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2024-2025 A GUIDE TO YOUR BENEFITS….
Group Accident Plan 2You can’t predict when or where an accident will strike. But you can make sure you have a safety net of nancial protection to help if an accidental injury occurs.Accidents can happen anytime, anywhere—at home or at work, on the playground or on the road. Some of the most common injuries include:l Broken bonesl Burnsl Concussionsl LacerationsColonial Life’s Group Accident Insurance helps you ll some of the gaps caused by increasing deductibles, co-payments and out-of-pocket costs related to an accidental injury. With this coverage you may not need to use your savings or secure a loan to help pay those unexpected out-of-pocket expenses associated with a covered accident. Here’s how it works...l Back or knee injuriesl Accidental injuries that send you tothe Emergency Room, Urgent Careor a doctor’s oce.Group Accident InsuranceImagine while cleaning the gutters, you fall from the ladder and break your leg.These are out-of-pocket expenses you may encounter: $100 Emergency room copay $250 Deductible (copays do not count toward deductible) $35 Specialist visit copay – orthopedic physician $350 Specialist visit copay – occupational/physical therapy for 10 days $735 Out-of-pocket expensesAnd here is a sample of benets you may be eligible for with Colonial Life’s Group Accident Insurance:$125 Accident Emergency Treatment $150 Accident Follow-up Doctor Visit ($50 per visit, up to 3 per accident)$100 Appliance (crutches) $1,125 Fracture (broken leg) $250 Occupational/Physical Therapy ($25/day for 10 days) $30 X-Ray (for diagnosis of broken leg) $1,780 of benefits paid to you in addition to other coverage you may have with other insurance companies. The claims example above is based on a covered person aged 41 who receives a complete fracture of the leg and requires non-surgical repair. The policy has exclusions and limitations. Costs of treatment and benet amounts may vary.
Your Colonial Life certicate also provides benets for the following injuries received as a result of a covered accident.l Burn (based on size and degree) ..................................................................................... $1,000 to $12,000l Burn - Skin Graft for 2nd or 3rd degree burns ........................................................50% of Burn benetl Coma .............................................................................................................................................................. $10,000l Concussion ........................................................................................................................................................$150l Emergency Dental Work ......................................$100 Extraction, $300 Crown, Implant, or Denturel Lacerations (based on size) ............................................................................................................$25 to $600Requires Surgeryl Eye Injury ............................................................................................................................................................ $300l Ruptured Disc ...................................................................................................................................................$500l Tendon/Ligament/Rotator Cu ............................................................. $500 - one, $750 - two or morel Torn Knee Cartilage ........................................................................................................................................$500Surgical Carel Blood/Plasma/Platelets .................................................................................................................................$300l Surgery (arthroscopic or exploratory) .....................................................................................................$150l Surgery (cranial, open abdominal or thoracic) ................................................................................. $1,500 l Surgery (hernia) ...............................................................................................................................................$200Benets listed are for each covered person per covered accident unless otherwise specied.Initial Carel Accident Emergency Treatment ..............$125lAir Ambulance ............................................ $1,500Common Accidental InjuriesDislocation (Separated Joint) Non-Surgical SurgicalHip $3,000 $6,000Knee$1,500 $3,000Ankle – Bone or Bones of the Foot$1,200 $2,400Collarbone (sternoclavicular)$750 $1,500Lower Jaw, Shoulder, Elbow, Wrist $450 $900Bone or Bones of the Hand $450 $900Collarbone (acromioclavicular and separation)$150 $300One Toe or Finger $150 $300Fracture (Broken Bone) Non-Surgical Surgical Depressed Skull $3,750 $7,500 Non-Depressed Skull $1,500 $3,000 Hip, Thigh $2,250 $4,500 Body of Vertebrae, Pelvis, Leg $1,125 $2,250 Bones of Face or Nose $525 $1,050 Upper Jaw, Maxilla $525 $1,050 Upper Arm between Elbow and Shoulder $525 $1,050 Lower Jaw, Mandible; Kneecap, Ankle, Foot $450 $900 Shoulder Blade, Collarbone, Vertebral Process $450 $900 Forearm, Wrist, Hand $450 $900 Rib $375 $750 Coccyx $300$600 Finger, Toe $150 $300 l Ambulance .......................................................$200l X-Ray Benet .....................................................$30
Transportation/Lodging AssistanceIf injured, the covered person must travel more than 50 miles from residence to receive special treatment and connement in a hospital. l Lodging (family member or companion) .................................................$150 per night up to 30 days for ............................................................................................a hotel/motel lodging costs l Transportation ...............................................................................$500 per round trip up to 3 round tripsAccident Hospital Carel Hospital Admission1 ............................................................................................................$1,000 per accidentl Hospital ICU Admission1 ....................................................................................................$1,500 per accident 1 We will not pay the hospital admission benet and the hospital intensive care unit (ICU) admission benet for the same covered accident simultaneously.l Hospital Connement2 ...........................................................$200 per day up to 365 days per accidentl Hospital ICU Connement2 ..................................................... $400 per day up to 15 days per accident 2 We will not pay the hospital connement benet and the hospital ICU connement benet simultaneously.Accident Follow-Up Carel Accident Follow-Up Doctor Visit .............................................................$50 (up to 3 visits per accident)l Appliances .............................................................................................. $100 (such as wheelchair, crutches)l Medical Imaging Study ......................................................................................................... $150 per accident (limit 1 per covered accident and 1 per calendar year)l Occupational or Physical Therapy ......................................................................$25 per day up to 10 daysl Pain Management (Epidural Anesthesia) ...................................... $100 (limit 1 per covered accident)l Prosthetic Devices/Articial Limb ....................................................... $500 - one, $1,000 - two or morel Rehabilitation Unit Connement 3 ..................... $100 per day up to 15 days per covered accident, ................................................................................................................................and 30 days per calendar year 3 We will not pay the hospital connement benet and the rehabilitation unit connement benet simultaneously.Accidental Dismembermentl Loss of Finger/Toe .................................................................................... $750 – one, $1,500 – two or more l Loss or Loss of Use of Hand/Foot/Sight of Eye ........................ $7,500 – one, $15,000 – two or moreCatastrophic AccidentFor severe injuries that result in the total and irrecoverable:l Loss of one hand and one foot l Loss of the sight of both eyesl Loss of both hands or both feet l Loss of the hearing of both earsl Loss or loss of use of one arm and one leg l Loss of the ability to speakl Loss or loss of use of both arms or both legs Named Insured ................ $50,000 Spouse ..............$50,000 Child(ren) .........$25,000365-day elimination period. Payable once per lifetime for each covered person. Accidental DeathAccidental Death Common Carrierl Named Insured $25,000 $100,000l Spouse $25,000 $100,000l Child(ren) $5,000 $20,000Benets listed are for each covered person per covered accident unless otherwise specied.
EXCLUSIONS AND LIMITATIONS We will not pay any benets for losses that are caused by, contributed to by or occur as a result of: felonies or illegal occupations; hazardous avocations; racing; semi-professional or professional sports; sickness; suicide or injuries which any covered person intentionally does to himself; war or armed conict; in addition to the exclusions listed above, we also will not pay the Catastrophic Accident benet for injuries that are caused by or are the result of: birth or intoxicants and narcotics. The covered person must incur a charge and the certicate must be in force for benets to be payable.For cost and complete details, see your Colonial Life benets counselor. Applicable to policy number GACC1.0-P and certicate number GACC1.0-C (including state abbreviations where used, for example: GACC1.0-C-TX). This is not an insurance contract and only the actual policy provisions will control. 100813My Coverage Worksheet (For use with your Colonial Life benets counselor) Who will be covered? (check one) Employee Only Employee & Spouse One-Parent Family Two-Parent FamilyWhen are covered accident benets available? (check one) On and O-Job Benets O-Job Only BenetsColonial Life 1200 Colonial Life BoulevardColumbia, South Carolina 29210coloniallife.com© 2012 Colonial Life & Accident Insurance Company Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.10/12Group Accident Plan 2 Will I have to answer health questions to receive coverage?Coverage is Guaranteed Issue. No health questions will be asked.What additional features are included?l Worldwide coveragel Portablel Compliant with Health Savings Account (HSA) guidelinesHow do I know how much a benet pays?Benet amounts are preset and not based on the medical expenses you are charged. You get a lump sum payment that is specic to the injury or treatment required.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 benets are paid directly to you (unless you specify otherwise).How do I le a claim?Visit coloniallife.com or call our Customer Service Department at 1.800.325.4368 for additional information.
For more information, talk with your benefits counselor.Group Critical Illness InsurancePlan 3 FullColonialLife.comIf you’re diagnosed with a covered critical illness, group 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.*The policy name is Critical Illness Group Specified Disease Insurance.For the diagnosis of this covered critical illness condition:1This percentage of the face amount is payable:Heart attack (myocardial infarction) 100%Stroke 100%End-stage renal (kidney) failure 100%Major organ failure 100%Coma 100%Permanent paralysis due to a covered accident 100%Blindness 100%Occupational infectious HIV or occupational infectioushepatitis B, C or D100%Coronary artery bypass gra surgery/disease225%GROUP CRITICAL CARE PLAN 3 FULLFace amount: $_______________ Critical illness benefitSubsequent diagnosis of a dierent critical illness3If you receive a benefit for a critical illness, and later you are diagnosed with a dierent critical illness, the original percentage of the face amount is payable for that particular critical illness.Subsequent diagnosis of the same critical illness3If you receive a benefit for a critical illness, and later you are diagnosed with the same critical illness, 25% of the original face amount is payable. Critical illness conditions that do not qualify are: coronary artery bypass gra surgery/coronary artery disease2 and occupational infectious HIV or occupational infectious hepatitis B, C or D.
ColonialLife.com1 Please refer to the certificate for complete definitions of covered conditions. 2 Benefit for coronary artery disease applicable in lieu of benefit for coronary artery bypass gra surgery when health savings account (HSA) compliant plan is selected.3 Dates of diagnoses of a covered critical illness must be separated by at least 180 days.THIS POLICY PROVIDES LIMITED BENEFITS.Insureds in MA must be covered by comprehensive health insurance before applying for this coverage.EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESSWe will not pay the Critical Illness Benefit or Benefit Payable Upon Subsequent Diagnosis of a Critical Illness that occursa as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; psychiatric or psychological conditions; suicide or injuries which any covered person intentionally does to himself; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.This is not an insurance contract and only the actual certificate provisions will control. Applicable to certificate form GCC1.0-C (including state abbreviations where used, for example: GCC1.0-C-TX). The certificate or its provisions may vary or be unavailable in some states. Please see your Colonial Life benefits counselor for details.11-16 | 100363-1Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2016 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
Your cost will vary based on the level of coverage you select. Whole Life InsuranceYou can’t predict your family’s future, but you can be prepared for it.You like to think that you’ll be there for your family in the years to come. But if something happened to you, would your family have the income they need?It’s not easy to think about such serious circumstances, but it’s important to make sure your family is financially protected. You can gain peace of mind with Colonial Life’s Whole Life Insurance.What is whole life insurance?Whole life insurance can help provide protection for you and those who depend on you. You won’t have to worry about becoming uninsurable later in life, and your premiums won’t increase as you get older.With whole life insurance, you receive a guaranteed death benefit, which can help with funeral costs and other immediate expenses. Also, throughout the life of the policy, you can access its cash value through a policy loan, and use the money for emergencies.What are the advantages of Colonial Life’s Whole Life Insurance? Your premiums will never increase because of changes in your health or age. You can take the policy with you even if you change jobs or retire, with no increase in premium. A guaranteed purchase option means you can purchase additional whole life coverage — without having to answer health questions — at three dierent points in the future. With the accelerated death benefit, you can request up to 75 percent of your policy’s death benefit to a maximum of $150,000 if you are diagnosed with a terminal illness.* An immediate $3,000 claim payment can help your designated beneficiary pay for funeral costs or other expenses.WHOLE LIFE 100030% of Americans (70 million) know they need more life insurance.Facts About Life, LIMRA 2015Talk with your Colonial Life benefits counselor for information about what level of coverage would work best for you.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company
EXCLUSIONS AND LIMITATIONSIf the insured commits suicide within two years from the coverage eective date or the date of reinstatement, whether he is sane or insane, we will not pay the death benefit. We will terminate this policy and return the premiums paid, minus any loans and loan interest to you. Product may vary by state. For costs and complete details of the coverage, call or write your Colonial Life benefits counselor or the company.This brochure is applicable to policy forms ICC07-WL-NGPO-65, ICC07-WL-NGPO-95, ICC08-WL-GPO-65, ICC08-WL-GPO-95.Product options Paid-up at age 65 or paid-up at age 95These two plan design options allow you to select what age your premium payments will end. You can choose to have your policy paid up when you reach age 65 or 95.Guaranteed purchase optionIf you are age 55 or younger when you purchase the policy, you have the option to purchase additional whole life coverage – without having to answer health questions – at three dierent points in the future. You may purchase up to your initial face amount, not to exceed a total combined maximum of $100,000 for all options.Additional coverage optionsSpouse whole life policy This policy oers a guaranteed death benefit, guaranteed level premiums and guaranteed cash value accumulation – whether or not you buy a policy on yourself. Spouse term life rider You can purchase term life coverage for your spouse, with a maximum death benefit of up to $50,000. 10-year and 20-year coverage periods are available, based on the policy you select. You can choose to convert this coverage to a cash value policy within certain time periods later on – without having to answer health questions.Juvenile whole life policyYou can purchase a policy while children are young and premiums are lower – whether or not you buy a policy on yourself. You may also increase the coverage when the child is 18, 21 and 24 without providing proof of good health. The plan design is paid-up at age 65.Children’s term life riderYou may purchase up to $10,000 in term life coverage for each of your eligible dependent children and pay one premium. You can later convert this coverage to a cash value life insurance policy – without having to answer health questions. You can add this additional coverage to either the primary or the spouse policy, but not both.Waiver of premium benefit riderYour premiums on the whole life policy and any riders attached to it will be waived if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period (the amount of time until benefits are payable).Accidental death benefit riderThis rider pays an additional benefit if you die as a result of an accident before age 70. The benefit doubles if the accident occurs while you are a fare-paying passenger. An additional 25% of the accidental death benefit will be paid should you die due to an injury sustained while driving or riding in a private passenger vehicle and wearing a seat belt.Benefits worksheetFor use with your Colonial Life benefits counselorTo learn more, talk with your Colonial Life benefits counselor.ColonialLife.com©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. 7-16 | 101318-3*Any payout would reduce the death benefit.£ YOU $ ___________________ FACE AMOUNTSelect the option:£ Paid-up at age 65£ Paid-up at age 95£ SPOUSE $ _______________ FACE AMOUNTSelect the option:£ Paid-up at age 65£ Paid-up at age 95Select any optional riders:£ Spouse term life rider $ _____________ face amount for ________-year term period£ Children’s term life rider $ _____________ face amount£ Waiver of premium benefit rider£ Accidental death benefit riderHOW MUCH COVERAGE DO YOU NEED?£ JUVENILE $ ______________ FACE AMOUNT
Group Disability InsuranceGROUP DISABILITY BASEYou never know when a disability could impact your way of life. Fortunately, there’s a way to help protect your income. If an accident or sickness prevents you from earning a paycheck, disability insurance can provide a monthly benefit to help you cover your ongoing expenses.Benefits worksheetHow much coverage do I need?Monthly benefit amount for o-job accident and o-job sickness: ______________Choose a monthly benefit amount between $400 and $7,500.*If your plan includes on-job accident/sickness benefits, the benefit is 50% of the o-job amount.How long will I receive benefits?Benefit period: _______ monthsThe partial disability benefit period is three months.When will my total disability benefits start?Aer an accident: _______ days Aer a sickness: _______ daysCan you aord to not protect your paycheck? You don’t have the same lifestyle expenses as the next person. That’s why you need disability coverage that can be customized to fit your specific needs.Aer calculating your monthly expenses, your benefits counselor can help you complete the benefits worksheet.ESTIMATED MONTHLY EXPENSES AMOUNTMortgage or rent$Utilities (electric/gas, phone, water, TV, Internet)$Transportation costs (gas, car payments) $Food$Health (medical needs and prescription drugs) $Other $TOTAL$ColonialLife.com*Subject to income requirements
EXCLUSIONS AND LIMITATIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of: alcoholism or drug addiction, felonies or illegal occupations, flying, hazardous avocations, intoxicants and narcotics, psychiatric or psychological conditions, racing, semi-professional or professional sports, suicide or injuries which you intentionally do to yourself, war or armed conflict. We will not pay for losses due to you giving birth within the first nine months aer the coverage eective date of the certificate. We will not pay for loss when the disability is a pre-existing condition as described in the certificate.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form GDIS-P-EE-TX and certificate form GDIS-C-EE-TX. This is not an insurance contract and only the actual policy and certificate provisions will control.©2015 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. 6-15 | 101296-1-TXProduct information and features Total disabilityTotally disabled or total disability means you are: unable to perform the material and substantial duties of your regular occupation, not working at any occupation, and under the regular and appropriate care of a doctor.Partial disabilityIf you are able to return to work part-time aer at least 14 days of being paid for a total disability, you may be able to still receive 50% of your total disability benefit.Waiver of premiumWe will waive your premium payments aer 90 consecutive days of a covered disability.Geographical limitationsIf you are disabled while outside of the United States, Mexico or Canada, you may receive benefits for up to 60 days before you have to return to the U.S. Issue ageCoverage is available from ages 17 to 74.PortabilityYou may be able to keep your coverage even if you change jobs.PremiumYour premium is based on your age when you purchase coverage and the amount of coverage you are eligible to buy. Your premium will not change as you age.For more information, talk with your benefits counselor.
Deductions per year: 24 These rates were prepared on 1/30/2017 based off of 165 eligible lives and are valid for 90 days.Group Accident for TXApplicable to policy forms GACC1.0-P & GACC1.0-ClOn/Off-Job Accident CoveragePlan 2ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY17-99 $7.47 $12.32 $14.28 $19.14Cancer Assist for TXApplicable to policy form CanAssistlwith Specified Disease Benefit, $100 Health Screening Benefit$4,000 Initial Diagnosis BenefitCOVERAGE LEVEL ISSUE AGE NAMED INSURED EMPLOYEE AND SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYLevel 1 17-75 $12.68 $20.18 $12.96 $20.46Level 2 17-75 $14.46 $22.81 $14.81 $23.16Level 3 17-75 $16.96 $28.08 $17.38 $28.51$5,000 Initial Diagnosis BenefitCOVERAGE LEVEL ISSUE AGE NAMED INSURED EMPLOYEE AND SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYLevel 1 17-75 $13.43 $21.43 $13.76 $21.76Level 2 17-75 $15.21 $24.06 $15.61 $24.46Level 3 17-75 $17.71 $29.33 $18.18 $29.81Group Critical Care for TXApplicable to policy forms GCC1.0-P & GCC1.0-ClFull CI Benefit, with Subsequent Diagnosis, $50 Health Screening Benefit, HSA CompliantNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 16-29 $2.60 $3.90 $2.70 $4.0530-39 $3.50 $5.30 $3.65 $5.4540-49 $5.70 $8.65 $5.85 $8.7550-59 $9.30 $14.50 $9.45 $14.6060-74 $14.45 $22.40 $14.55 $22.50$15,000 16-29 $3.18 $4.73 $3.33 $4.9530-39 $4.53 $6.83 $4.75 $7.0540-49 $7.83 $11.85 $8.05 $12.0050-59 $13.23 $20.63 $13.45 $20.7860-74 $20.95 $32.48 $21.10 $32.63$20,000 16-29 $3.75 $5.55 $3.95 $5.8530-39 $5.55 $8.35 $5.85 $8.6540-49 $9.95 $15.05 $10.25 $15.2550-59 $17.15 $26.75 $17.45 $26.9560-74 $27.45 $42.55 $27.65 $42.75MobilOil Federal Credit Union Sherry BrandaPage 1 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice
Group Critical Care for TXApplicable to policy forms GCC1.0-P & GCC1.0-ClFull CI Benefit, with Subsequent Diagnosis, $50 Health Screening Benefit, HSA CompliantNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$25,000 16-29 $4.33 $6.38 $4.58 $6.7530-39 $6.58 $9.88 $6.95 $10.2540-49 $12.08 $18.25 $12.45 $18.5050-59 $21.08 $32.88 $21.45 $33.1360-74 $33.95 $52.63 $34.20 $52.88Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 16-29 $3.70 $5.60 $3.85 $5.7030-39 $5.60 $8.40 $5.70 $8.5040-49 $10.00 $15.05 $10.10 $15.1550-59 $17.20 $26.75 $17.35 $26.9060-74 $27.45 $42.55 $27.60 $42.65$15,000 16-29 $4.83 $7.28 $5.05 $7.4330-39 $7.68 $11.48 $7.83 $11.6340-49 $14.28 $21.45 $14.43 $21.6050-59 $25.08 $39.00 $25.30 $39.2360-74 $40.45 $62.70 $40.68 $62.85$20,000 16-29 $5.95 $8.95 $6.25 $9.1530-39 $9.75 $14.55 $9.95 $14.7540-49 $18.55 $27.85 $18.75 $28.0550-59 $32.95 $51.25 $33.25 $51.5560-74 $53.45 $82.85 $53.75 $83.05$25,000 16-29 $7.08 $10.63 $7.45 $10.8830-39 $11.83 $17.63 $12.08 $17.8840-49 $22.83 $34.25 $23.08 $34.5050-59 $40.83 $63.50 $41.20 $63.8860-74 $66.45 $103.00 $66.83 $103.25Whole Life 1000 for TXApplicable to policy forms ICC07-WL-NGPO-65,ICC07-WL-NGPO-95, ICC08-WL-GPO-65, ICC08-WL-GPO-95,WL-NGPO-65, WL-NGPO-95, WL-GPO-65, WL-GPO-95,ICC16-WL1000J and WL1000JlAdult Base Plan Paid-Up at Age 95Non-Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $10.28 $19.06 $25.06 $32.9235 $15.01 $28.52 $38.66 $51.0445 $23.04 $44.58 $60.81 $80.5855 $38.79 $76.08 $96.62 $128.3365 $71.70 $141.89 $160.75 $213.83MobilOil Federal Credit Union Sherry Branda(Continued...)Page 2 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice
Whole Life 1000 for TXApplicable to policy forms ICC07-WL-NGPO-65,ICC07-WL-NGPO-95, ICC08-WL-GPO-65, ICC08-WL-GPO-95,WL-NGPO-65, WL-NGPO-95, WL-GPO-65, WL-GPO-95,ICC16-WL1000J and WL1000JlAdult Base Plan Paid-Up at Age 95Tobacco RatesISSUE AGE $25,000 $50,000 $75,000 $100,00025 $13.99 $26.48 $32.60 $42.9635 $21.37 $41.23 $49.94 $66.0845 $31.70 $61.90 $80.00 $106.1655 $58.13 $114.75 $132.18 $175.7565 $108.14 $214.79 $213.03 $283.53Group Disability for TX AAA Risk ClassApplicable to policy forms GDIS-P & GDIS-ClOff-Job Accident and Off-Job Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,500* $2,000* $3,000* $4,000**monthly benefit amount7 days Accident/7 days Sickness 17-49 $12.15 $18.23 $24.30 $36.45 N/A50-64 $14.00 $21.00 $28.00 $42.00 N/A65-74 $16.95 $25.43 $33.90 $50.85 N/A14 days Accident/14 days Sickness 17-49 $7.85 $11.78 $15.70 $23.55 $31.4050-64 $9.20 $13.80 $18.40 $27.60 $36.8065-74 $11.80 $17.70 $23.60 $35.40 $47.206 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $1,000* $1,500* $2,000* $3,000* $4,000**monthly benefit amount7 days Accident/7 days Sickness 17-49 $15.35 $23.03 $30.70 $46.05 N/A50-64 $20.25 $30.38 $40.50 $60.75 N/A65-74 $26.35 $39.53 $52.70 $79.05 N/A14 days Accident/14 days Sickness 17-49 $10.70 $16.05 $21.40 $32.10 $42.8050-64 $13.50 $20.25 $27.00 $40.50 $54.0065-74 $18.00 $27.00 $36.00 $54.00 $72.00Important 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.© 2014 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.Natalie J. Teltow | natalie@colonialtx.com | (713) 206-8880MobilOil Federal Credit Union Sherry Branda(Continued...)Page 3 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice