Insurance Company See page 4 for Important Notice

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Continued Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Health Screening Benefit Cancer Benefit Non Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY 15 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 8 30 11 30 14 45 19 10 23 15 30 50 42 65 52 70 70 10 83 45 12 60 17 25 22 05 29 25 35 40 46 95 65 55 81 00 107 70 128 25 10 70 13 70 16 85 21 50 25 55 33 05 45 05 55 25 72 65 86 15 25 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 12 40 17 40 22 65 30 40 37 15 49 40 69 65 86 40 115 40 137 65 18 80 26 55 34 55 46 55 56 80 76 05 107 05 132 80 177 30 211 55 16 40 21 40 26 65 34 40 41 15 53 65 73 65 90 65 119 65 142 15 50 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 22 65 32 65 43 15 58 65 72 15 96 65 137 15 170 65 228 65 273 15 34 30 49 80 65 80 89 80 110 30 148 80 210 80 262 30 351 30 419 80 30 65 40 65 51 15 66 65 80 15 105 15 145 15 179 15 237 15 282 15 Applicable to policy form CI 1 0 TWO PARENT FAMILY 15 15 19 80 24 60 31 80 37 95 49 35 67 95 83 55 110 25 130 95 23 05 30 80 38 80 50 80 61 05 80 05 111 05 137 05 181 55 216 05 42 80 58 30 74 30 98 30 118 80 156 80 218 80 270 80 359 80 428 80 Page 2 of 4 Underwritten by Colonial Life Accident Insurance Company See page 4 for Important Notice

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Continued Critical Illness 1 0 for NC l with Subsequent Diagnosis Coverage Health Screening Benefit Cancer Benefit Tobacco Rates ISSUE AGE 15 000 25 000 50 000 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 70 NAMED INSURED 10 85 15 80 21 95 29 30 36 95 47 75 65 30 83 30 106 55 128 00 16 65 24 90 35 15 47 40 60 15 78 15 107 40 137 40 176 15 211 90 31 15 47 65 68 15 92 65 118 15 154 15 212 65 272 65 350 15 421 65 EMPLOYEE SPOUSE 16 65 24 30 33 75 45 00 56 85 73 50 100 35 127 95 163 65 196 65 25 55 38 30 54 05 72 80 92 55 120 30 165 05 211 05 270 55 325 55 47 80 73 30 104 80 142 30 181 80 237 30 326 80 418 80 537 80 647 80 ONE PARENT FAMILY 13 40 18 35 24 50 31 85 39 50 50 30 67 85 85 70 109 10 130 70 20 90 29 15 39 40 51 65 64 40 82 40 111 65 141 40 180 40 216 40 39 65 56 15 76 65 101 15 126 65 162 65 221 15 280 65 358 65 430 65 Term Life ITL5000 for NC l 30 Year Term Base Plan Chronic Care Accelerated Death Benefit Non Tobacco Rates ISSUE AGE 25 000 50 000 25 11 39 12 58 35 14 66 15 95 45 22 94 30 92 75 000 16 87 21 93 44 37 100 000 21 17 27 92 57 83 Applicable to policy form CI 1 0 TWO PARENT FAMILY 19 20 26 70 36 30 47 55 59 40 75 90 102 90 130 35 166 20 199 35 29 80 42 30 58 30 77 05 96 80 124 30 169 30 215 05 274 80 330 05 56 30 81 30 113 30 150 80 190 30 245 30 335 30 426 80 546 30 656 80 Applicable to policy form ITL5000 Page 3 of 4 Underwritten by Colonial Life Accident Insurance Company See page 4 for Important Notice

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Continued Term Life ITL5000 for NC l 30 Year Term Base Plan Chronic Care Accelerated Death Benefit Tobacco Rates ISSUE AGE 25 000 50 000 25 20 85 20 37 35 25 10 26 91 45 40 42 57 66 75 000 28 56 38 37 84 50 Whole Life Plus IWL5000 for NC l Adult Base Plan Paid Up at Age 100 Non Tobacco Rates ISSUE AGE 50 000 25 46 00 35 62 58 45 99 41 55 162 24 65 288 74 Tobacco Rates ISSUE AGE 25 35 45 55 65 50 000 80 33 97 75 145 54 245 32 419 57 100 000 92 00 125 16 198 83 324 49 577 48 100 000 160 66 195 49 291 07 490 65 839 13 150 000 137 99 187 74 298 24 486 73 866 22 150 000 240 99 293 24 436 61 735 97 1 258 70 Applicable to policy form ITL5000 100 000 36 75 49 83 111 33 Applicable to policy forms ICC19 IWL5000 70 IWL5000 70 ICC19 IWL5000 100 IWL5000 100 ICC19 IWL5000J IWL5000J and rider forms ICC19 R IWL5000 STR R IWL5000 STR ICC19 R IWL5000 CTR R IWL5000 CTR ICC19 R IWL5000 WP R IWL5000 WP ICC19 R IWL5000 ACCD R IWL5000 ACCD ICC19 R IWL5000 CI R IWL5000 CI ICC19 R IWL5000 CC R IWL5000 CC ICC19 R IWL5000 GPO R IWL5000 GPO ICC23 IWL5000 LTC IWL5000 LTC Important Notice Insurance coverage has exclusions and limitations that may affect benefits payable For a complete description of benefits limitations and exclusions please refer to an outline of coverage sample policy certificate proposal description or see your Colonial Life benefits counselor Coverage type benefits and rates vary by state Coverage may not 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 4838 Page 4 of 4 Underwritten by Colonial Life Accident Insurance Company See page 4 for Important Notice

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Northern Piedmont Counseling 2024 Last Name First M I DOB Street Address Apartment Unit City Phone Job Title Sex Spouse s Name State E mail Address Date of Hire Social Security No Sex ZIP Tobacco Y or N Spouse s DOB Height Weight Dependent 1 Name DOB Sex Dependent 3 Name DOB Sex Dependent 2 Name DOB Sex Dependent 4 Name DOB Sex Beneficiary Name Address DOB phone relationship Monthly Rates Colonial Accident Everyday mishaps to broken bones burns cuts to more extensive accidents Pays 200 for seeking treatment The more severe the accident the more money paid 50K Life insurance 50 Wellness for each adult family member on the plan Individual 26 51 Ind Spouse 36 32 Ind Child 39 70 Family 49 50 Colonial Hospital 24 hr admission 3000 payout 1500 Surgical Outpatient Surgical ICU daily benefit Ind 17 49 50 10 50 59 68 25 60 64 90 45 Ind Sp 17 49 95 05 50 59 129 80 60 64 171 80 Ind Child 17 49 68 15 50 59 86 30 60 64 108 50 Family 17 49 113 10 50 59 147 85 60 64 189 85 Colonial Short Term Disability Provides a source of income while out of work Pays after day 1 accident off job after day 7 of illness If 24hr hospital admission pays on DAY 1 1000 1500 monthly 3 mo 0 7 Age 17 49 55 65 50 64 68 10 65 74 98 70 I d like a rate based on annual hourly income Amount allowed _____Rate____ Dental 2 annual cleanings x rays Pays 50 80 major services Individual 42 30 Ind Spouse 80 78 Ind Child 99 60 Family 148 70 Critical Care Cancer Pays in a lump sum 10K 75K for diagnosis Ex 25K pay out 35 39 yr old non tobacco 19 10 I would like a rate _______ Life Pay out to beneficiary 25K 100K I would like a rate _______ Signature _______________________________ Date ____________________

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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

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Policyholder Service Guide At Colonial Life our goal is to give you an excellent customer experience that is simple modern and personal Getting started Consider your options The easiest way to manage your business with us is through the My Colonial Life policyholder section of ColonialLife com Whether online or by phone we ll provide the service you need To sign up for the website 1 Visit ColonialLife com 2 Click Register at the top right 3 On the sign up page click Join the Policyholder Website Need ColonialLife com Submit your claim using our eClaims system 3 File health screening wellness and doctor s office visit claims up to 18 months 3 3 Check the status of your claim 3 3 Review print or download a copy of your policy certificate 3 Access claim and service forms 3 3 Access your claim correspondence 3 3 3 Complete a notification for a life claim 3 3 Update your contact information After providing some basic information you ll be ready to go 800 325 4368 Filing claims eClaims With the eClaims feature on ColonialLife com you can file claims online by simply answering a few questions and uploading your supporting documentation You re able to spend less time on paperwork and we re able to process your claim faster With eClaims you can file most claims online including Accident Hospital confinement indemnity Disability Critical illness Cancer Vision You can access eClaims through your computer or mobile device and upload any required supporting documentation Once you re logged in to ColonialLife com visit the Claims Center and select File an Online Claim to get started

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Contact us Online ColonialLife com Log in and click on Contact Us to email us Telephone 1 800 325 4368 Contact Center representatives are available Monday through Friday 8 a m to 8 p m ET Information is available 24 7 through our automated phone system Please have your Social Security or policy number ready when you call Hearing impaired customers Customers with a Telecommunications Device for the Deaf TDD should call 803 798 4040 If you do not have a TDD call Voiance Telephone Interpretation Services at 844 495 6105 to reach us Health screening wellness claims The quickest way to receive the applicable benefits for your health screening wellness services is to file online For health screening wellness claims within 18 months of the date you are filing the claim click on File a Wellness Claim Online on the Claims Center page If you do not want to file online you can use the automated customer service center at 1 800 325 4368 For health screening wellness claims over 18 months you ll be directed to print out a paper claim form under the claims and service forms section on the Claims Center page Paper claims If you don t want to file online download the form you need by visiting the Claims Center page on ColonialLife com and clicking on claims and service forms For instructions on how to correctly complete your claim form view the claims videos on the Claims Center page Be sure that you complete all sections of the claim form Also include a diagnosis from your doctor along with copies of any appropriate bills if required Keep a copy of your claim information for your records When we receive information regarding your claim you ll be notified by telephone or email If you select the electronic messaging option you ll receive a call when the claim is processed Claim tips and information When submitting your claim make sure to include all required supporting documentation as this will allow us to process your claim quicker To view correspondence pertaining to your claim visit ColonialLife com Once you log in to your secure account select My Correspondence from the home page Whether you submit your claims online or by paper form you can select optional services that authorize us to Communicate claims information via electronic messaging to your phone number Send claim benefits overnight by deducting a fee from your claim payment Release information to your benefits representative plan administrator or family member You can always check the status of your claim on the My Colonial Life site at ColonialLife com ColonialLife com Applicable to vision rider on the individual dental plan 2016 Colonial Life Accident Insurance Company Columbia SC Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand 4 16 43233 37