O A GUIDE TO Y UR BENEFITS Message
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MBCO ENGINEERING LLC GROUP SHORT TERM DISABILITY INSURANCE Short Term Disability PROVISIONS QUOTED ALL OTHER EMPLOYEES Contributions Employer pays 100 Minimum Participation Requirement 100 Minimum Hours for Eligibility 30 hours per week Elimination Period Injury Sickness 7 days injury 7 days sickness Maximum Duration of Benefits 12 weeks Definition of Disability Residual Maternity 6 weeks 8 weeks for c section Weekly Benefit 60 Maximum Weekly Benefit 1 000 Guaranteed Issue 1 000 Minimum Weekly Benefit 25 Coverage Type Non occupational Rehabilitation Services Participation is voluntary FICA Match Not included OFFSETS Employers get the full value of Unum s income protection coverage because we don t deduct employee s salary continuation or accumulated sick leave benefits from our short term disability payments VOLUNTARY REHABILITATION AND RETURN TO WORK ASSISTANCE After a disability most people want to get back to work We will provide an additional 10 in disability benefits to a maximum amount per month if the employee is eligible and participating in the rehabilitation and return to work program 2
MBCO ENGINEERING LLC GROUP LONG TERM DISABILITY INSURANCE Long Term Disability PROVISIONS QUOTED ALL OTHER EMPLOYEEES Contributions Employer pays 100 Minimum Participation Requirement 100 Minimum Hours for Eligibility 30 hours per week Elimination Period 90 days Maximum Duration of Benefits SS ADEA social security normal retirement age Definition of Disability 2 year own occupation with residual Monthly Benefit 60 Maximum Monthly Benefit 4 000 Guaranteed Issue 4 000 Accumulation Period 30 days Work Incentive Benefit 12 months Earnings Offset Method Proportionate loss Integration with other Disability Benefits Primary Family Minimum Monthly Benefit Greater of 100 or 10 of gross disability payment Mental Illness Limitation 24 months Self Reported Limitation 24 months Pre Existing Condition 3 12 exclusion Rehabilitation Services Participation is voluntary Survivor Benefit 3 times gross monthly benefit 4
MBCO ENGINEERING LLC Long Term Disability continued PROVISIONS QUOTED ALL OTHER EMPLOYEEES Worksite Modification Greater of 1 000 or 2 times monthly disability benefit Employee Assistance Program Included Travel Assistance Included SERVICES FOR EMPLOYEES IN TIME OF NEED Included at no extra cost an Employee Assistance Program that offers access to advice and resources for everyday issues as well as more serious ones and Emergency Travel Assistance that can help when the unexpected occurs 100 miles or more from home VOLUNTARY REHABILITATION AND RETURN TO WORK ASSISTANCE After a disability most people want to get back to work We will provide an additional 10 in disability benefits to a maximum amount per month if your employee is eligible and participating in the rehabilitation and return to work program 5
MBCO ENGINEERING LLC GROUP BASIC TERM LIFE AND AD D Coverage Effective Date June 1 2025 Rate Guarantee 2 Years Life Employee Basic Coverage PROVISIONS QUOTED ALL OTHER EMPLOYEES Contributions Employer pays 100 Minimum Hours for Eligibility 30 hours per week Benefit Amount 50 000 Guaranteed Issue Amount 50 000 Waiver of Premium Qualifying Ages Less than age 60 Premium Waiver Benefit Maximum To age 65 Waiver of Premium Elimination Period 9 months Age Reduction Schedule First Reduction 65 at age 65 Second Reduction 50 at age 70 AD D Employee Basic Coverage PROVISIONS QUOTED ALL OTHER EMPLOYEES Contributions Employer pays 100 Skkkkk 7
MBCO ENGINEERING LLC AD D Employee Basic Coverage continued PROVISIONS QUOTED ALL OTHER EMPLOYEES Benefit Amount 50 000 Waiver of Premium Not applicable Age Reduction Schedule Matches employee life age reduction schedule Skkkkk Life Additional Benefits Applies to all covered insureds PROVISIONS QUOTED ALL OTHER EMPLOYEES Accelerated Benefit 100 of coverage amount up to 250 000 24 months life expectancy Portability Included Conversion Included AD D Additional Benefits Applies to all covered insureds PROVISIONS QUOTED ALL OTHER EMPLOYEES Airbag Seatbelt Benefit Airbag 5 up to 5 000 Seatbelt 10 up to 25 000 Repatriation Benefit 10 000 Exposure and Disappearance Benefit Full amount Childcare Benefit 5 up to 10 000 per year 12 000 maximum over 4 years Common Carrier Benefit Included INNOVATIVE TECH Advanced solutions and seamless integrations help make benefits easier more effective and better connected to the modern workforce PEOPLE WHO LISTEN Experienced service teams provide empathy and expertise when it matters most supporting employees and helping HR navigate the toughest challenges PURPOSE DRIVEN Unum is committed to helping the working world thrive throughout life s moments and bringing that caring spirit to all our communities PLAN INFORMATION Delayed Effective Date Employee Insurance coverage will be delayed if the employee is not in active employment because of an injury sickness temporary layoff or leave of absence on the date that insurance would otherwise become effective 8
MBCO ENGINEERING LLC GROUP VOLUNTARY TERM LIFE AND AD D Coverage Effective Date June 1 2025 Rate Guarantee 3 Years VOLUNTARY PREMIUM SECTION Age Band Employee Life Monthly Rates per 1 000 Spouse Life Monthly Rates per 1 000 Child Life Monthly Rate per 1 000 15 24 0 060 0 060 0 301 25 29 0 070 0 070 30 34 0 090 0 090 35 39 0 130 0 130 40 44 0 180 0 180 45 49 0 290 0 290 50 54 0 410 0 410 55 59 0 640 0 640 60 64 0 820 0 820 65 69 1 000 1 000 70 74 1 840 1 840 75 6 490 6 490 Employee AD D Monthly Rate per 1 000 Spouse AD D Monthly Rate per 1 000 Child AD D Monthly Rate per 1 000 0 036 0 041 0 079 Note The premium paid for child coverage is based on the cost of coverage for one child regardless of how many children you have
MBCO ENGINEERING LLC Life Employee Voluntary Coverage PROVISIONS QUOTED Full time Employees Contributions Employee pays 100 Minimum Hours for Eligibility 30 hours per week Benefit Amount 10 000 increments to a maximum of the lesser of 5 X your annual earnings rounded to the next higher 10 000 or 500 000 Minimum benefit amount of 10 000 Guaranteed Issue Amount 100 000 Evidence of Insurability Requirements for Increases EOI is required for elected increases over the guaranteed issue amount Evidence of Insurability Requirements for Change in Family Status EOI is required for elected increases over the guaranteed issue amount Waiver of Premium Qualifying Ages Less than age 60 Premium Waiver Benefit Maximum To age 65 Waiver of Premium Elimination Period 9 months Age Reduction Schedule First Reduction 65 at age 65 Second Reduction 50 at age 70 Life Spouse Voluntary Coverage PROVISIONS QUOTED Full time Employees Contributions Employee pays 100 Benefit Amount 5 000 increments to a maximum of 100 000 Guaranteed Issue Amount 25 000 Evidence of Insurability Requirements for Increases EOI is required for elected increases over the guaranteed issue amount Evidence of Insurability Requirements for Change in Family Status EOI is required for elected increases over the guaranteed issue amount Waiver of Premium Not applicable Age Reduction Schedule Coverage reduces by the same percentage and at the same time as the employee The amount of Life Insurance for a dependent will not be more than the employee voluntary Life amount The employee must be covered for Life in order to insure dependents for Life
MBCO ENGINEERING LLC Life Child Voluntary Coverage PROVISIONS QUOTED Full time Employees Contributions Employee pays 100 Benefit Amount Live birth to 14 days 1 000 14 days to 6 months old 1 000 6 months and older 2 000 increments to a maximum of 10 000 Waiver of Premium Not applicable Child Age Limit Dependent children are eligible up to age 26 The amount of Life Insurance for a dependent will not be more than the employee Voluntary Life amount The employee must be covered for Life in order to insure dependents for Life AD D Employee Voluntary Coverage PROVISIONS QUOTED Full time Employees Contributions Employee pays 100 Benefit Amount 10 000 increments to a maximum of the lesser of 5 X your annual earnings rounded to the next higher 10 000 or 500 000 Minimum benefit amount of 10 000 Waiver of Premium Not applicable Age Reduction Schedule Matches employee life age reduction schedule AD D Spouse Voluntary Coverage PROVISIONS QUOTED Full time Employees Contributions Employee pays 100 Benefit Amount 5 000 increments to a maximum of 100 000 Age Reduction Schedule Coverage reduces by the same percentage and at the same time as the employee The amount of AD D Insurance for a dependent will not be more than the employee voluntary AD D amount The employee must be covered for AD D in order to insure dependents for AD D AD D Child Voluntary Coverage PROVISIONS QUOTED Full time Employees Contributions Employee pays 100 Benefit Amount Live birth to 14 days 1 000 14 days to 6 months old 1 000 6 months and older 2 000 increments to a maximum of 10 000 Child Age Limit Dependent children are eligible up to age 26 The amount of AD D Insurance for a dependent will not be more than the employee voluntary AD D amount The employee must be covered for AD D in order to insure dependents for AD D 14
MBCO ENGINEERING LLC Life Additional Benefits Applies to all covered insureds PROVISIONS QUOTED Full time Employees Accelerated Benefit 100 of coverage amount up to 250 000 24 months life expectancy Portability Included Conversion Included AD D Additional Benefits Applies to all covered insureds PROVISIONS QUOTED Full time Employees Airbag Seatbelt Benefit Airbag 5 up to 5 000 Seatbelt 10 up to 25 000 Repatriation Benefit 10 000 Exposure and Disappearance Benefit Full amount INNOVATIVE TECH Advanced solutions and seamless integrations help make benefits easier more effective and better connected to the modern workforce PEOPLE WHO LISTEN Experienced service teams provide empathy and expertise when it matters most supporting employees and helping HR navigate the toughest challenges PURPOSE DRIVEN Unum is committed to helping the working world thrive throughout life s moments and bringing that caring spirit to all our communities PLAN INFORMATION Delayed Effective Date Employee Insurance coverage will be delayed if the employee is not in active employment because of an injury sickness temporary layoff or leave of absence on the date that insurance would otherwise become effective Spouse Your Spouse s Coverage Effective Date will be delayed if your Spouse is an inpatient in a Hospital Hospice or other health care facility is confined at home under the care of a Physician If your Spouse s Coverage Effective Date is delayed due to the conditions above your Spouse s coverage will begin on the date your Spouse is no longer an inpatient in a Hospital Hospice or other healthcare facility or the date your Spouse is no longer confined at home under the care of a Physician Child ren This provision does not apply to Children 15
MBCO ENGINEERING LLC GROUP VISION INSURANCE Powered by EyeMed Coverage Effective Date June 1 2025 Rate Guarantee 48 Months Frames Once per 12 Months Employee 1 69 Employee Spouse 3 38 Employee Child ren 3 71 Employee Family 5 82 Employees Eligible for Coverage Minimum Hours for Eligibility 36 30 hours per week BENEFIT FREQUENCIES Frames Once per 12 months Exam Std Plastic Lenses Frames Contact Lenses 1 per 12 months 1 per 12 months 1 per 12 months 1 per 12 months VISION NETWORKS Members have the freedom to choose any provider from EyeMed s Insight network Our network offers the right mix of independent national retail and regional retail providers like Lens Crafters Pearle Vision Target Optical JC Penney and Sears Optical Members can also purchase glasses and contact lenses online at Glasses com and ContactsDirect com DISCOUNTS You get everyday member savings like 40 off a complete second pair of prescription glasses from participating in network providers You also get extra savings on LASIK procedures or discounts on hearing health care and services Find a provider 24 7 at EyeMedVisionCare com Unum 22
MBCO ENGINEERING LLC PLAN DESCRIPTION In Network Out of Network EXAM 10 copay Up to 40 Retinal imaging benefit subject to provider availability 39 Not Covered Single Vision 25 copay Up to 30 Bifocal 25 copay Up to 50 Trifocal 25 copay Up to 70 Lenticular 25 copay Up to 70 Standard Progressive Lens 90 copay Up to 50 Tier 1 110 copay Up to 50 Tier 2 120 copay Up to 50 Tier 3 135 copay Up to 50 Tier 4 90 copay 80 of charge less than 120 allowance Up to 50 Polycarbonate Lenses Under age 19 Covered Up to 32 Standard Polycarbonate lenses Covered Up to 32 Standard Scratch Resistant Coating Covered Up to 12 UV Coating Covered Up to 12 FRAMES Members may select any frame available 150 retail allowance Up to 105 CONTACT LENSES In lieu of eyeglass lenses Elective Std Contacts 150 allowance Up to 150 Medical Necessary Covered Up to 210 Standard contact lens fitting exam fee Covered Up to 40 Specialty Contact Lens Fitting Exam Fee 55 allowance Up to 40 MATERIALS Standard plastic lenses Premium Progressive Lens Lens Options 23
MBCO ENGINEERING LLC The standard contact lens fitting exam fee applies to a new or existing contact lens user who wears spherical disposable daily wear or extended wear lenses only The specialty contact lens fitting exam fee applies to a new or existing contact lens user who wears toric gas permeable mono fit or multi focal lenses LASIK DISCOUNT We offer nationwide access to discounts on LASIK surgery through a partnership with TLC Vision Discounts are also available with participating local providers This is not an insured benefit Visit our web site to find the specialist closest to you DISCOUNTS ON OPTICAL MATERIALS Unum Vision Powered by EyeMed members will receive the following discounts on materials at in network providers only 40 off for a complete second pair of glasses 20 off non prescription sunglasses 20 off remaining balance beyond plan coverage Unum Vision members will also receive additional savings on lens options at in network providers UV Treatment 15 Tint solid and gradient 15 Standard Plastic Scratch Coating 15 Standard Polycarbonate Adults 40 Standard Anti Reflective Coating 45 Premium Anti Reflective Coating Tier 1 57 Tier 2 68 Photochromic Transitions 75 Non insured options unless listed in the Plan Description as a covered benefit and subject to change HEARING SAVINGS PLAN Unum offers a Hearing Savings Plan at no additional cost to all of its Unum Vision Powered by EyeMed members Partnering with Amplifon the Hearing Savings Plan provides 40 off hearing exams at thousands of convenient locations nationwide Discounted set pricing on thousands of hearing aids including those with the newest most advanced technology Low price guarantee if you find the same product at a lower price elsewhere Amplifon will beat it by 5 60 day hearing aid trial period with no restocking fees Free batteries for 2 years with initial purchase 3 year warranty plus loss and damage coverage 24
MBCO ENGINEERING LLC GROUP DENTAL INSURANCE Coverage Effective Date June 1 2025 Rate Guarantee 12 Months Passive PPO Employee 12 87 Employee Spouse 25 53 Employee Child ren 35 34 Employee Family 52 72 Minimum Hours for Eligibility 30 hours per week PLAN DESCRIPTION Passive PPO IN OUT OF NETWORK Deductible 50 ANNUAL MAXIMUM 3 PER FAMILY Waived for Class A Applies to Class B C Services Benefit Year Maximum 1 500 Applies to Class A B C Services if applicable Orthodontia Maximum Lifetime 2 000 Annual NONE Applies to Class D Services Co insurance Class A Preventive Class B Basic Class C Major Class D Orthodontics Reimbursements 100 80 50 50 In Network Fee Schedule Out of Network 90th percentile 2
MBCO ENGINEERING LLC PLAN SERVICES Passive PPO Class A Preventive Services Class B Basic Services Class C Major Services Class D Orthodontics Waiting Period None Routine exams 2 per 12 months Prophylaxis 2 per 12 months Bitewing x rays max 4 films 1 per 12 months Full mouth x ray 1 per 36 months Fluoride to age 16 1 per 12 months Sealants to age 16 permanent molars 1 per 36 months Adjunctive pre diagnostic oral cancer screening 1 per 12 months for ages 40 Waiting Period None Emergency pain 1 per 12 months Space maintainers Fillings Posterior composite restorations Simple extractions Non surgical periodontics Periodontal maintenance 2 per 12 months Endodontics root canals Surgical periodontics gum treatments Waiting Period None Anesthesia subject to review covered with complex oral surgery Oral surgery surgical extractions impactions Inlays Onlays Crowns bridges dentures and implants Repairs crown denture and bridges Waiting Period None Orthodontia Lifetime Annual Maximum 2 000 None Dependent Children to age 19 only Up to 25 of lifetime allowance may be payable on initial banding 20 GDN DENTAL NETWORKS Unum Dental members have the freedom to choose a dentist from our large national network Find a certified independently reviewed provider and take your dental program to a new level of comprehensive care at unumdentalcare com HEARING SAVINGS PLAN Offered at no additional cost the Hearing Savings Plan provides 40 off hearing exams at thousands of locations nationwide 30 60 discounts off MSRP on name brand hearing instruments and on call support from professional hearing counselors 3
Accident Insurance Breathe easier for whatever life throws your way Accidents can happen anywhere and in the most unexpected ways Even with medical insurance it may not be enough to pay all of your medical expenses like your deductible and co insurance MBCO Engineering is pleased to offer Colonial Life Accident Insurance which can help with expenses by providing you a lump sum benefit that can be used for your out of pocket expenses such as emergency room doctor s bills and travel costs So if you get injured in an accident you can breathe easier about your medical bills and focus on your recovery The average cost of an accidental injury in the U S is 6 0001 Top causes of sports and recreational injuries treated in the ER2 Exercise Cycling Basketball Skateboarding Scooters Football Playground equipment 1 CDC Cost of Injury report 2023 2 Strategic Market Research Sports Injuries Statistics 2023
How accident insurance works Flexible coverage With accident coverage you have stronger protection so you can focus on your health and recovery instead of worrying about paying your medical expenses Here s how it works Your plan provides coverage for injuries and services from everyday mishaps to catastrophic events including injury treatment and recovery care benefits A set amount is payable based on the injury and the treatment needed for simple and complex injuries Benefits are payable directly to you unless otherwise specified and you can use them to pay your bills as you see fit Works alongside your Health Savings Account HSA Coverage is available for you your spouse and eligible dependent children You don t need to answer medical questions or have a physical exam to get accident coverage Benefit payments aren t reduced by any other insurance that you may have with another company Your plan may have additional benefits such as Accidental death and dismemberment Accident hospital benefits Wellbeing assistance Active lifestyles Certain benefits and riders may be unavailable in certain states or for certain accounts Give your benefits a boost We know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life Group Accident includes a Benefit Booster to provide additional financial support for serious accidents If you have more than 5 000 in payable benefits for a covered accident we will give you a 500 boost to your benefits to help you with whatever expenses you have BENEFITS STORY Olivia was driving to the store when she got into a car accident Olivia s Premier plan benefits helped her cover her medical expenses when she was injured in a car accident helping her to focus on her recovery OLIVIA S ACCIDENT BENEFITS 400 250 250 Olivia arrived by ambulance at the nearest emergency room and received immediate care Ambulance Emergency department visit Injury due to auto accident The doctor ordered an X ray and discovered Olivia had fractured her thigh femur He also ordered a CT scan of her head to check for a brain injury X ray Medical Imaging Fracture thigh 60 400 4 200 Olivia required surgery for her leg Surgical repair thigh fracture General anesthesia 4 200 300 Olivia boarded her pet for two nights after her surgery Pet boarding 2 days 20 x 2 40 Olivia had 8 sessions of physical therapy to help regain the strength in her leg and two follow up appointments with her doctor Therapy services 8 sessions Physician follow up visits 2 visits 55 x 8 440 50 x 2 100 Olivia s benefits for this accident totaled more than 5 000 Benefit Booster For illustrative purposes only Benefit amounts may vary and may not cover all expenses Total Includes domestic partner where permitted by law Sickness Hospital Benefits may be subject to a pre existing condition provision Payable once per Insured per covered accident 500 11 140
Accidental Death and Dismemberment AD D Benefits These benefits can help pay for expenses related to an accidental death They can also help pay costs related to recovery and rehabilitation from an accidental dismemberment including costs that your medical plan doesn t cover like co pays and deductibles Accidental death and dismemberment benefits are available to you with group accident coverage as well as all your covered family members Talk with your benefits counselor about the level of AD D benefits available to you Benefits are per covered person per covered accident unless stated otherwise BENEFITS PREMIER Accidental Death Named Insured 50 000 Accidental Death Spouse 50 000 Accidental Death Children 10 000 Accidental Death Common Carrier Named Insured 200 000 Accidental Death Common Carrier Spouse 200 000 Accidental Death Common Carrier Children 40 000 Accidental Dismemberment Both Feet 100 000 Accidental Dismemberment Both Hands 100 000 Accidental Dismemberment One Foot 15 000 Accidental Dismemberment One Hand 15 000 Accidental Dismemberment Thumb and Index Finger of the same Hand 7 500 Coma 7 or more consecutive days 20 000 Home Alterations and Automobile Modifications 2 000 Loss of Use Hearing one ear 15 000 Loss of Use Hearing both ears 100 000 Loss of Use Sight of one Eye 15 000 Loss of Use Sight of both Eyes 100 000 Loss of Use Speech 100 000 Paralysis Uniplegia 15 000 Paralysis Hemiplegia 100 000 Paralysis Paraplegia 100 000 Paralysis Triplegia 100 000 Paralysis Quadriplegia 100 000 Accident Hospital Benefits These benefits can help with medical costs related to a hospital stay for a covered accident including costs that your health insurance may not cover Accident hospital benefits are available to you with group accident coverage as well as all your covered family members Talk with your benefits counselor about the level of accident hospital benefits available to you Benefits are per covered person per covered accident unless stated otherwise BENEFITS PREMIER Hospital Admission 1 500
BENEFITS PREMIER Hospital Admission ICU 2 500 Hospital Confinement Daily Stay Maximum of 365 days per Insured per Covered Accident 350 Hospital ICU Confinement Daily Stay Maximum of 15 days per Insured per Covered Accident 600 Hospital Sub Acute ICU Confinement Daily Stay Maximum of 30 days per Insured per Covered Accident 500 Short Stay 8 to less than 20 hours 200 Active Lifestyles Benefits This benefit increases the amount you receive by 20 for your covered eligible benefits giving you more financial protection for the unexpected The active lifestyles benefit is available to you with group accident coverage as well as all your covered family members ELIGIBLE BENEFITS Concussion Fractures surgical repair Connective tissue damage General surgery abdominal thoracic cranial exploratory Connective tissue surgery Knee cartilage meniscus injury Dislocations Knee cartilage meniscus surgery Dislocations surgical repair Lacerations Emergency dental repair Medical imaging Eye injury Ruptured or herniated disc Eye surgery Ruptured or herniated disc surgery Fractures X ray or ultrasound Active lifestyles benefit applies to any combination of these injuries or services due to a covered accident Building Benefit This benefit can increase the value of your accident coverage the longer you keep it by increasing the amount you receive for covered eligible benefits giving you more financial protection for the unexpected The building benefit is available to you with group accident coverage as well as all your covered family members The building benefit applies to benefits for injury fractures and dislocations treatment surgery and recovery care due to a covered accident as described in the certificate of coverage Additional benefits may be eligible for the building benefit to apply Refer to the certificate of coverage for a complete list of covered benefits OF MONTHS COVERED BENEFITS INCREASE 13 36 months 5 37 60 months 10 61 months 15 Building benefit applies to any combination of these injuries or services due to a covered accident This benefit is payable once per insured per covered accident
Wellbeing Assistance Benefit This benefit can help reduce the risk of serious illness through early detection of disease or other risk factors giving you more protection from the unexpected The wellbeing assistance benefit is available to you with group accident coverage as well as all your covered family members WELLBEING ASSISTANCE BENEFIT Payable once per covered person per calendar year subject to a 30 day waiting period 50 COVERED TESTS Blood test for triglycerides Bone marrow testing BRCA1 or BRCA2 testing Breast ultrasound CA 15 3 blood test for breast cancer CA125 blood test for ovarian cancer Carotid doppler CEA blood test for colon cancer Chest x ray Colonoscopy Echocardiogram ECHO Electrocardiogram EKG ECG Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA blood test for prostate cancer Serum cholesterol test to determine level of HDL and LDL Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy
Accident Coverage Benefits The following benefits are payable once per covered person for each covered accident unless otherwise noted PREMIER Injury Benefits 2nd Degree Burns At least 5 but less than 20 of skin surface 750 2nd Degree Burns 20 or greater of skin surface 1 500 3rd Degree Burns Less than 5 of skin surface 3 000 3rd Degree Burns At least 5 but less than 20 of skin surface 10 000 3rd Degree Burns 20 or greater of skin surface 21 000 Concussion or Acquired Brain Injury 500 Connective Tissue Damage One Connective Tissue 100 Connective Tissue Damage Two or more Connective Tissues 200 Eye Injury 400 Hearing Loss Injuries Once per lifetime per year per Insured 120 Injury due to Auto Accident 250 Internal Injuries 200 Knee Cartilage Meniscus Injury 200 Lacerations No Repair 75 Lacerations Repair Less than 2 inches 150 Lacerations Repair At least 2 inches but less than 6 inches 600 Lacerations Repair 6 inches or greater 1 200 Loss of a Digit Partial Partial Dismemberment of one finger or toe 400 Loss of a Digit Partial Partial Dismemberment of two or more fingers or toes 800 Loss of a Digit One Digit except a Thumb or Big Toe 1 000 Loss of a Digit One Digit a Thumb or Big Toe 1 500 Loss of a Digit Two or more Digits 3 000 Ruptured or Herniated Disc One Disc 200 Ruptured or Herniated Disc Two or more Discs 400 Fractures and Dislocation Benefits Maximum of two times the combined total amount for the bone with the highest benefit amount across Fractures and Dislocation and corresponding Surgical Repair benefits Fractures Ankle including malleus and lower tibia or fibula 1 200 Fractures Bones of the Face or Nose except mandible or maxilla 1 295 Fractures Coccyx Sacrum 420 Fractures Collarbone clavicle sternum 1 200 Fractures Finger 200 Fractures Foot or Heel except toes 1 200 Fractures Forearm radius or ulna 1 200 Fractures Hand except fingers 1 200
PREMIER Fractures Hip 4 200 Fractures Kneecap patella 1 200 Fractures Leg mid to upper tibia and or fibula 2 400 Fractures Lower Jaw mandible except alveolar process 1 200 Fractures Pelvis includes ilium ischium pubis acetabulum except coccyx 3 225 Fractures Rib 500 Fractures Shoulder Blade scapula 1 200 Fractures Skull Depressed Skull fracture except bones of face or nose 5 000 Fractures Skull Non depressed Skull fracture except bones of face or nose 2 400 Fractures Thigh femur 4 200 Fractures Toe 200 Fractures Upper Arm between Elbow and Shoulder humerus 1 400 Fractures Upper Jaw maxilla except alveolar process 1 400 Fractures Vertebrae body of except vertebral processes 3 600 Fractures Vertebral Processes 810 Fractures Wrist except fingers 1 200 Fractures Chip fracture Payable as a of the applicable Fractures benefit 25 Dislocations Ankle 1 600 Dislocations Bone or Bones of the Foot except toes 1 600 Dislocations Bone or Bones of the Hand except fingers 1 050 Dislocations Collarbone acromioclavicular and separation 280 Dislocations Collarbone sternoclavicular 1 100 Dislocations Elbow 600 Dislocations Finger 260 Dislocations Hip 4 000 Dislocations Knee except patella 2 000 Dislocations Lower Jaw 990 Dislocations Shoulder glenohumeral 1 200 Dislocations Toe 260 Dislocations Wrist 750 Dislocations Incomplete dislocation Payable as a of the applicable Dislocations benefit 25 Treatment Benefits Air Ambulance 2 000 Ambulance Ground or Water 400 Durable Medical Equipment Tier 1 65 Durable Medical Equipment Tier 2 125
PREMIER Durable Medical Equipment Tier 3 250 Emergency Dental Repair Dental Crown Denture or Implant 600 Emergency Dental Repair Dental Extraction Filling or Chip Repair 200 Emergency Department Calendar Year Maximum 250 4 Family Care One benefit per day for all Insureds combined regardless of the number of Children up to a maximum of three days per Covered Accident 50 Injections to Prevent or Limit Infection 50 Lodging 30 days per Covered Accident 250 Medical Imaging 400 Pain Management Injections 150 Pet Boarding One benefit per day for all Insureds combined regardless of the number of pets up to a maximum of three days per Covered Accident 20 Prosthetic Device or Artificial Limb One Device or Limb 1 750 Prosthetic Device or Artificial Limb Two or more Devices or Limbs 3 500 Skin Grafts Due to Burns Payable as a of the applicable Burn benefit 50 Skin Grafts Not due to Burns Less than 20 of skin surface 375 Skin Grafts Not due to Burns 20 or greater of skin surface 750 Transfusions 500 Transportation 200 Treatment in a Physician s Office or Urgent Care Facility Calendar Year Maxium 150 4 X Rays or Ultrasound 60 Surgery Benefits Anesthesia Epidural or Regional Anesthesia 150 Anesthesia General Anesthesia 300 Connective Tissue Exploratory without Repair 150 Connective Tissue Repair for One Connective Tissue 1 100 Connective Tissue Repair for Two or more Connective Tissues 2 200 Eye Surgery 400 Surgical Repair Dislocations Payable as a of the applicable Injury benefit 100 Surgical Repair Fractures Payable as a of the applicable Injury benefit 100 General Surgery Abdominal Thoracic or Cranial 2 000 General Surgery Exploratory 275 Hernia Surgery 400
PREMIER Knee Cartilage Meniscus Surgery Exploratory without Repair 150 Knee Cartilage Meniscus Surgery Knee Cartilage Meniscus with Repair 1 050 Outpatient Surgical Facility 400 Ruptured or Herniated Disc Surgery Exploratory without Repair 150 Ruptured or Herniated Disc Surgery Repair for One Disc 1 000 Ruptured or Herniated Disc Surgery Repair for Two or more Discs 2 000 Recovery Care Benefit At Home Care Five days per Covered Accident 125 Physician Follow Up Visits Max Per Covered Accident Max Per Calendar Year 50 4 24 Rehabilitation or Sub Acute Rehabilitation Unit Confinement 15 days per Covered Accident 200 Therapy Services Speech Physical Therapy Occupational Respiratory and Vestibular Therapy Additional Therapy Services included in the base plan Cognitive Communication Therapy Cognitive Rehabilitation Therapy Community Reintegration Services Neurobehavioral Neurocognitive Therapy and Rehabilitation Neurofeedback Therapy Neurophysiological Neuropsychological Post acute Transition Services Psychophysiological Testing or Treatment and Remediation 15 days per Covered Accident 55 Additional Benefits Benefit Booster 5 000 in Payable Claims Contact your Colonial Life benefits counselor to learn more about accident insurance 500 Scan the code to the right to see how accident insurance can help you or go to ColonialLife com ee accident
EXCLUSIONS AND LIMITATIONS Accident plans will not provide benefits for a claim that is caused by contributed to by or resulting from any of the following Elective procedures Felonies or illegal occupations Hazardous avocations Impaired driving Incarceration Racing Semi professional or professional sports Sickness Suicide or self inflicted injuries War or armed conflict The definition of hospital does not include certain facilities HEALTH SAVINGS ACCOUNT HSA COMPATIBLE This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate It may also be offered to employees who do not have HSAs THIS INSURANCE PROVIDES LIMITED BENEFITS THIS IS AN EXCEPTED BENEFITS POLICY IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY This coverage is a supplement to health insurance It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this insurance This information is not intended to be a complete description of the insurance coverage available The insurance or its provisions may vary or be unavailable in some states The insurance has exclusions and limitations which may affect any benefits payable Applicable to policy form GAC4100 P and certificate form GAC4100 C including state abbreviations where used for example GAC4100 P TX and GAC4100 CTX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company An insurance producer may be in contact with you Underwritten by Colonial Life Accident Insurance Company Columbia SC ColonialLife com 2024 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing FOR EMPLOYEES 8 24 NS 2149804 brand of Colonial Life Accident Insurance Company
Hospital Indemnity Insurance How will you pay for what your health insurance won t cover No matter how well you plan you can t predict when sudden medical expenses could impact your way of life If you re admitted to the hospital for a covered accident or covered sickness Group Medical Bridge SM Colonial Life s hospital indemnity insurance could help pay for out of pocket costs One family s journey Nathan was doing yard work with his wife when his chest pains began After an emergency room visit the couple was relieved to learn it was a false alarm A few weeks later Nathan had a follow up appointment with his family doctor Nathan s Group Medical Bridge benefits helped pay for the out of pocket expenses associated with his medical care NATHAN S OUT OF POCKET EXPENSES Emergency room co pay Deductible Doctor s visit co pay Coinsurance 100 1 500 25 1 800 3 425 NATHAN S BENEFITS To learn more contact Emergency room visit 100 Diagnostic procedure 250 Hospital confinement 1 500 Doctor s office visit 25 Only 37 of Americans would have enough savings to pay an unexpected expense of around 1 000 Bankrate com Survey How Americans Contend with Unexpected Expenses Jan 6 2016 1 875 ColonialLife com NS 15574 Plan 2 This is an example and does not represent your actual plan benefits Cost of treatment benefits and benefit amounts may vary Benefits may not cover all expenses The policy has exclusions and limitations GROUP MEDICAL BRIDGE GMB7000
Hospital Indemnity Insurance These benefits are available for you your spouse and eligible dependent children Basic benefits Hospital confinement 1 000 per day 2 000 per day Waiver of Premium Available after 30 continuous days of a covered confinement of the named insured Maximum of one day per covered person per calendar year Additional benefits This brochure provides an overview of the plan For complete details refer to your certificate Daily hospital confinement 100 per day Maximum of 365 days per covered person per confinement Diagnostic procedure 250 per day Maximum of one day per covered person per calendar year Outpatient surgical procedure 500 per day 1 000 per day Maximum of 1 500 per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedure Diagnostic and outpatient procedures The following procedures are a sampling of the procedures that may be covered Surgical procedures must be performed by a doctor in a hospital or ambulatory surgical center Diagnostic procedures Breast Biopsy incisional needle stereotactic Cardiac Angiogram Arteriogram Thallium stress test Transesophageal echocardiogram TEE Diagnostic radiology Computerized tomography CT scan Electroencephalogram EEG Magnetic resonance imaging MRI Myelogram Nuclear medicine test Positron emission tomography PET scan Digestive Barium enema lower GI series Barium swallow upper GI series Esophagogastroduodenoscopy EGD Ear nose throat mouth Laryngoscopy Gynecological Amniocentesis Cervical biopsy Cone biopsy Endometrial biopsy Hysteroscopy Loop electrosurgical excisional procedure LEEP Liver Biopsy Lymphatic Biopsy Miscellaneous Bone marrow aspiration biopsy Renal Biopsy Respiratory Biopsy Bronchoscopy Pulmonary function test PFT Skin Biopsy Excision of lesion Thyroid Biopsy Urologic Cystoscopy Tier 1 outpatient surgical procedures Breast Axillary node dissection Lumpectomy Cardiac Pacemaker insertion Digestive Colonoscopy Hemorrhoidectomy Ear nose throat mouth Adenoidectomy Tonsillectomy Gynecological Dilation and curettage D C Endometrial ablation Liver Paracentesis Musculoskeletal Carpal cubital repair or release Foot surgery Skin Skin grafting Colonoscopy must result in polyp removal or be recommended by a physician for the purposes of treating or diagnosing a sickness Tier 2 outpatient surgical procedures Breast Breast reconstruction Breast reduction Cardiac Angioplasty Cardiac catheterization Digestive Exploratory laparoscopy Laparoscopic appendectomy Ear nose throat mouth Ethmoidectomy Mastoidectomy Eye Cataract surgery Glaucoma surgery Gynecological Hysterectomy Myomectomy Musculoskeletal Arthropscopic knee surgery with knee cartilage repair Fracture Thyroid Excision of a mass Urologic Lithotripsy EXCLUSIONS AND LIMITATIONS THIS POLICY PROVIDES LIMITED BENEFITS PRE EXISTING CONDITION LIMITATION We will not pay benefits for Hospital Confinement or any of the following benefit s for any covered person when such loss results from a preNS 15574 Plan 2 4 21 NS 15574
existing condition as defined in this certificate unless the covered person has satisfied the pre existing condition limitation period shown on the Certificate Schedule Rehabilitation Unit Confinement Specified Critical Illness Daily Hospital Confinement Outpatient Surgical Procedure Inpatient Mental and Nervous Diagnostic Procedure GENERAL EXCLUSIONS We will not pay any benefits for injuries received in accidents or for sicknesses which are caused by contributed to by or occur as a result of the covered person s Being intoxicated or under the influence of any narcotics unless administered on the advice of his doctor or physician Treatment for dental care or dental procedures unless treatment is the result of a covered accident Undergoing elective procedures or cosmetic surgery This includes procedures or hospital confinement for complications arising from elective or cosmetic surgery This does not include congenital birth defects or anomalies of a child or reconstructive surgery Committing or attempting to commit a felony or engaging in an illegal occupation Having a disorder including but not limited to affective disorders neurosis anxiety stress and adjustment reactions Alzheimer s Disease and other organic senile dementias are not considered mental or nervous disorders This exclusion does not apply to the Inpatient Mental and Nervous benefit if included Dependent child s pregnancy including services rendered to her child after birth Committing or trying to commit suicide or his injuring himself intentionally whether he is sane or not Being exposed to war or any act of war declared or undeclared or serving in the armed forces of any country or authority Losses as a result of acts of terrorism or nuclear release committed by individuals or groups will not be excluded from coverage unless the covered person who suffered the loss committed the act of terrorism or nuclear release HOSPITAL CONFINEMENT LIMITATIONS We will not pay benefits for hospital confinement or daily hospital confinement due to any covered person giving birth within the first nine 9 months after the coverage effective date of the certificate as a result of a normal pregnancy including cesarean Complications of pregnancy will be covered to the same extent as any other covered sickness WELL BABY CARE LIMITATION We will not pay benefits for hospital confinement or daily hospital confinement if included of a newborn child following his birth unless he is injured or sick This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P 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 4 21 NS 15574
Group Critical Illness Insurance You can t predict an illness but you can be prepared No matter where you are in life you never know when you or a loved one could have a sudden illness Fortunately medical advancements and early detection are helping many people survive critical illnesses These technologies and tests can lead to increased medical expenses With health insurance only covering some of these costs an unexpected illness could make it difficult for you to pay your regular monthly bills such as housing utilities and child care Critical illness insurance from Colonial Life helps supplement 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 Key benefits Available coverage for spouse and eligible dependent children at 50 of your coverage amount Cover your eligible dependent children at no additional cost Receive coverage regardless of medical history within specified limits Works alongside your health savings account HSA Benefits payable regardless of other insurance ColonialLife com 2 22 NS 451564 GCI6000 CRITICAL ILLNESS AND CANCER
Group Critical Illness Insurance Preparing for a lifelong journey Rebecca was born with Down syndrome Her parents critical illness coverage provided a benefit that can help cover expenses related to Rebecca s care and her changing needs HOW THEIR COVERAGE HELPED The lump sum amount from the family coverage benefit helped pay for Plan 2 When life takes an unexpected turn due to a critical illness diagnosis your focus should be on recovery not finances Colonial Life s group critical illness insurance helps provide financial support by providing a lump sum benefit payable directly to you for your greatest needs Coverage amount ____________________________ Critical illness and cancer benefits PERCENTAGE OF APPLICABLE COVERAGE AMOUNT COVERED CRITICAL ILLNESS CONDITION 100 100 100 100 100 100 100 100 Benign brain tumor Coma End stage renal kidney failure Heart attack myocardial infarction Loss of hearing A hospital stay and treatment for corrective heart surgery Physical therapy to build muscle strength Loss of sight Loss of speech Major organ failure requiring transplant Occupational infectious HIV or occupational infectious hepatitis B C or D Stroke 100 100 100 25 Sudden cardiac arrest Coronary artery disease Special needs daycare For illustrative purposes only PERCENTAGE OF APPLICABLE COVERAGE AMOUNT COVERED CANCER CONDITION Invasive cancer including all breast cancer 100 Non invasive cancer 25 Skin cancer initial diagnosis 400 per lifetime Subsequent diagnosis of a different critical illness2 If you receive a benefit for a critical illness and are later diagnosed with a different critical illness 100 of the coverage amount may be payable for that particular critical illness Subsequent diagnosis of the same critical illness2 If you receive a benefit for a critical illness and are later diagnosed with the same critical illness 3 25 of the coverage amount is payable for that critical illness Reoccurrence of invasive cancer including all breast cancer If you receive a benefit for invasive cancer and are later diagnosed with a reoccurrence of invasive cancer 25 of the coverage amount is payable if treatment free for at least 12 months and in complete remission prior to the date of reoccurrence excludes non invasive or skin cancer 1 R efer to the certificate for complete definitions of covered conditions 2 Dates of diagnoses of a covered critical illness must be separated by more than 180 days 3 Critical illnesses that do not qualify include coronary artery disease loss of hearing loss of sight loss of speech and occupational infectious HIV or occupational infectious hepatitis B C or D 2 22 NS 451564 Additional covered conditions for dependent children COVERED CONDITION Cerebral palsy Cleft lip or palate Cystic fibrosis Down syndrome Spina bifida PERCENTAGE OF APPLICABLE COVERAGE AMOUNT 100 100 100 100 100
Group Critical Illness Insurance Wellbeing Assistance Benefit The wellbeing assistance benefit can help reduce the risk of serious illness through early detection of disease or risk factors Wellbeing assistance benefit 100 Maximum of one test per covered person per calendar year subject to a 30 day waiting period before the benefit is payable The test must be performed after the waiting period 2 22 NS 451564 Blood test for triglycerides Bone marrow testing BRCA1 or BRCA2 testing genetic test for breast cancer Breast ultrasound 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 Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA blood test for prostate cancer Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis blood test for myeloma Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy GCI6000 WELLBEING ASSISTANCE BENEFIT
Group Critical Illness Insurance First Diagnosis Building Benefit Rider The first diagnosis building benefit rider provides a lump sum payment in addition to the coverage amount when you are diagnosed with a covered critical illness or invasive cancer including all breast cancer This benefit is for you and all your covered family members Payable once per covered person per lifetime Named insured Accumulates 1 000 each year Covered spouse dependent children Accumulates 500 each year The benefit amount accumulates each rider year the rider is in force before a diagnosis is made up to a maximum of 10 years If diagnosed with a covered critical illness or invasive cancer including all breast cancer before the end of the first rider year the rider will provide one half of the annual building benefit amount Coronary artery disease is not a covered critical illness Non invasive and skin cancer are not covered cancer conditions 2 22 NS 451564 GCI6000 FIRST DIAGNOSIS BUILDING BENEFIT RIDER
Deductions per year 12 These rates were prepared on 5 28 2025 and are valid for 90 days Group Accident GAC4100 for TX Applicable to policy forms GAC4100 P GAC4100 C l Additional Benefits Accident Hospital Benefits Premier Active Lifestyles Wellbeing Assistance Standard 50 Building Benefit On Off Job Accident Coverage BENEFIT LEVEL AD D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENT CHILD REN EMPLOYEE SPOUSE AND DEPENDENT CHILD REN Premier Premier 21 39 34 09 47 05 60 00 17 99 Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD Group Critical Illness GCI6000 for TX l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 100 Benefit First Diagnosis Building Benefit Non Tobacco Rates 10 000 20 000 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 12 50 15 30 18 20 24 32 30 44 39 91 49 27 60 50 76 42 88 02 88 02 16 50 21 00 25 70 35 82 45 94 62 01 77 87 98 10 127 72 150 92 150 92 18 74 22 96 27 18 36 51 45 75 60 45 75 15 92 21 116 37 134 17 134 17 24 44 31 26 38 08 53 51 68 75 93 65 118 55 149 31 194 27 229 87 229 87 12 50 15 30 18 20 24 32 30 44 39 91 49 27 60 50 76 42 88 02 88 02 16 50 21 00 25 70 35 82 45 94 62 01 77 87 98 10 127 72 150 92 150 92 18 74 22 96 27 18 36 51 45 75 60 45 75 15 92 21 116 37 134 17 134 17 24 44 31 26 38 08 53 51 68 75 93 65 118 55 149 31 194 27 229 87 229 87 Page 1 of 4 Underwritten by Colonial Life Accident Insurance Company See page 3 for Important Notice
Continued Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD Group Critical Illness GCI6000 for TX l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 100 Benefit First Diagnosis Building Benefit Non Tobacco Rates 35 000 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 22 50 29 55 36 95 53 07 69 19 95 16 120 77 154 50 204 67 245 27 245 27 32 99 43 71 54 43 79 01 103 25 143 45 183 65 234 96 311 12 373 42 373 42 22 50 29 55 36 95 53 07 69 19 95 16 120 77 154 50 204 67 245 27 245 27 32 99 43 71 54 43 79 01 103 25 143 45 183 65 234 96 311 12 373 42 373 42 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 16 02 20 57 25 12 34 92 44 71 59 80 74 79 92 75 118 21 136 81 136 81 22 42 29 77 37 12 53 32 69 51 95 10 120 49 152 85 200 21 237 41 237 41 23 75 30 54 37 34 52 11 66 99 90 49 113 99 141 37 180 04 208 34 208 34 32 85 43 84 54 84 79 21 103 79 143 59 183 39 232 77 304 74 361 34 361 34 16 02 20 57 25 12 34 92 44 71 59 80 74 79 92 75 118 21 136 81 136 91 22 42 29 77 37 12 53 32 69 51 95 10 120 49 152 85 200 21 237 41 237 61 23 75 30 54 37 34 52 11 66 99 90 49 113 99 141 37 180 04 208 34 208 44 32 85 43 84 54 84 79 21 103 79 143 59 183 39 232 77 304 74 361 34 361 54 Tobacco Rates 10 000 20 000 Page 2 of 4 Underwritten by Colonial Life Accident Insurance Company See page 3 for Important Notice
Continued Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD Group Critical Illness GCI6000 for TX l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 100 Benefit First Diagnosis Building Benefit Tobacco Rates 35 000 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 32 02 43 57 55 12 80 92 106 71 148 05 189 04 243 00 323 21 388 31 388 31 46 50 63 79 81 09 119 86 158 99 223 24 287 49 369 87 491 79 590 84 590 84 32 02 43 57 55 12 80 92 106 71 148 05 189 04 243 00 323 21 388 31 388 66 46 50 63 79 81 09 119 86 158 99 223 24 287 49 369 87 491 79 590 84 591 19 Group Medical Bridge GMB7000 for TX Age Banded Applicable to Policy Forms GMB7000 P GMB7000 C l Without Wellbeing Assistance Outpatient Surgical Procedure Option 1 500 1000 1500 Diagnostic Procedure Option 1 250 Daily Hospital Confinement HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY Level 2 1000 17 49 50 59 60 64 65 99 23 50 33 20 43 35 60 45 44 25 65 65 88 40 123 70 36 20 45 90 56 05 73 15 56 95 78 35 101 10 136 40 HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY Level 4 2000 17 49 50 59 60 64 65 99 32 90 45 40 60 45 84 45 61 15 89 85 124 00 173 60 49 60 62 10 77 15 101 15 77 85 106 55 140 70 190 30 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 2025 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 Page 3 of 4 Underwritten by Colonial Life Accident Insurance Company See page 3 for Important Notice
The Problem Your benefits strategy is only as good as your employees ability to navigate it And the truth is most employees don t navigate it well leading to poor utilization and rising claims Healthcare costs for U S employers are expected to rise 9 from 2025 to 2026 driven by expensive drugs hidden prices low health literacy and billing markups Employers must act now to control costs while still delivering high value competitive benefits The Solution The Healthcare Navigator Endorsed by the National Patient Advocacy Foundation and Mark Cuban s Cost Plus Drugs Company The Healthcare Navigator is a comprehensive healthcare concierge platform designed to empower employees to take control of their healthcare spending Our comprehensive 10 in 1 solution includes local hospital cost comparisons quality metrics for providers medical bill negotiation AI affordable labs and prescriptions a 24 7 digital personal health advisor and more Results and Impact Empower your employees to make informed healthcare decisions with convenient healthcare navigation all from their phone Easily cut unnecessary costs and while steering your employees decisions and lightening your HR benefits workload Save Time for HR Our platform eases HR s workload by directing employees to The Healthcare Navigator for healthcare guidance while reducing expenses Reduce Employer Costs Slash claims through using our employee steerage platform that saves an average of 4 678 per engaged employee Employers see a reduction in claims of up to 30 with The Healthcare Navigator Positive Impact on Employees 91 of users report a positive influence on their healthcare decision making driving better care outcomes and lowering their stress in nav Impressive Engagement 61 72 open rate among engaged users every 2 months
What Your Employees Get with The Healthcare Navigator 1 Nurse Navigation For employees who would rather talk to our nurse navigators than use our app our team is ready to help your employees get the cost effective quality care they need 2 Benefit Questions Answered Instantly Employees can ask our Benefit Manager AI anything about their health plan and get instant accurate answers no confusion no digging 3 Cut Procedure Costs with Cost Compass Help employees compare procedure prices and avoid low quality care by navigating them to high performing hospitals using quality scores and pricing data 4 Lower Bills with Care Genius AI Automatically identify billing errors and negotiate medical bills saving employees thousands with zero lift from your HR team 5 Find Top Doctors with Pocket Doc Let employees easily search for high quality providers that have cost effective procedure prices 6 Mental Health Support with Lumimind Employees can access AI driven therapy or live therapists to manage stress burnout and anxiety boosting well being and productivity 7 Health Literacy Training Employees can access important health literacy training videos to improve their abillity to navigate the healthcare system like a professional 8 Boost Engagement We drive usage through proactive outreach text email app alerts and nurse support so your team actually uses the benefit 9 55 70 Off Labs Medications Thanks to our partnerships with low cost PBMs and labs employees save instantly on essential services and prescriptions cutting claim costs fast 10 Stay Informed in Minutes Quick reads on healthcare trends keep employees and HR up to date without the overwhelm Optional Add Ons Fast Pass Doctor Access Get employees into top rated local doctors within 48 hours no long waits In Person Therapy Add live virtual therapy sessions with licensed therapists if preferred Weight Loss Program A full service solution lab testing nutritionist personal trainer and effective compound meds all tailored for real results
How can Why my claim still be won t in process I called my they pay insurance my claim It s been two carrier but now months Services I m just more denied confused Do I have mail order prescription benefits Call the Benefit Resource Center BRC We re Here To Help We speak insurance Our Benefits Specialists can help you with Deciding which plan is the best for you Medicare basics with your employer plan Benefit plan policy questions Coordination of benefits Eligibility claim problems with carriers Finding in network providers Information about claim appeals process Access to care issues Allowable family status election changes Obtaining case management services Transition of care when changing carriers Group disability claims Claim escalation appeal resolution Filing claims for out of network services Benefit Resource Center BRC Southwest usi com Toll Free 855 874 0110 Monday through Friday 8 00am to 5 00pm Eastern Central Standard Time