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Benefit Booklet 2024
Colonial Life provides benefits that employees want for the unexpected moments in life Whether planning for retirement growing their families or saving for college they know an injury or illness won t derail their dreams For more information Shelley Hartsell 704 883 4838 Shelley Hartsell ColonialLifeSales com Life is anything but expected That s why we re here Plan options Accident insurance Helps offset unexpected medical expenses such as emergency room fees deductibles and copayments that can result from a fracture dislocation or other covered accidental injury Hospital insurance Provides a lump sum benefit for a covered hospital confinement or outpatient surgery to help with co payments and deductibles that are not covered by most major medical plans Critical illness Cancer Supplements your major medical coverage by providing a lump sum benefit you can use to pay the direct and indirect costs related to a covered critical illness and cancer Disability Provides financial protection to cover income loss from a covered disability Dental Vision Annual cleanings x rays basic and comprehensive services Life insurance Enables you to tailor coverage for your individual needs and helps provide financial security for your family members
Accident 1.0 -Preferred with Health Screening BenetAccidents happen in places where you and your family spend the most time – at work, in the home and on the playground – and they’re unexpected. How you care for them shouldn’t be. In your lifetime, which of these accidental injuries have happened to you or someone you know?l Sports-related accidental injuryl Broken bonel Burnl Concussionl Lacerationl Back or knee injuriesColonial Life’s Accident Insurance is designed to help you ll some of the gaps caused by increasing deductibles, co-payments and out-of-pocket costs related to an accidental injury. The benet to you is that you may not need to use your savings or secure a loan to pay expenses. Plus you’ll feel better knowing you can have greater nancial security.l Car accidentsl Falls & spillsl Dislocationl Accidental injuries that send you to the Emergency Room, Urgent Care or doctor’s oceWhat additional features are included?l Worldwide coveragel Portablel Compliant with Healthcare Spending Account (HSA) guidelinesWill my accident claim payment be reduced if I have other insurance?You’re paid regardless of any other insurance you may have with other insurance companies, and the benets are paid directly to you (unless you specify otherwise).What if I change employers?If you change jobs or leave your employer, you can take your coverage with you at no additional cost. Your coverage is guaranteed renewable as long as you pay your premiums when they are due or within the grace period. Can my premium change?Colonial Life can change your premium only if we change it on all policies of this kind in the state where your policy was issued. How do I le a claim?Visit coloniallife.com or call our Customer Service Department at 1.800.325.4368 for additional information.Accident Insurance
Your Colonial Life policy also provides benets for the following injuries received as a result of a covered accident.l Burn (based on size and degree) ....................................................................................$1,000 to $12,000l Coma .............................................................................................................................................................$10,000l Concussion .......................................................................................................................................................$150l Emergency Dental Work .......................................$75 Extraction, $300 Crown, Implant, or Denturel Lacerations (based on size) ........................................................................................................... $50 to $800Requires Surgeryl Eye Injury ...........................................................................................................................................................$300l Tendon/Ligament/Rotator Cu .......................................................... $500 - one, $1,000 - two or morel Ruptured Disc ..................................................................................................................................................$500l Torn Knee Cartilage .......................................................................................................................................$500Surgical Carel Surgery (cranial, open abdominal or thoracic) ................................................................................$1,500l Surgery (hernia) ..............................................................................................................................................$150l Surgery (arthroscopic or exploratory) ....................................................................................................$250l Blood/Plasma/Platelets ................................................................................................................................$300Benets listed are for each covered person per covered accident unless otherwise specied.Initial Carel Accident Emergency Treatment........... $150 l Ambulance .......................................$400l X-ray Benet ...................................................$50 l Air Ambulance ............................. $2,000Common Accidental InjuriesDislocations (Separated Joint) Non-Surgical SurgicalHip $6,600 $13,200 Knee (except patella) $3,300 $6,600 Ankle – Bone or Bones of the Foot (other than Toes) $2,640 $5,280 Collarbone (Sternoclavicular) $1,650 $3,300 Lower Jaw, Shoulder, Elbow, Wrist $990 $1,980 Bone or Bones of the Hand $990 $1,980 Collarbone (Acromioclavicular and Separation) $330 $660 One Toe or Finger $330 $660 Fractures Non-Surgical Surgical Depressed Skull $5,500 $11,000 Non-Depressed Skull $2,200 $4,400 Hip, Thigh $3,300 $6,600 Body of Vertebrae, Pelvis, Leg $1,650 $3,300 Bones of Face or Nose (except mandible or maxilla) $770 $1,540 Upper Jaw, Maxilla $770 $1,540 Upper Arm between Elbow and Shoulder $770 $1,540 Lower Jaw, Mandible, Kneecap, Ankle, Foot $660 $1,320 Shoulder Blade, Collarbone, Vertebral Process $660 $1,320 Forearm, Wrist, Hand $660 $1,320 Rib $550 $1,100 Coccyx $440 $880 Finger, Toe $220 $440
Transportation/Lodging AssistanceIf injured, covered person must travel more than 50 miles from residence to receive special treatment and connement in a hospital.l Transportation ............................................................................. $500 per round trip up to 3 round tripsl Lodging (family member or companion) ............................................... $125 per night up to 30 days for a hotel/motel lodging costsAccident Hospital Carel Hospital Admission* ........................................................................................................$1,500 per accidentl. Hospital ICU Admission* ................................................................................................$3,000 per accident* We will pay either the Hospital Admission or Hospital Intensive Care Unit (ICU) Admission, but not both.l Hospital Connement .........................................................$250 per day up to 365 days per accidentl Hospital ICU Connement ...................................................$500 per day up to 15 days per accidentAccident Follow-Up Carel Accident Follow-Up Doctor Visit ..........................................................$50 (up to 3 visits per accident)l Medical Imaging Study ......................................................................................................$250 per accident (limit 1 per covered accident and 1 per calendar year)l Occupational or Physical Therapy ..................................................... $35 per treatment up to 10 daysl Appliances ..........................................................................................$125 (such as wheelchair, crutches)l Prosthetic Devices/Articial Limb ....................................................$500 - one, $1,000 - more than 1l Rehabilitation Unit .................................................$100 per day up to 15 days per covered accident, and 30 days per calendar year. Maximum of 30 days per calendar yearAccidental Dismembermentl Loss of Finger/Toe .................................................................................$750 – one, $1,500 – two or morel 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 or l Loss of the ability to speakl Loss or loss of use of both arms or both legs Named Insured ................ $25,000 Spouse ..............$25,000 Child(ren) ......... $12,500365-day elimination period. Amounts reduced for covered persons age 65 and over. Payable once per lifetime for each covered person. Accidental DeathAccidental Death Common Carrierl Named Insured $25,000 $100,000l Spouse $25,000 $100,000l Child(ren) $5,000 $20,000
EXCLUSIONS We will not pay benets for losses that are caused by or are the result of: hazardous avocations; felonies or illegal occupations; racing; semi-professional or professional sports; sickness; suicide or self-inicted injuries; war or armed conict; in addition to the exclusions listed above, we also will not pay the Catastrophic Accident benet for injuries that are caused by or are the result of: birth; intoxication.For cost and complete details, see your Colonial Life benets counselor. Applicable to policy form Accident 1.0-HS-NC. This is not an insurance contract and only the actual policy provisions will control. Colonial Life 1200 Colonial Life BoulevardColumbia, South Carolina 29210coloniallife.com71740-NC©2014 Colonial Life & Accident Insurance Company | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 6-14Health Screening Benet l $50 per covered person per calendar yearProvides a benet if the covered person has one of the health screening tests performed. This benet is payable once per calendar year per person and is subject to a 30-day waiting period.Tests include:l. Blood test for triglyceridesl. Bone marrow testingl. Breast ultrasoundl. CA 15-3 (blood test for breast cancer) l. CA125 (blood test for ovarian cancer) l. Carotid doppler l. CEA (blood test for colon cancer) l. Chest x-ray l. Colonoscopy l. Echocardiogram (ECHO) l. Electrocardiogram (EKG, ECG) l. Fasting blood glucose test l. Flexible sigmoidoscopy l. Hemoccult stool analysisl. Mammographyl. Pap smearl. PSA (blood test for prostate cancer)l. Serum cholesterol test to determine level of HDL and LDL l. Serum protein electrophoresis (blood test for myeloma) l. Stress test on a bicycle or treadmill l. Skin cancer biopsy l. Thermography l. ThinPrep pap test l. Virtual colonoscopy Accident 1.0 -Preferred with Health Screening BenetMy Coverage Worksheet (For use with your Colonial Life benets counselor) Who will be covered? (check one) Employee Only Spouse Only One Child Only Employee & Spouse One-Parent Family, with Employee One-Parent Family, with Spouse Two-Parent FamilyWhen are covered accident benets available? (check one) On and O -Job Benets O -Job Only Benets
For more information talk with your benefits counselor ColonialLife com Hospital Confinement Indemnity Insurance Plan 1 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 _____1_5_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 ICU 500 per day Health savings account HSA compatible This plan is compatible with HSA guidelines This plan may also be o ered to employees who do not have HSAs Colonial Life Accident Insurance Company s Individual Medical Bridge o ers an HSA compatible plan in most states 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 IMB7000 PLAN 1 1 21 562880
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
Disability InsuranceHow you can protect your incomeIf you become disabled, you could be out of work for a while. Without your income, how would you pay for your everyday living expenses? Fortunately, Colonial Life offers nancial protection options that can help you. What can cause a disability? Many accidents or sicknesses can lead to short term disability claims, including pregnancy and childbirth; injuries from a major accident including dislocations, sprains and fractures; back problems; side effects from medicines or medical procedures; and some mental illnesses. Regardless of your age or health, a disabling sickness or accidental injuries could keep you out of work for weeks or even months.How reliable is your safety net? While many people with disabilities look to workers’ compensation or Social Security Disability Insurance (SSDI) for help, these resources aren’t always reliable. In fact, 68% of workers who apply for SSDI are denied.1 Even if these resources can help, they might not be enough to meet your nancial obligations.How to help yourself You can be better prepared to preserve your way of life with short term disability insurance. Disability insurance features:• Benets payable directly to you in regular payments if you can’t work because of a covered accident or sickness (injury or illness).• Disability benets may be available if you return to work part time. • In most cases, you can keep your coverage even if you change jobs, as long as you pay your premiums when due.Your Colonial Life benets counselor can help you determine the amount of coverage that’s right for you.70%of Americans worry about having enough emergency savings to cover a month’s worth of living expenses.2Nearly25%of 20 year olds can expect to be out of work for at least a year for a disabling condition before they retire.3DISABILITY INSURANCE
Disability Insurance Worksheet You can tailor disability coverage to t your specic needs. Talk with your benets counselor about your expenses and other paid leave benets, such as state paid medical leave, to help determine the coverage that’s right for you.4MONTHLY EXPENSES ROUND TO THE NEAREST HUNDREDRent or mortgage (insurance, minor home repairs) $Transportation (car note, bus fare, insurance, gas, maintenance)$Utilities (cell phone, Wi-Fi, electricity/gas, water) $Food and household necessities (toiletries, cleaning supplies)$Childcare (daycare, after-school care) $Health (medical needs and prescription drugs) $Other (gym/fitness, streaming/cable, extracurricular) $Total monthly expenses (add lines 1-7 together) $Your state’s paid medical leave approximate benefits (if any):Monthly benefit: _____________ Benefit period up to: _____________Talk with your Colonial Life benets counselor to learn more about disability insurance.ColonialLife.com1. Social Security Administration, SSI Annual Statistical Report, 2021.2. Bankrate, Bankrate’s 2023 annual emergency savings report, 2023. 3. Social Security Administration, Disability and Death Probability Tables for Insured Workers, 2022.4. State paid medical leave (PML) benets fall under state-specic program names. For example, in New Jersey, it may be referred to as Temporary Disability Insurance (TDI). Not available in all states.For policies issued or delivered in the Commonwealth of Virginia, THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benets payable. Applicable to policy forms ISTD3000 and rider form ISTD3000-ADIB (including state abbreviations where used, for example: ISTD3000-TX and ISTD3000-ADIB-TX ), policy form DIS1000 (including state abbreviations where used, for example DIS1000-TX), policy form ED-DIS 1.0 (including state abbreviations where used, for example ED-DIS 1.0-TX), policy form ICC21-DIP3000 and rider form ICC21-DIP3000-R-DIS, policy form GDIS-P and certicate form GDIS-C (including state abbreviations where used, for example: GDIS-P-EE-TX and GDIS-C-EE-TX), and policy form VSTDMP and certicate form VSTDC (including state abbreviations where used, for example VSTDMP-TX and VSTDC-TX). Not applicable in Oregon for policy form ICC21-DIP3000 and rider form ICC21-DIP3000-R-DIS. For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company. An insurance producer may contact you.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 6-23 | 101165-10
For more information, talk with your benefits counselor.Dental InsurancePlan 3 – $1,500, 100% | 80% | 50% IDN8000 – PLAN 3Dental 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 detailsThe 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:ColonialLife.comCLASS TYPE OF SERVICE INSURANCE PAYSClass A Preventive services 100%Class B Basic services 80%Class C Major services 50%See reverse for covered procedures and waiting periods.NetworkOur national dental network o ers 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.3To locate a participating dentist, access the provider search at ColonialLifeDental.com.
Covered procedures and waiting periodsColonialLife.comPreventive 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 treatmentMajor 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)4-18 | 101838-1©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. 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 aect any benefits payable. See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability.
Dental PPO InsuranceVision RiderLife is full of unexpected moments, and healthy vision can help you see them all. Our vision coverage helps you and your family maintain your vision wellness, with coverage for eye exams and optical materials, such as eyeglasses or contact lenses.VISION BENEFITS IN-NETWORK OUT-OF-NETWORKCO-PAYSExam (once per 12 months) $10 co-pay $35 allowanceMaterials $25 co-pay See belowSTANDARD PLASTIC LENSES (once per 12 months)Single vision Covered by co-pay $25 allowanceBifocal Covered by co-pay $40 allowanceTrifocal Covered by co-pay $50 allowanceLenticular $80 allowance $50 allowanceProgressive $70 allowance $40 allowancePolycarbonate lenses (for dependents to age 19) Covered by co-pay N/AFRAMES (once per 12 months)Choose any frame available at provider locations$120 allowance $50 allowanceCONTACT LENSES (once per 12 months; in lieu of eyeglass lenses and frames)Benet includes materials, t and follow-up. Provider may charge t separately, leaving entire allowance for materials.Elective $120 allowance $100 allowanceMedically necessary $210 allowance $210 allowanceVISION NETWORK — MAXIMIZE YOUR BENEFITSYou can maximize your vision benets with any provider in our large, nationwide network. Our network includes independent optometrists and ophthalmologists, as well as retail stores such as:• Walmart and Sam’s Club Optical • Target Optical • Pearle Vision • Visionworks • Costco1 You can choose different providers to use your benets for eye exams and eyeglasses or contact lenses. IDN8000 - VISION RIDER FIND A PROVIDER OR REFER A PROVIDERFind a network provider near you on our Vision Provider Directory at ColonialLifeVision.com. If your preferred provider isn’t in our network, you can send their contact information to referaprovider@ColonialLife.com, and one of our network recruiters will reach out to them.
THIS POLICY PROVIDES LIMITED BENEFITS.A NETWORK ACCESS PLAN IS AVAILABLE.This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy forms IDN8000-AK-17 and IDN8000-NC and rider forms R-VSN8000-AK-17 and R-VSN8000-NC. 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.© 2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 11-21 | 101851-2-AK-NC1. Optometrists at Costco Optical outlets are independent of Costco and may not be in network. Special payment and reimbursement terms apply for material purchases at Costco. Additional discounts are not applicable. 2. These schedules are subject to change without notice. Added value discounts may not be available in all geographical areas and may vary by network. Not all providers, such as Walmart, Sam’s Club and Costco Optical, choose to participate in these programs. Some frames and lens items may have manufacturer restrictions and cannot be discounted. Special lens packages that combine numerous lens enhancements at value price points are not covered by these added value programs. Programs may not be combined with any other promotions or discounts.ColonialLifeVision.comSPECIAL SAVINGS ON MATERIAL PURCHASES2Some network providers offer special pricing and discounts for certain vision materials, including lens add-ons and a second pair of glasses. See the chart below for details. Participating providers are designated as “Value Added” or “Service Plus” in the Provider Directory at ColonialLifeVision.com. VALUE-ADDED PROVIDERSSPECIAL PRICING AND DISCOUNTS ON LENS OPTIONS FOR FIRST PAIR OF GLASSES (ADD-ONS FOR INSURED PURCHASES)SPECIAL PRICING AND DISCOUNTS ON PURCHASE OF SECOND PAIR OF GLASSES 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 .............................. $15• Solid tinting/gradient tinting ... $15• Standard scratch-resistant coating ................................... $15• Standard antireective coating ...................................$45• Premium antireective coating ...................................$70• Ultra-antireective coating ................... 20% discount • Polarized lenses ...................... $75• Transition lenses .....................$75• Progressive lenses: ‐ Standard .............................$110 ‐ Premium .............................$170 ‐ Ultra .................... 20% discount • Standard polycarbonate lenses .....................................$40• High index (single vision) ‐ 1.56–1.60 ..............................$60 ‐ 1.66+ .................... 20% discount • High index (multifocal) ‐ 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 to 15% discount, depending on type• Other products ... 20% discount on nonprescription sunglasses and other products/solutions• UV Coating• Solid tinting/gradient tinting• Standard scratch-resistant coating• Standard antireective coating• Premium antireective coating• Transition lenses• Standard polycarbonate lensesNote: Not a covered benet. Prices shown reect member payment. Discounts reect percentage off the regular price.For more information about our vision coverage, talk with your benets counselor.
BENEFIT DESCRIPTION BENEFIT AMOUNTCancer insurance helps provide financial protection through a variety of benefits. These benefits are not only for you but also for your covered family members.For more information, talk with your benefits counselor.CANCER ASSIST – LEVEL 3Air ambulance .................................................................................$2,000 per tripTransportation to or from a hospital or medical facility [max. of two trips per confinement]Ambulance .....................................................................................$250 per tripTransportation to or from a hospital or medical facility [max. of two trips per confinement]AnesthesiaAdministered during a surgical procedure for cancer treatment ■ General anesthesia ......................................................................... 25% of surgical procedures benefit■ Local anesthesia ............................................................................$40 per procedureAnti-nausea medication .....................................................................$50 per day administered orDoctor-prescribed medication for radiation or chemotherapy [$200 monthly max.] per prescription filledBlood/plasma/platelets/immunoglobulins .............................................. $175 per dayA transfusion required during cancer treatment [$10,000 calendar year max.]Bone marrow donor screening .............................................................$50Testing in connection with being a potential donor [once per lifetime]Bone marrow or peripheral stem cell donation .........................................$750Receiving another person’s bone marrow or stem cells for a transplant [once per lifetime]Bone marrow or peripheral stem cell transplant .......................................$7,000 per transplantTransplant you receive in connection with cancer treatment [max. of two bone marrow transplant benefits per lifetime]Cancer vaccine .................................................................................$50An FDA-approved vaccine for the prevention of cancer [once per lifetime]Companion transportation .................................................................$0.50 per mileCompanion travels by plane, train or bus to accompany a covered cancer patient more than 50 miles one way for treatment [up to $1,200 per round trip]Egg(s) extraction or harvesting/sperm collection and storageExtracted/harvested or collected before chemotherapy or radiation [once per lifetime]■ Egg(s) extraction or harvesting/sperm collection .........................................$1,000■ Egg(s) or sperm storage (cryopreservation) ...............................................$350Experimental treatment .....................................................................$300 per dayHospital, medical or surgical care for cancer [$15,000 lifetime max.]Family care .....................................................................................$50 per dayInpatient or outpatient treatment for a covered dependent child [$2,500 calendar year max.]Hair/external breast/voice box prosthesis ...............................................$350 per calendar yearProsthesis needed as a direct result of cancerHome health care services ..................................................................$100 per dayExamples include physical therapy, occupational therapy, speech therapy and audiology; prosthesis and orthopedic appliances; rental or purchase of durable medical equipment [up to 30 days per calendar year or twice the number of days hospital confined, whichever is greater]Hospice (initial or daily care)An initial, one-time benefit and a daily benefit for treatment [$15,000 lifetime max. for both]■ Initial hospice care [once per lifetime] .....................................................$1,000■ Daily hospice care ..........................................................................$50 per dayCancer InsuranceLevel 3 Benefits
BENEFIT DESCRIPTION BENEFIT AMOUNTColonialLife.com4-15 | 101484-1©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.The policy has limitations and exclusions that may aect benefits payable. Most benefits require that a charge be incurred. Coverage may vary by state and may not be available in all states. For cost and complete details, see your benefits counselor.This chart highlights the benefits of policy form CanAssist (including state abbreviations where used, for example: CanAssist-TX). This chart is not complete without form number 101481. Hospital confinementHospital stay (including intensive care) required for cancer treatment■ 30 days or less ..........................................................................................$250 per day■ 31 days or more ........................................................................................$500 per dayLodging .....................................................................................................$75 per dayHotel/motel expenses when being treated for cancer more than 50 miles from home [70-day calendar year max.]Medical imaging studies .................................................................................$175 per studySpecific studies for cancer treatment [$350 calendar year max.]Outpatient surgical center ..............................................................................$300 per daySurgery at an outpatient center for cancer treatment [$900 calendar year max.]Private full-time nursing services ......................................................................$125 per dayServices while hospital confined other than those regularly furnished by the hospitalProsthetic device/artificial limb ........................................................................$2,000 per device or limbA surgical implant needed because of cancer surgery [payable one per site, $4,000 lifetime max.]Radiation/chemotherapyWeekly benefit [max. once per week]■ Injected chemotherapy by medical personnel ........................................................$750■ Radiation delivered by medical personnel ............................................................$750Monthly chemotherapy benefit [max. once per month]■ Self-injected ............................................................................................$300■ Pump ...................................................................................................$300■ Topical ..................................................................................................$300■ Oral hormonal [1-24 months] ..........................................................................$300■ Oral hormonal [25+ months] ...........................................................................$150■ Oral non-hormonal ..................................................................................... $300Reconstructive surgery ..................................................................................$60 per surgical unitA surgery to reconstruct anatomic defects that result from cancer treatment[up to $3,000 per procedure, including 25% for general anesthesia]Second medical opinion .................................................................................$300A second physician’s opinion on cancer surgery or treatment [once per lifetime]Skilled nursing care facility .............................................................................$100 per dayConfinement to a covered facility aer hospital release [up to the number of days paid for hospital confinement]Skin cancer initial diagnosis ............................................................................$400A skin cancer diagnosis while the policy is in force [once per lifetime]Supportive or protective care drugs and colony stimulating factors ...........................$150 per dayDoctor-prescribed drugs to enhance or modify radiation/chemotherapy treatments [$1,200 calendar year max.] Surgical procedures ......................................................................................$60 per surgical unitInpatient or outpatient surgery for cancer treatment [$5,000 max. per procedure]Transportation ............................................................................................$0.50 per mileTravel expenses when being treated for cancer more than 50 miles from home [up to $1,200 per round trip]Waiver of premium .......................................................................................Is availableNo premiums due if the named insured is disabled longer than 90 consecutive days
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 __1_0_K__ _7_5_K______ 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
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
In the U S medical spending in the last 12 months of life is nearly 80 000 per person HealthAffairs org End Of Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported July 2017 Your cost will vary based on the level of coverage you select Talk with your benefits counselor for information about what level of coverage would work best for you Whole Life Insurance You can t predict your family s future but you can be prepared for it You like to think that you ll be there for your family in the years to come But if something happened to you would your family have the income they need It s not easy to think about such serious circumstances but it s important to make sure your family is financially protected You can gain peace of mind with whole life insurance from Colonial Life Advantages of whole life insurance Permanent coverage that stays the same throughout the life of the policy Guaranteed level premiums that do not increase because of changes in health or age Access to the policy s cash value through a policy loan for emergencies1 Benefit for the beneficiary that is typically tax free Benefits and features Two plan options to choose what age your premium payments will end Paid Up at Age 70 or Paid Up at Age 100 Stand alone spouse policy available whether or not you buy a policy for yourself Flexibility to keep the policy if you change jobs or retire Built in terminal illness accelerated death benefit that provides up to 75 of the policy s death benefit up to 150 000 if you re diagnosed with a terminal illness2 Immediate 3 000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses Pays cash surrender value at age 100 when the policy endows WHOLE LIFE IWL5000
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
Term Life Insurance Peace of mind for you and your loved ones You want what s best for your family and that includes making sure they re prepared for the future With term life insurance from Colonial Life Accident Insurance Company you can provide financial security to help them cover their ongoing living expenses Advantages of term life insurance Lower cost when compared to cash value life insurance Same benefit payout throughout the duration of the policy Several term period options for flexibility during high need years 44 of Americans say their household would face financial hardship within six months should a wage earner die unexpectedly LIMRA 2022 Life Insurance Barometer Study Benefit for the beneficiary that is typically tax free Benefits and features Stand alone spouse policy available whether or not you buy a policy for yourself GA P Guaranteed premiums that do not increase during the selected term Ability to convert all or a portion of the benefit amount into cash value life insurance Flexibility to keep the policy if you change jobs or retire Built in terminal illness accelerated death benefit that provides up to 75 of the policy s death benefit up to 150 000 if you re diagnosed with a terminal illness1 Premium savings for face amounts over 250 000 based on your health 54 of Americans have life insurance coverage with an average coverage gap of 200 000 LIMRA 2021 Industry Associations Unite to Help Address the Life Insurance Coverage Gap in the United States TERM LIFE ITL5000
How to File a Claim for Colonial Life Benefits FOR FASTEST RESULTS FILE ONLINE 1 Go to ColonialLife com access to login or register 2 Fill out the required information and click Submit 3 Enjoy streamlined claims management and faster service online DIGITALLY FILE ALL TYPES OF CLAIMS Disability Insurance Accident Hospital Insurance Life Insurance Critical Illness Cancer Insurance Wellness benefits for screening tests Not sure which type of claim to file No problem Just answer a few questions on the portal and we ll help you figure everything out BEFORE YOU FILE Review the appropriate claims checklist at ColonialLife com and have this information handy to make the process go smoothly Proper documentation must be submitted when filing your claim AFTER YOU FILE Check your claim status and manage your claim by logging into your account at ColonialLife com access Live chat is also available 9 a m 5 p m EST OTHER WAYS TO FILE A CLAIM Fax 1 800 880 9325 Mail P O Box 100195 Columbia SC 29202 Colonial Life is committed to providing you our valued customer a market leading claims experience We look forward to serving you on ColonialLife com On the policyholder portal you can View benefit details Here you ll find a copy of your policy to see what s covered and benefit amounts Track your claim Log in anytime to view status or opt in to receive status alerts by email or text so you know instantly if we require additional information Sign up for direct deposit to get approved payments up to a week faster than paper check Colonial Life insurance products are underwritten by Colonial Life Accident Insurance Company Columbia SC 2022 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company ADR 1312251
Thank you Colonial Life Voluntary Benefits Please contact Shelley Hartsell Benefits Specialist 704 883 4838 Sh e l le y Ha rtse l l C o lo n i a lLi feS a le s c om