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E mployee Benefits GuideDecember 2024– November 2025EligibilityAll full-time employees are eligible to enroll in the employee benefits outlined in this guide. If you are a newlyhired employee, you become eligible for benefits 1st of the month following your 30thday of full timeemployment. Employees may also enroll their spouse and any dependent children up to the age of 26 in thebenefits they elect. If a dependent child turns 26 during the plan year, he or she will automatically be removedfrom the benefits at the end of their birth month as they are no longer eligible. For questions on dependentchildren Eligibility, please visithttps://www.healthcare.gov/young-adults/children-under-26/.Open EnrollmentWe are moving to Aetna for Medical and renewing with Humana for Dental, Vision. We will also continueoffering VOLUNTARY SUPPLEMENTAL benefits through Colonial. Open Enrollment is from November 15th–November 22nd. To get enrolled this year, all eligible employees may speak to a Benefits Counselor. BenefitCounselors will be available VIRTUALLY to meet with each employee individually and review all benefitoptions.Schedule a meeting with a Benefit Counselor by clickingHERE or scanning QR code:Elections must be made no later than November 22nd. This is an active enrollment which means allemployees must speak to a Benefits Counselor and either elect or decline each line of coverage as weare changing our medical insurance carrier. You must speak to a counselor and elect/decline coverageeven if you are not making any changes. You cannot make a mid-year change to your benefits unless youhave a qualifying life event, so now is the time to evaluate the needs of your family.Qualifying Life EventIf you have a qualifying life event during the plan year, you have 30 days from the date of the event to notifyHR of any changes that need to be made to your benefit coverages. Examples of a qualifying life event includemarriage, divorce, birth, or adoption of a child, change in child’s dependent status, or death.Contents:Page 2 – Benefit ConciergePage 3 – Medical Benefits (Aetna)Page 4 - Money Saving TipsPage 5 – Dental & Vision (Humana)Page 6 – Voluntary Supplemental Products (Colonial) Message
E mployee Benefits GuideDecember 2024– November 2025At Triple C Project Services, we strive to provide our valued employeeswith the most exceptional of benefits. One of the value-added features ofour benefit program is that it comes with a Personal Concierge.Your benefits are provided to through a firm called “AssuredPartners.”As part of their relationship, they provide a Dedicated Account Managerto assist staff with any insurance related issues, questions, or concerns.The moment you discover there is any issue or have any questions,please contact them!The sooner you can get your account manager involved, the faster theissue can be addressed, and questions can be answered.
E mployee Benefit GuideDecember 2024– November 2025The benefit descriptions shown below are partial summaries. Consult the certificate of coverage and oficial summary for further details..Web: www.Aetna.comGroup Number: TBDMedical PlansPlease note:- M andatory Generic / Step Therapy / Maintenance drugs- after two retail fills, you are required to fill a 90-day supplyat CVS Caremark® M ail Service Pharmacy or CVS Pharmacy.- Your plans are EPO’s. They work just like PPO plans. However, you must go to providers “ in-network.” Life threatingevents are treated as “ in-network.” There is no coverage in Alaska or Hawaii.Buy Up Plan / Opt. 3Aetna AFA OAAS 2500 100%$0LXR CY V24 EPOMid Plan / Opt. 2:Aetna AFA OAAS 3000 100%$0LXR CY V24 EPOBase Plan / Opt. 1Aetna AFA OAAS 7350 100% IntRXCY V24 EPOBasic Benefit OverviewOAAS NetworkOAAS NetworkOAAS NetworkNetwork$2,500 / $5,000$3,000 / $6,000$7,350 / $14,700Annual Deductible (Single/Family)$6,000 / $12,000$6,500 / $13,000$9,100 / $18,200Annual Out-of-Pocket Limit(Single/Family)100% / 0%100% / 0%100% / 0%CoinsuranceNo CostNo CostNo CostRoutine Preventive Care Visit$25$35$40Primary Care Office Visit$75$75$80 After DeductibleSpecialist Office Visit0% After Deductible0% After Deductible$250 Copay + 0% After DeductibleOutpatient Surgery and Facility Charge0% After Deductible0% After Deductible0% After DeductibleMajor Diagnostic Testing0% After Deductible0% After Deductible$500 Copay + 0% After DeductibleInpatient Hospitalization(Facility/Physician)Emergency Services$300 + 0% After Deductible$300 + 0% After Deductible$500 Copay + 0% After DeductibleEmergency Room$75$75 Copay$100 CopayUrgent CareOffice Visit CopayOffice Visit CopayOffice Visit CopayTelehealthPrescription Drugs 2 x’s Copay for 90 Day Supply$3 / $10$3 / $10$3 / $10Preferred Generic (Tier 1A / Tier 1)$45$45$50 After DeductiblePreferred Brand$75$75$80 After DeductibleNon-Preferred Gen/Brand20% up to $250 / 40% up to $50020% up to $250 / 40% up to$50020% up to $250 After Deductible /40% up to $500 After DeductibleSpecialty (Preferred/Non-Preferred)Cost per Paycheck*$74.05$69.52$50.75Employee Only$192.93$179.10$125.21Employee + Spouse$152.94$142.23$100.16Employee + Child(ren)$266.82$247.20$171.48Employee + Family
E mployee Benefits GuideDecember 2024 – November 2025Money Saving Tips:1. Always make sure your doctor and facility where you areseeking medical services are both in-network.2. Know when to go where:1. Emergency Room visits are for life-threateningemergencies only (ex: seizures, major blood loss,compound fractures, head injury)2. Urgent care is for urgent but not life-threateningconcerns (ex: a few stitches)3. Primary Care Doctor is for sickness that cannot bediagnosed via telemedicine (ex: strep throat, sprain)3. Telemedicine allows you to speak with a doctor over thephone within minutes and can be used to treat severalconditions, such as the flu, earache, sinus infections,allergies, etc. If you aren’t sure, start here!4. When filling a prescription, ask for generic or over-the-counter equivalent. Note: if you’ve seen a commercial forthat drug, it is most likely a specialty and will cost you.
.Web: www.Humana.comGroup Number: 808675Phone Number: 800-233-4013Humana Dental PPOBasic Benefit Overview$50Annual Deductible/Individual$150Annual Deductible/FamilyUnlimitedAnnual Plan Maximum (per person)Type I100%Preventive ServicesType II80% after DeductibleBasic Services (Fillings, Simple Extractions)Type III50% after DeductibleMajor Services (Bridges, Dentures)Type IVNot CoveredOrthodontia (Child Only)Cost Per Pay-Check$6.77Employee Only$13.54Employee + Spouse$17.27Employee + Child(ren)$24.04Employee + FamilyE mployee Benefits GuideDecember 2024– November 2025Humana Voluntary Dental PlanCost Per Pay-Check$2.38Employee Only$4.76Employee + Spouse$4.53Employee + Child(ren)$7.11Employee + FamilyHumana Voluntary Vision Plan 130Web: www.Humana.comGroup Number: 808675Phone Number: 877-398-2980VisionBasic Benefit Overview$10Exams every 12 months$15Lenses every 12 months$130 Allowance(20% off additional balance)Frames every 24 months$130 AllowanceContacts every 12 months*
Deductions per year: 52Individual Disability - ISTD3000 for TX AA Risk ClassApplicable to policy form Individual DisabilitylOff Job Accident & Off Job Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $700* $1,000* $2,000* $4,000* $6,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $4.44 $6.35 $12.69 $25.38 N/A50-64 $5.10 $7.29 $14.58 $29.17 N/A65-74 $6.19 $8.84 $17.68 $35.35 N/A14 days Accident/14 days Sickness 17-49 $2.89 $4.13 $8.26 $16.52 $26.8550-64 $3.51 $5.01 $10.02 $20.03 $32.5565-74 $4.36 $6.23 $12.46 $24.92 $40.506 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $700* $1,000* $2,000* $4,000* $6,500**monthly benefit amount7 days Accident/7 days Sickness 17-49 $5.57 $7.96 $15.92 $31.85 N/A50-64 $7.35 $10.50 $21.00 $42.00 N/A65-74 $9.55 $13.64 $27.28 $54.55 N/A14 days Accident/14 days Sickness 17-49 $3.91 $5.58 $11.17 $22.34 $36.3050-64 $4.99 $7.13 $14.26 $28.52 $46.3565-74 $6.59 $9.42 $18.83 $37.66 $61.20Accident 1.0 for TXApplicable to policy forms ACCIDENT 1.0-HS and ACCIDENT1.0-NSlOn/Off-Job Accident CoverageISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYPreferred without health screening 0-80 $4.38 $5.92 $7.04 $8.58Cancer Assist for TXApplicable to policy form CanAssistlwith $50 Health Screening Benefit$5,000 Initial Diagnosis BenefitCOVERAGE LEVEL ISSUE AGE NAMED INSURED EMPLOYEE AND SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYLevel 2 17-75 $5.86 $9.34 $6.05 $9.53Level 3 17-75 $7.01 $11.78 $7.24 $12.00Individual Medical Bridge for TXApplicable to policy form Individual Medical Bridgel$1000 Hospital Confinement Benefit and Outpatient Surgical Procedure Benefit with a calendar year maximum of $1500.ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENTCHILDRENEMPLOYEE, SPOUSE ANDDEPENDENT CHILDREN17-49 $4.34 $8.25 $5.84 $9.7550-59 $6.21 $11.80 $7.70 $13.3060-64 $8.17 $15.52 $9.67 $17.0265-75 $10.50 $19.94 $12.00 $21.44Page 1 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Individual Medical Bridge for TXApplicable to policy form Individual Medical Bridgel$2000 Hospital Confinement Benefit and Outpatient Surgical Procedure Benefit with a calendar year maximum of $1500.ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENTCHILDRENEMPLOYEE, SPOUSE ANDDEPENDENT CHILDREN17-49 $7.52 $14.27 $10.41 $17.1650-59 $10.57 $20.10 $13.45 $22.9960-64 $14.13 $26.83 $17.01 $29.7165-75 $18.43 $35.01 $21.33 $37.89Critical Illness 1.0 for TXApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $1.05 $1.59 $1.05 $1.5925-29 $1.22 $1.87 $1.22 $1.8730-34 $1.40 $2.17 $1.40 $2.1735-39 $1.95 $3.00 $1.95 $3.0040-44 $2.32 $3.55 $2.32 $3.5545-49 $3.02 $4.61 $3.02 $4.6150-54 $3.85 $5.91 $3.85 $5.9155-59 $4.75 $7.27 $4.75 $7.2760-64 $5.88 $9.02 $5.88 $9.0265-70 $7.12 $10.94 $7.12 $10.94$20,000 17-24 $1.61 $2.42 $1.61 $2.4225-29 $1.93 $2.98 $1.93 $2.9830-34 $2.30 $3.58 $2.30 $3.5835-39 $3.41 $5.24 $3.41 $5.2440-44 $4.15 $6.34 $4.15 $6.3445-49 $5.53 $8.47 $5.53 $8.4750-54 $7.19 $11.05 $7.19 $11.0555-59 $8.99 $13.78 $8.99 $13.7860-64 $11.25 $17.28 $11.25 $17.2865-70 $13.75 $21.11 $13.75 $21.11$30,000 17-24 $2.16 $3.25 $2.16 $3.2525-29 $2.65 $4.08 $2.65 $4.0830-34 $3.20 $4.98 $3.20 $4.9835-39 $4.86 $7.48 $4.86 $7.4840-44 $5.97 $9.14 $5.97 $9.1445-49 $8.05 $12.32 $8.05 $12.3250-54 $10.54 $16.20 $10.54 $16.2055-59 $13.24 $20.28 $13.24 $20.2860-64 $16.63 $25.54 $16.63 $25.5465-70 $20.37 $31.29 $20.37 $31.29(Continued...)Page 2 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Critical Illness 1.0 for TXApplicable to policy form CI-1.0lwith Subsequent Diagnosis Coverage, Health Screening BenefitTobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$10,000 17-24 $1.28 $1.96 $1.28 $1.9625-29 $1.58 $2.42 $1.58 $2.4230-34 $1.98 $3.04 $1.98 $3.0435-39 $2.74 $4.20 $2.74 $4.2040-44 $3.55 $5.44 $3.55 $5.4445-49 $4.56 $6.99 $4.56 $6.9950-54 $5.74 $8.79 $5.74 $8.7955-59 $7.28 $11.19 $7.28 $11.1960-64 $8.76 $13.45 $8.76 $13.4565-70 $10.72 $16.48 $10.72 $16.48$20,000 17-24 $2.07 $3.16 $2.07 $3.1625-29 $2.67 $4.08 $2.67 $4.0830-34 $3.45 $5.33 $3.45 $5.3335-39 $4.98 $7.64 $4.98 $7.6440-44 $6.59 $10.13 $6.59 $10.1345-49 $8.62 $13.22 $8.62 $13.2250-54 $10.98 $16.82 $10.98 $16.8255-59 $14.07 $21.62 $14.07 $21.6260-64 $17.02 $26.14 $17.02 $26.1465-70 $20.95 $32.19 $20.95 $32.19$30,000 17-24 $2.85 $4.36 $2.85 $4.3625-29 $3.75 $5.74 $3.75 $5.7430-34 $4.93 $7.61 $4.93 $7.6135-39 $7.22 $11.08 $7.22 $11.0840-44 $9.64 $14.81 $9.64 $14.8145-49 $12.68 $19.45 $12.68 $19.4550-54 $16.22 $24.85 $16.22 $24.8555-59 $20.85 $32.05 $20.85 $32.0560-64 $25.28 $38.84 $25.28 $38.8465-70 $31.17 $47.91 $31.17 $47.91Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base PlanNon-Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00016 $1.55 $2.48 $2.43 $3.18 $3.9417 $1.55 $2.48 $2.43 $3.18 $3.9418 $1.55 $2.48 $2.43 $3.18 $3.9419 $1.55 $2.48 $2.43 $3.18 $3.9420 $1.55 $2.48 $2.43 $3.18 $3.94(Continued...)Page 3 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base PlanNon-Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00021 $1.55 $2.48 $2.43 $3.18 $3.9422 $1.55 $2.48 $2.43 $3.18 $3.9423 $1.55 $2.48 $2.43 $3.18 $3.9424 $1.55 $2.48 $2.43 $3.18 $3.9425 $1.55 $2.48 $2.43 $3.18 $3.9426 $1.56 $2.53 $2.43 $3.18 $3.9427 $1.58 $2.57 $2.43 $3.18 $3.9428 $1.60 $2.62 $2.43 $3.18 $3.9429 $1.62 $2.67 $2.43 $3.18 $3.9430 $1.64 $2.72 $2.43 $3.18 $3.9431 $1.67 $2.78 $2.45 $3.21 $3.9832 $1.69 $2.85 $2.49 $3.27 $4.0533 $1.72 $2.92 $2.54 $3.34 $4.1534 $1.75 $2.99 $2.59 $3.43 $4.2735 $1.77 $3.05 $2.67 $3.54 $4.4236 $1.79 $3.10 $2.78 $3.70 $4.6337 $1.81 $3.16 $2.92 $3.92 $4.9238 $1.84 $3.21 $3.10 $4.19 $5.2939 $1.86 $3.28 $3.31 $4.51 $5.7140 $1.90 $3.36 $3.56 $4.87 $6.1941 $1.94 $3.46 $3.81 $5.26 $6.7142 $1.99 $3.59 $4.09 $5.68 $7.2743 $2.06 $3.76 $4.38 $6.11 $7.8444 $2.14 $3.96 $4.69 $6.57 $8.4645 $2.23 $4.20 $5.03 $7.08 $9.1346 $2.34 $4.47 $5.40 $7.64 $9.8847 $2.46 $4.78 $5.81 $8.26 $10.7148 $2.60 $5.12 $6.27 $8.94 $11.6149 $2.75 $5.50 $6.76 $9.68 $12.5950 $2.92 $5.93 $7.28 $10.47 $13.6551 $3.11 $6.41 $7.86 $11.33 $14.8052 $3.33 $6.95 $8.49 $12.27 $16.0553 $3.58 $7.57 $9.16 $13.28 $17.4054 $3.86 $8.27 $9.89 $14.38 $18.8655 $4.16 $9.03 $10.69 $15.57 $20.4656 $4.50 $9.87 $11.58 $16.91 $22.2557 $4.87 $10.79 $12.59 $18.43 $24.2658 $5.27 $11.79 $13.75 $20.16 $26.5759 $5.71 $12.89 $15.08 $22.16 $29.2560 $6.19 $14.10 $16.61 $24.46 $32.3061 $6.72 $9.63 $18.34 $27.05 $35.76(Continued...)Page 4 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base PlanNon-Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00062 $7.31 $10.60 $20.28 $29.97 $39.6563 $7.96 $11.68 $22.45 $33.21 $43.9864 $8.67 $12.88 $24.84 $36.80 $48.7765 $9.46 $14.20 $27.48 $40.76 $54.03Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00016 $2.33 $4.44 $4.20 $5.84 $7.4817 $2.34 $4.47 $4.20 $5.84 $7.4818 $2.35 $4.49 $4.20 $5.84 $7.4819 $2.36 $4.52 $4.20 $5.84 $7.4820 $2.37 $4.54 $4.20 $5.84 $7.4821 $2.38 $4.56 $4.20 $5.84 $7.4822 $2.39 $4.59 $4.20 $5.84 $7.4823 $2.40 $4.61 $4.20 $5.84 $7.4824 $2.41 $4.64 $4.20 $5.84 $7.4825 $2.42 $4.66 $4.20 $5.84 $7.4826 $2.42 $4.68 $4.20 $5.84 $7.4827 $2.44 $4.71 $4.20 $5.84 $7.4828 $2.45 $4.73 $4.20 $5.84 $7.4829 $2.46 $4.77 $4.20 $5.84 $7.4830 $2.48 $4.81 $4.20 $5.84 $7.4831 $2.51 $4.90 $4.25 $5.91 $7.5732 $2.56 $5.02 $4.32 $6.02 $7.7333 $2.61 $5.14 $4.43 $6.18 $7.9434 $2.66 $5.26 $4.57 $6.40 $8.2335 $2.70 $5.37 $4.76 $6.68 $8.5936 $2.74 $5.47 $5.00 $7.04 $9.0737 $2.78 $5.57 $5.30 $7.50 $9.6938 $2.82 $5.67 $5.70 $8.09 $10.4839 $2.86 $5.78 $6.20 $8.84 $11.4840 $2.92 $5.92 $6.80 $9.73 $12.6741 $3.00 $6.11 $7.46 $10.73 $14.0042 $3.11 $6.38 $8.16 $11.78 $15.4043 $3.25 $6.75 $8.89 $12.88 $16.8644 $3.44 $7.21 $9.66 $14.03 $18.4045 $3.66 $7.78 $10.49 $15.27 $20.0546 $3.92 $8.43 $11.41 $16.65 $21.9047 $4.22 $9.17 $12.47 $18.24 $24.0248 $4.55 $10.00 $13.70 $20.09 $26.4849 $4.92 $10.91 $15.09 $22.18 $29.27(Continued...)Page 5 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base PlanTobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00050 $5.31 $11.90 $16.59 $24.43 $32.2751 $5.75 $12.99 $18.11 $26.71 $35.3052 $6.21 $14.15 $19.65 $29.02 $38.3853 $6.72 $15.41 $21.21 $31.35 $41.5054 $7.25 $16.75 $22.80 $33.74 $44.6955 $7.83 $18.19 $24.47 $36.24 $48.0256 $8.45 $19.75 $26.22 $38.87 $51.5157 $9.13 $21.45 $28.07 $41.65 $55.2258 $9.88 $23.32 $30.04 $44.60 $59.1759 $10.69 $25.34 $32.13 $47.74 $63.3460 $11.56 $27.51 $34.34 $51.05 $67.7661 $12.46 $18.80 $36.67 $54.54 $72.4262 $13.39 $20.01 $39.10 $58.19 $77.2863 $14.32 $21.27 $41.63 $61.98 $82.3464 $15.25 $22.58 $44.24 $65.91 $87.5765 $16.18 $23.92 $46.93 $69.93 $92.9320-Year Spouse Term Life BenefitISSUE AGE $10,000 $20,000 $30,000 $40,000 $50,00016 $0.54 $1.09 $1.63 $2.18 $2.7217 $0.54 $1.09 $1.63 $2.18 $2.7218 $0.54 $1.09 $1.63 $2.18 $2.7219 $0.54 $1.09 $1.63 $2.18 $2.7220 $0.54 $1.09 $1.63 $2.18 $2.7221 $0.54 $1.09 $1.63 $2.18 $2.7222 $0.54 $1.09 $1.63 $2.18 $2.7223 $0.54 $1.09 $1.63 $2.18 $2.7224 $0.54 $1.09 $1.63 $2.18 $2.7225 $0.54 $1.09 $1.63 $2.18 $2.7226 $0.54 $1.09 $1.63 $2.18 $2.7227 $0.54 $1.09 $1.63 $2.18 $2.7228 $0.54 $1.09 $1.63 $2.18 $2.7229 $0.54 $1.09 $1.63 $2.18 $2.7230 $0.54 $1.09 $1.63 $2.18 $2.7231 $0.55 $1.10 $1.65 $2.21 $2.7632 $0.57 $1.13 $1.70 $2.26 $2.8333 $0.58 $1.17 $1.75 $2.34 $2.9234 $0.61 $1.22 $1.83 $2.45 $3.0635 $0.65 $1.30 $1.94 $2.59 $3.2436 $0.69 $1.38 $2.08 $2.77 $3.4637 $0.74 $1.49 $2.23 $2.98 $3.72(Continued...)Page 6 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Term Life (ITL5000) for TXApplicable to policy form ITL5000l20-Year Term Base Plan20-Year Spouse Term Life BenefitISSUE AGE $10,000 $20,000 $30,000 $40,000 $50,00038 $0.81 $1.61 $2.42 $3.22 $4.0339 $0.88 $1.75 $2.63 $3.51 $4.3840 $0.96 $1.92 $2.87 $3.83 $4.7941 $1.05 $2.10 $3.14 $4.19 $5.2442 $1.15 $2.30 $3.44 $4.59 $5.7443 $1.26 $2.52 $3.77 $5.03 $6.2944 $1.38 $2.76 $4.14 $5.52 $6.8945 $1.51 $3.03 $4.54 $6.05 $7.5746 $1.66 $3.32 $4.98 $6.64 $8.3047 $1.82 $3.63 $5.45 $7.27 $9.0948 $1.99 $3.97 $5.96 $7.95 $9.9349 $2.17 $4.34 $6.51 $8.68 $10.8550 $2.37 $4.73 $7.10 $9.46 $11.83Children's Term Life BenefitISSUE AGE $10,000 $20,0000-18 $1.15 $2.31Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2021 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.(Continued...)Page 7 of 7Underwritten by Colonial Life & Accident Insurance CompanySee page 7 for Important Notice
Individual Short-Term Disability Insurance ISTD3000 BASEYou never know when a disability could impact your way of life. Fortunately, there’s a way to help protect your income. If an accident or sickness prevents you from earning a paycheck, disability insurance can provide a monthly benefit to help you cover your ongoing expenses.Benefits worksheetHow much coverage do I need?Monthly benefit amount for o-job accident and o-job sickness: ______________Choose a monthly benefit amount between $400 and $6,500.*If your plan includes on-job accident/sickness benefits, the benefit is 50% of the o-job amount.How long will I receive benefits?Benefit period: _______ monthsThe partial disability benefit period is three months.When will my total disability benefits start?Aer an accident: _______ days Aer a sickness: _______ daysCan you aord to not protect your paycheck? You don’t have the same lifestyle expenses as the next person. That’s why you need disability coverage that can be customized to fit your specific needs.Aer calculating your monthly expenses, your benefits counselor can help you complete the benefits worksheet.ESTIMATED MONTHLY EXPENSES AMOUNTMortgage or rent$Utilities (electric/gas, phone, water, TV, Internet)$Transportation costs (gas, car payments) $Food$Health (medical needs and prescription drugs) $Other $TOTAL$ColonialLife.com*Subject to income requirements
EXCLUSIONS AND LIMITATIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of: cosmetic surgery, felonies or illegal occupations, flying, hazardous avocations, intoxicants and narcotics, mental or nervous disorders, racing, semi-professional or professional sports, substance abuse, suicide or injuries which you intentionally do to yourself, war or armed conflict. We will not pay for losses due to you giving birth within the first nine months aer the coverage eective date of the policy. We will not pay for loss when the disability is a pre-existing condition as described in the policy.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form ISTD3000-TX and rider form ISTD3000-ADIB-TX. This is not an insurance contract and only the actual policy and rider provisions will control.©2015 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 7-15 | 101629-TXProduct information Total disability definitionTotally disabled or total disability means you are: unable to perform the material and substantial duties of your occupation, not, in fact, working at any occupation, and under the regular and appropriate care of a physician.How partial disability worksIf you are able to return to work part-time aer at least 14 days of being paid for a total disability, you may be able to still receive 50% of your total disability benefit.Waiver of premiumWe will waive your premium payments aer 90 consecutive days of a covered disability.Geographical limitationsIf you are disabled while outside of the United States, Canada or Mexico, you may receive benefits for up to 60 days before you have to return to the U.S. in order to continue receiving benefits.Issue ageCoverage is available from ages 17 to 74.Keep your coverage You can keep your coverage to age 75 at no additional cost, even if you change jobs, as long as you pay your premiums when they are due.PremiumYour premium is based on your age when you purchase coverage and the amount of coverage you are eligible to buy. Your premium will not change as you age.For more information, talk with your benefits counselor.
Accident 1.0-PreferredAccidents 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 .........................................................................................................................................................$60l Emergency Dental Work .......................................$75 Extraction, $300 Crown, Implant, or Denturel Lacerations (based on size) ........................................................................................................... $30 to $500Requires 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) ....................................................................................................$200l Blood/Plasma/Platelets ................................................................................................................................$300Benets listed are for each covered person per covered accident unless otherwise specied.Initial Carel Accident Emergency Treatment............$125 l Ambulance .......................................$200l X-ray Benet ................................................... $30 l Air Ambulance ............................. $2,000Common Accidental InjuriesDislocations (Separated Joint) Non-Surgical SurgicalHip $2,200 $4,400Knee (except patella) $1,100 $2,200Ankle – Bone or Bones of the Foot (other than Toes) $880 $1,760Collarbone (Sternoclavicular) $550 $1,100Lower Jaw, Shoulder, Elbow, Wrist $330 $660Bone or Bones of the Hand $330 $660Collarbone (Acromioclavicular and Separation) $110 $220One Toe or Finger $110 $220Fractures Non-Surgical Surgical Depressed Skull $2,750 $5,500 Non-Depressed Skull $1,100 $2,200 Hip, Thigh $1,650 $3,300 Body of Vertebrae, Pelvis, Leg $825 $1,650 Bones of Face or Nose (except mandible or maxilla) $385 $770 Upper Jaw, Maxilla $385 $770 Upper Arm between Elbow and Shoulder $385 $770 Lower Jaw, Mandible, Kneecap, Ankle, Foot $330 $660 Shoulder Blade, Collarbone, Vertebral Process $330 $660 Forearm, Wrist, Hand $330 $660 Rib $275 $550 Coccyx $220 $440 Finger, Toe $110 $220
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* ........................................................................................................ $1,000 per accidentl Hospital ICU Admission* ................................................................................................$2,000 per accident* We will pay either the Hospital Admission or Hospital Intensive Care Unit (ICU) Admission, but not both.l Hospital Connement ......................................................... $225 per day up to 365 days per accidentl Hospital ICU Connement ...................................................$450 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 ......................................................................................................$150 per accident (limit 1 per covered accident and 1 per calendar year)l Occupational or Physical Therapy ..................................................... $25 per treatment up to 10 daysl Appliances ..........................................................................................$100 (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-NS-TX.This is not an insurance contract and only the actual policy provisions will control. 71743-2-TXMy 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 BenetsColonial Life 1200 Colonial Life BoulevardColumbia, South Carolina 29210coloniallife.com©2011 Colonial Life & Accident Insurance Company.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.Colonial Life and Making benets count are registered service marks of Colonial Life & Accident Insurance Company. 10/11Accident 1.0-Preferred
For more information, talk with your benefits counselor.Hospital Confinement Indemnity InsurancePlan 2IMB7000 – PLAN 2The surgeries listed below are only a sampling of the surgeries that may be covered. Surgeries must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, please refer to your policy.Tier 1 outpatient surgical procedures Breast– Axillary node dissection– Breast capsulotomy– Lumpectomy Cardiac– Pacemaker insertion Digestive– Colonoscopy– Fistulotomy– Hemorrhoidectomy– Lysis of adhesions Skin– Laparoscopic hernia repair– Skin graing Ear, nose, throat, mouth– Adenoidectomy– Removal of oral lesions– Myringotomy– Tonsillectomy– Tracheostomy– Tympanotomy Gynecological– Dilation and curettage (D&C)– Endometrial ablation– Lysis of adhesions Liver– Paracentesis Musculoskeletal system– Carpal/cubital repair or release– Foot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair)– Removal of orthopedic hardware– Removal of tendon lesionOur 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 .........................................................................$_______________ Maximum of one benefit per covered person per calendar yearObservation room .................................................................................. $100 per visitMaximum of two visits per covered person per calendar yearRehabilitation unit confinement .................................................................$100 per dayMaximum of 15 days per confinement with a 30-day maximum per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered hospital confinement of the named insuredOutpatient surgical procedure Tier 1.................................................................................................$_______________ Tier 2.................................................................................................$_______________Maximum of $________________ per covered person per calendar year for all covered outpatient surgical procedures combined
THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONS We will not pay benefits for losses which are caused by: dental procedures, elective procedures and cosmetic surgery, felonies or illegal occupations, intoxicants or narcotics, pregnancy of a dependent child, psychiatric or psychological conditions, suicide or injuries which any covered person intentionally does to himself or herself, war, or giving birth within the first nine months aer the eective date of the policy. We will not pay benefits for hospital confinement of a newborn who is neither injured nor sick. We will not pay benefits for loss during the first 12 months aer the eective date due to a pre-existing condition. A pre-existing 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 eective date of the policy.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number IMB7000-AK and IMB7000-TX. This is not an insurance contract and only the actual policy provisions will control.ColonialLife.com©2016 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 6-16 | 101578-AK-TX Breast– Breast reconstruction– Breast reduction Cardiac– Angioplasty– Cardiac catheterization Digestive– Exploratory laparoscopy– Laparoscopic appendectomy– Laparoscopic cholecystectomy Ear, nose, throat, mouth– Ethmoidectomy– Mastoidectomy– Septoplasty– Stapedectomy– Tympanoplasty Eye– Cataract surgery– Corneal surgery (penetrating keratoplasty)– Glaucoma surgery (trabeculectomy)– Vitrectomy Tier 2 outpatient surgical procedures Gynecological– Hysterectomy– Myomectomy Musculoskeletal system– Arthroscopic knee surgery with meniscectomy (knee cartilage repair)– Arthroscopic shoulder surgery– Clavicle resection– Dislocations (open reduction with internal fixation)– Fracture (open reduction with internal fixation)– Removal or implantation of cartilage– Tendon/ligament repair Thyroid– Excision of a mass Urologic – Lithotripsy
Air 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............................................................................$30 per procedureAnti-nausea Medication .....................................................................$40 per day administered orDoctor-prescribed medication for radiation or chemotherapy [$160 monthly max.] per prescription filledBlood/Plasma/Platelets/Immunoglobulins ............................................$150 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 .......................................$500Receiving another person’s bone marrow or stem cells for a transplant [once per lifetime]Bone Marrow or Peripheral Stem Cell Transplant .....................................$4,000 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 $1,000 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 ........................................$700■ Egg(s) or Sperm Storage (Cryopreservation) ..............................................$200Experimental Treatment ...................................................................$250 per dayHospital, medical or surgical care for cancer [$12,500 lifetime max.]Family Care ....................................................................................$40 per dayInpatient or outpatient treatment for a covered dependent child [$2,000 calendar year max.]Hair/External Breast/Voice Box Prosthesis .............................................$200 per calendar yearProsthesis needed as a direct result of cancerHome Health Care Services ................................................................$75 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 dayBENEFIT DESCRIPTION BENEFIT AMOUNTCancer InsuranceLevel 2 BenefitsOur cancer 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 2
The policy has limitations and exclusions that may aect benefits payable. Most benefits require that a charge be incurred. Policy may not be available in all states and may vary by state. 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 #101481.Hospital ConfinementHospital stay (including intensive care) required for cancer treatment■ 30 days or less ..........................................................................................$150 per day■ 31 days or more ........................................................................................$300 per dayLodging .....................................................................................................$50 per dayHotel/motel expenses when being treated for cancer more than 50 miles from home [70-day calendar year max.]Medical Imaging Studies ................................................................................ $125 per studySpecific studies for cancer treatment [$250 calendar year max.]Outpatient Surgical Center ............................................................................$200 per daySurgery at an outpatient center for cancer treatment [$600 calendar year max.]Private Full-time Nursing Services ...................................................................$75 per dayServices while hospital confined other than those regularly furnished by the hospitalProsthetic Device/Artificial Limb ......................................................................$1,500 per device or limbA surgical implant needed because of cancer surgery [payable one per site, $3,000 lifetime max.]Radiation/ChemotherapyWeekly Benefit [max. once per week]■ Injected chemotherapy by medical personnel ........................................................$500■ Radiation delivered by medical personnel ............................................................$500Monthly Chemotherapy Benefit [max. once per month]■ Self-Injected ............................................................................................$200■ Pump ...................................................................................................$200■ Topical ..................................................................................................$200■ Oral Hormonal [1-24 months] ..........................................................................$200■ Oral Hormonal [25+ months]...........................................................................$100■ Oral Non-Hormonal ....................................................................................$200Reconstructive Surgery ................................................................................$40 per surgical unitA surgery to reconstruct anatomic defects that result from cancer treatment[up to $2,500 per procedure, including 25% for general anesthesia]Second Medical Opinion ................................................................................$200A 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 ...........................................................................$300A skin cancer diagnosis while the policy is in force [once per lifetime]Supportive or Protective Care Drugs and Colony Stimulating Factors ......................$100 per dayDoctor-prescribed drugs to enhance or modify radiation/chemotherapy treatments [$800 calendar year max.] Surgical Procedures .....................................................................................$50 per surgical unitInpatient or outpatient surgery for cancer treatment [$3,000 max. per procedure]Transportation ............................................................................................ $0.50 per mileTravel expenses when being treated for cancer more than 50 miles from home [up to $1,000 per round trip]Waiver of Premium ......................................................................................Is availableNo premiums due if the named insured is disabled longer than 90 consecutive daysBENEFIT DESCRIPTION BENEFIT AMOUNT©2014 Colonial Life & Accident Insurance CompanyColonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.1-14ColonialLife.com101483
Air 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 dayBENEFIT DESCRIPTION BENEFIT AMOUNTCancer InsuranceLevel 3 BenefitsOur cancer 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 3
The policy has limitations and exclusions that may aect benefits payable. Most benefits require that a charge be incurred. Policy may not be available in all states and may vary by state. 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 #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 daysBENEFIT DESCRIPTION BENEFIT AMOUNT©2014 Colonial Life & Accident Insurance CompanyColonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.1-14ColonialLife.com101484
For more information, talk with your benefits counselor.ColonialLife.comSubsequent diagnosis of a dierent critical illness3If you receive a benefit for a specified critical illness, and later you are diagnosed with a dierent specified critical illness, the original percentage of the face amount is payable for that particular specified critical illness.Subsequent diagnosis of the same critical illness3If 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: coronary artery bypass gra surgery/disease2 and occupational infectious HIV or occupational infectious hepatitis B, C or D.Specified Critical Illness InsuranceIf you’re diagnosed with a covered critical illness, 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: $_______________ For the diagnosis of this covered critical illness condition:1This percentage of the face amount is payable:Heart attack (myocardial infarction) 100%Stroke 100%End-stage renal (kidney) failure 100%Major organ failure 100%Permanent paralysis due to a covered accident 100%Coma 100%Blindness 100%Occupational infectious HIV or occupational infectious hepatitis B, C or D100%Coronary artery bypass gra surgery/disease225%Critical illness benefitCRITICAL ILLNESS 1.0 WITH SUBSEQUENT DIAGNOSIS 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.
Term Life InsurancePeace of mind for you and your loved onesYou 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 Benefit for the beneficiary that is typically tax-freeBenefits and features Stand-alone spouse policy available whether or not you buy a policy for yourself 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 illness Premium savings for face amounts over $250,000 based on your healthTERM LIFE (ITL5000)LIMRA, 2017 Insurance Barometer Study.of Americans would have trouble paying living expenses immediately or within several months if the primary wage-earner died.54%married/partnered consumersLIMRA, 2018 Insurance Barometer Study.1-in-3wish their spouse or partner would purchase more life insurance.
How much coverage do you need?To learn more, talk with your Colonial Life benefits counselor.EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage eective date or the date of reinstatement, we will not pay the death benefit. We will terminate this policy and return the premiums paid, without interest. Product may vary by state. For cost and complete details of the coverage, call or write your Colonial Life benefits counselor or the company. This brochure is applicable to policy forms ICC18-ITL5000/ITL5000 and rider forms ICC18-R-ITL5000-STR/R-ITL5000-STR, ICC18-R-ITL5000-CTR/R-ITL5000-CTR, ICC18-R-ITL5000-WP/R-ITL5000-WP, ICC18-R-ITL5000-ACCD/R-ITL5000-ACCD, ICC18-R-ITL5000-CI/R-ITL5000-CI, ICC18-R-ITL5000-CC/R-ITL5000-CC and applicable state variations. Spouse term life riderYour spouse may receive a maximum death benefit of $50,000; 10-year and 20-year spouse term riders are available. Children’s term life riderYou can purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy – not both.Accidental death benefit riderThe beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70. The benefit doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benefit riderIf a licensed health care practitioner certifies that you have a chronic illness, you may receive an advance on all or a portion of the death benefit, available in a one-time lump sum or monthly payments. A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living. Premiums are waived during the benefit period. Critical illness accelerated death benefit riderIf you suer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benefit is payable. A subsequent diagnosis benefit is included.Waiver of premium benefit riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period. 6-19 | 101895-1ColonialLife.com1 Any payout would reduce the death benefit. Benefits may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits.2 Activities of daily living are bathing, continence, dressing, eating, toileting and transferring.3 You must resume premium payments once you are no longer disabled.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.Optional ridersAt an additional cost, you can purchase the following riders for even more financial protection.£ YOU $ ___________________ Select the term period:£ 10-year£ 15-year£ 20-year£ 30-year£ SPOUSE $ ___________________ Select the term period:£ 10-year£ 15-year£ 20-year£ 30-yearSelect any optional riders:£ Spouse term life rider $ _____________ face amount for ________-year term period£ Children’s term life rider $ _____________ face amount£ Accidental death benefit rider£ Chronic care accelerated death benefit rider£ Critical illness accelerated death benefit rider£ Waiver of premium benefit rider