Unlimited Integration - Benefits Guide : simplebooklet.com

Employee Benefits Guide December 2024– November 2025EligibilityAll full-time employees are eligible to enroll in the employee benefits outlined in this guide. If you are a newly hired employee, you become eligible for benefits 1st of the month following your 60th day of employment. Employees may also enroll their spouse and any dependent children up to the age of 26 in the benefits they elect. If a dependent child turns 26 during the plan year, he or she will automatically be removed from the benefits at the end of their birth month as they are no longer eligible. For questions on dependent children Eligibility, please visit https://www.healthcare.gov/young-adults/children-under-26/. Open EnrollmentWe are renewing with Blue Cross Blue Shield for Medical and Principal for Dental, Vision. Life and Disability. We will also be offering NEW VOLUNTARY SUPPLEMENTAL benefits through Colonial. Open Enrollment is from November 13th – November 14th. To get enrolled this year, all eligible employees will need to speak to a Benefits Counselor. Benefit Counselors will be available VIRTUALLY to meet with each employee individually and review all benefit options. Schedule a meeting with a Benefit Counselor by clicking HERE or scanning QR code:Elections must be made no later than November 14th. This is an active enrollment which means all employees must speak to a Benefits Counselor and either elect or decline all coverages as we are changing our medical insurance carrier. You must speak to a counselor and elect/decline coverage even if you are not making any changes. You cannot make a mid-year change to your benefits unless you have 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 notify HR of any changes that need to be made to your benefit coverages. Examples of a qualifying life event include marriage, divorce, birth, or adoption of a child, change in child’s dependent status, or death.Contents:Page 2 – Benefit ConciergePage 3 – Medical Benefits (Blue Cross Blue Shield)Page 4 - Money Saving TipsPage 5 – Dental (Principal)Page 6 – Vision (Principal) Page 7 - Life & Disability (Principal)Page 20 – Voluntary Supplemental Products (Colonial) Message

Page 2

Page 3

Employee 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.BCBSTX.com Group Number: 237447Phone Number: 800-521-2227 Medical PlansPlease note: - Mandatory Generic / Step Therapy apply to Drugs. If you go to a pharmacy that is non “Preferred, copays will be higher)- NEW Plan 1: This is an HMO. You must designate a primary care doctor and must obtain a referral to see a specialist. There is no coverage if you go “out of network” and no coverage outside of Texas.- Plan 2: Compatible with a Health Savings Account (HSA) and allows for pre-tax/tax deductible contributions into an HSA Bank Account. - HSA Contribution limits for 2025- Individual: $4,300 / Family: $8,550 / Age 55+: extra $1,000- You may not contribute pre-tax $’s into an HSA if enrolled in Medicare.Basic Benefit OverviewNEW PLAN Option 1Blue Cross Blue Shield HMO G9E5ADTPlan 2: Blue Cross Blue Shield PPO B660CHC (HSA Qualified)Plan 3:Blue Cross Blue Shield PPOS661CHCPlan 4:Blue Cross Blue Shield PPO G653CHCNetworkBlue Advantage HMO Blue Choice Network PPO Blue Choice Network PPO Blue Choice Network PPOAnnual Deductible (Single/Family)$1,250 / $3,750 $6,500 / $13,000 $3,500 / $10,500 $1500 / $4500Annual Out-of-Pocket Limit (Single/Family)$5,250 / $10,500 $7,250 / $14,500 $9,000 / $18,000 $6,000 / $12,000Coinsurance20% 30% 30% 20%Routine Preventive Care VisitNo Cost No Cost No Cost No CostPrimary Care Office Visit$45 30% after Deductible $50 $40Specialist Office Visit$90 30% after Deductible $90 $80Outpatient Surgery and Facility Charge$250 + 20% After Deductible30% after Deductible $300 + 30% after Deductible 20% after DeductibleMajor Diagnostic Testing$250 + 20% After Deductible30% after Deductible $250 + 30% after Deductible $100 + 20% after DeductibleInpatient Hospitalization (Facility/Physician)$300 + 20% After Deductible30% after Deductible $350 + 30% after Deductible 20% after DeductibleEmergency ServicesEmergency Room$600 + 20% After Deductible$650+ 30% after Deductible $750 + 30% after Deductible $500 + 20% after DeductibleUrgent Care$75 30% after Deductible $100 Copay $75TelehealthOffice Visit Copay 30% after Deductible Office Visit Copay Office Visit CopayPrescription Drugs 3 x’s Copay for 90 Day Supply ( Preferred Pharmacies: Walgreens / Walmart / HEB ) NO CVSPreferred Generic$0 10% after Deductible $0 $0 Non-Preferred Generic $10 10% after Deductible $10 $10Preferred Brand$50 20% after Deductible $50 $50Non-Preferred Brand $100 30% after Deductible $100 $100Preferred Specialty$150 40% after Deductible $150 $150Non-Preferred Specialty $250 50% after Deductible $250 $250Cost per Paycheck* - Rates will be provided by Benefit Counselors

Page 4

Page 5

Page 6

Page 7

Page 8

Page 9

Page 10

Page 11

Deductions per year: 24 These rates were prepared on 11/5/2024 and are valid for 90 days.Group Accident (GAC4100) for TXApplicable to policy forms GAC4100-P,GAC4100-ClAdditional Benefits:On/Off-Job Accident CoverageBENEFIT LEVEL AD&D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE ANDSPOUSEEMPLOYEE ANDDEPENDENTCHILD(REN)EMPLOYEE, SPOUSEAND DEPENDENTCHILD(REN)Premier Not Included 17-99 $6.46 $9.89 $15.60 $19.10Premier Preferred 17-99 $7.55 $11.73 $17.10 $21.38Group Medical Bridge (GMB7000) for TXAge-BandedApplicable to Policy Forms GMB7000–P & GMB7000-ClWithout Wellbeing Assistance, Outpatient Surgical Procedure: Option 1 - ($500 / $1000 / $1500)HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 2: $100017-49 $7.50 $13.83 $11.71 $18.0350-59 $10.38 $20.48 $14.58 $24.6860-64 $13.95 $28.63 $18.16 $32.8365-99 $18.38 $38.18 $22.58 $42.38HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-49 $12.20 $22.28 $18.41 $28.4850-59 $16.48 $32.58 $22.68 $38.7860-64 $22.50 $46.43 $28.71 $52.6365-99 $30.38 $63.13 $36.58 $69.33Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $4.45 $6.53 $4.45 $6.5325-29 $5.73 $8.48 $5.73 $8.4830-34 $7.08 $10.43 $7.08 $10.4335-39 $10.08 $15.00 $10.08 $15.0040-44 $13.08 $19.50 $13.08 $19.5045-49 $18.03 $27.15 $18.03 $27.1550-54 $22.90 $34.80 $22.90 $34.8055-59 $29.65 $45.08 $29.65 $45.0860-64 $39.93 $60.68 $39.93 $60.6865-69 $48.63 $74.03 $48.63 $74.0370-74 $48.63 $74.03 $48.63 $74.03Page 1 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice

Page 12

Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$30,000 17-24 $7.45 $10.80 $7.45 $10.8025-29 $10.00 $14.70 $10.00 $14.7030-34 $12.70 $18.60 $12.70 $18.6035-39 $18.70 $27.75 $18.70 $27.7540-44 $24.70 $36.75 $24.70 $36.7545-49 $34.60 $52.05 $34.60 $52.0550-54 $44.35 $67.35 $44.35 $67.3555-59 $57.85 $87.90 $57.85 $87.9060-64 $78.40 $119.10 $78.40 $119.1065-69 $95.80 $145.80 $95.80 $145.8070-74 $95.80 $145.80 $95.80 $145.80Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$15,000 17-24 $6.25 $9.08 $6.25 $9.0825-29 $8.35 $12.23 $8.35 $12.2330-34 $10.45 $15.38 $10.45 $15.3835-39 $15.25 $22.58 $15.25 $22.5840-44 $20.05 $29.85 $20.05 $29.8545-49 $27.93 $42.08 $27.93 $42.0850-54 $35.73 $54.30 $35.73 $54.3055-59 $46.53 $70.80 $46.53 $70.8060-64 $62.95 $95.78 $62.95 $95.7865-69 $76.90 $117.00 $76.90 $117.0070-74 $76.90 $117.00 $76.98 $117.08$30,000 17-24 $11.05 $15.90 $11.05 $15.9025-29 $15.25 $22.20 $15.25 $22.2030-34 $19.45 $28.50 $19.45 $28.5035-39 $29.05 $42.90 $29.05 $42.9040-44 $38.65 $57.45 $38.65 $57.4545-49 $54.40 $81.90 $54.40 $81.9050-54 $70.00 $106.35 $70.00 $106.3555-59 $91.60 $139.35 $91.60 $139.3560-64 $124.45 $189.30 $124.45 $189.3065-69 $152.35 $231.75 $152.35 $231.7570-74 $152.35 $231.75 $152.50 $231.90(Continued...)Page 2 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice

Page 13

Whole Life Plus (IWL5000) for TXApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100Non-Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00025 $4.60 $11.50 $23.00 $34.50 $46.0035 $6.26 $15.65 $31.29 $46.94 $62.5845 $9.94 $24.86 $49.71 $74.56 $99.4255 $16.23 $40.56 $81.12 $121.69 $162.2565 $28.88 $72.19 $144.37 $216.56 $288.74Tobacco RatesISSUE AGE $10,000 $25,000 $50,000 $75,000 $100,00025 $8.04 $20.09 $40.17 $60.25 $80.3335 $9.78 $24.44 $48.88 $73.31 $97.7545 $14.56 $36.39 $72.77 $109.15 $145.5455 $24.53 $61.33 $122.66 $184.00 $245.3365 $41.96 $104.89 $209.79 $314.68 $419.5720-Year Spouse Term Life BenefitISSUE AGE $10,000 $20,000 $30,000 $40,000 $50,00025 $1.66 $3.32 $4.98 $6.64 $8.2935 $2.11 $4.21 $6.31 $8.42 $10.5245 $3.79 $7.57 $11.35 $15.14 $18.92Children's Term Life BenefitISSUE AGE $10,000 $20,0000-18 $2.50 $5.00Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2024 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 3 of 3Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice

Page 14

Group Accident InsurancePremier PlanIf you are in an accident, your focus should be on recovery, not how you’re going to pay your bills. Colonial Life accident insurance can pay benets directly to you to use however you like — from medical costs to everyday expenses. Whether you’ve had a fall or a car accident, these benets can offer nancial support when you need it.Our coverage includes:• Benets payable directly to you• No medical questions to qualify for coverage• Coverage for simple and complex injuries• Benets payable regardless of other insurance• Worldwide coverage• Works alongside your Health Savings Account (HSA)BENEFITS STORY Milo was working in his yard when he tripped and injured his hand.With Colonial Life accident benets, Milo was able to pay the annual deductible and co-payments for his health insurance plan without using his savings or taking on debt.MILO’S ACCIDENT BENEFITSMilo went to an urgent care facility and received immediate care.Treatment in a physician’s office or urgent care facility$150The doctor ordered an X-ray and discovered Milo had fractured his hand.• X-ray• Fracture (hand)$60$1,200The doctor also found that Milo had a cut on his hand but did not require stitches. Laceration (no repair) $75Milo was discharged with a splint. Durable medical equipment $65Over the next several weeks, Milo had two follow-up appointments with his doctor. Physician follow-up visits (2 visits)$50 x 2 = $100Total $1,650For illustrative purposes only. Benet amounts may vary and may not cover all expenses. GROUP ACCIDENT (GAC4100) — PREMIER PLAN

Page 15

Give your benets a boostWe know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life. Group Accident includes a Benet Booster* to provide additional nancial support for serious accidents. If you have more than $5,000 in payable benets for a covered accident, we will give you a $500 boost to your benets to help you with whatever expenses you have. *Payable once per Insured per covered accidentBENEFITS STORY Olivia was driving to the store when she got into a car accident.Olivia’s benets helped her cover her medical expenses when she was injured in a car accident, helping her to focus on her recovery.OLIVIA’S ACCIDENT BENEFITSOlivia arrived by ambulance at the nearest emergency room and received immediate care.• Ambulance• Emergency department visit• Injury due to auto accident$400$250 $250The 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 brain injury.• X-ray• Medical imaging• Fracture (thigh)$60$400 $4,200Olivia required surgery for her leg.• Surgical repair (thigh fracture)• General anesthesia$4,200 $300Olivia boarded her pet for two nights after her surgery. Pet boarding (2 days) $20 x 2 = $40Olivia had eight 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 = $100Olivia’s benefits for this accident totaled more than $5,000.Benefit Booster $500Total $11,140For illustrative purposes only. Benet amounts may vary and may not cover all expenses. Benets are per covered person per covered accident unless stated otherwiseInjury benets • Burns (based on size and degree) ............. $750–$21,000• Concussion ........................................ $500• Connective tissue damage ......................$100–$200• Eye injury .......................................... $400 • Hearing loss injuries ..................................$120(Maximum once per lifetime per ear per insured)• Injury due to auto accident ........................... $250 • Internal injuries ..................................... $200 • Knee cartilage (meniscus) injury ...................... $200 • Lacerations ...................................$75–$1,200• Loss of a digit — partial .........................$400–$800• Loss of a digit ..............................$1,000–$3,000• Ruptured or herniated disc ......................$200–$400

Page 16

Fracture benets• Injury .......................................$200–$5,000 Examples: nger: $200 | wrist: $1,200 | hip: $4,200• Surgical repair of fracture ............................100%(Payable as an additional % of the applicable fractures benet)• Chip fracture ........................................25% (Payable as a % of the applicable fractures benet)Dislocation benets• Injury .......................................$260–$4,000 Examples: elbow: $600 | ankle: $1,600 | hip: $4,000• Surgical repair of dislocation ..........................100%(Payable as an additional % of the applicable dislocations benet)• Incomplete dislocation ................................25%(Payable as a % of the applicable dislocations benet)Treatment benets• Air ambulance .....................................$2,000 • Ambulance (ground or water) ......................... $400 • Durable medical equipment ......................$65–$250• Emergency dental repair ........................$200–$600• Emergency department .............................. $250(Maximum 4 per year) • Family care ................................... $50 per day (Maximum of one benet per day for all insureds combined, up to a maximum of three days per covered accident, regardless of the number of children)• Injections to prevent or limit infection ...................$50 • Lodging ..................................... $250 per day (Maximum 30 days)• Medical imaging ..................................... $400 • Pain management injections ..........................$150 • Pet boarding .................................. $20 per day (Maximum of one benet per day for all insureds combined, up to a maximum of three days per covered accident, regardless of the number of pets that are boarded)• Prosthetic device or articial limb ............$1,750–$3,500• Skin grafts (due to burns) .............................50%(Payable as a % of the applicable burn benet)• Skin grafts (not due to burns) ....................$375–$750• Transfusions ........................................ $500 • Transportation ............................... $200 per trip (Maximum 6 one-way trips)• Treatment in a physician’s oce or urgent care facility ...$150(Maximum 4 per year) • X-ray or ultrasound ....................................$60Surgery benets• Anesthesia ....................................$150–$300• Connective tissue surgery .....................$150–$2,200• Eye surgery ......................................... $400• General surgery –Abdominal, thoracic, or cranial ...................$2,000 –Exploratory surgery ...............................$275 • Hernia surgery ...................................... $400 • Knee cartilage (meniscus) surgery ..............$150–$1,050• Outpatient surgical facility ............................$400 • Ruptured or herniated disc surgery ............ $150–$2,000Recovery care benets• At-home care ................................ $125 per day(Maximum 5 days) • Benet Booster .....................................$500• Physician follow-up visits ............................. $50 (Maximum 6 days per covered accident and 24 days per calendar year)• Rehabilitation or sub-acute rehabilitation unit connement .............................$200 per day (Maximum 15 days per covered accident and 30 days per calendar year)• Therapy services (speech, physical therapy, occupational therapy) ..........................$55 per day(Maximum 15 days)Options checked below have been chosen by your employer to enhance your Group Accident Coverage.  Recovery Plus package• Behavioral health therapy ...................$55 per day (Maximum 15 days)• Post-traumatic stress disorder (PTSD) ............ $200 • Prescription drug .................................$25 • Additional therapy services (chiropractic, acupuncture, alternative therapy) ......$55 (Existing therapy services benet maximum applies to additional therapy services, maximum 15 days)• Injury due to felonious act of violence or sexual assault ................................ $250(Maximum once per insured per calendar year, with an accompanying police report) Gunshot wound benetThis benet can help pay your medical expenses if you receive a non-fatal gunshot wound. It offers you a lump sum for a covered injury regardless of any other insurance you may have and includes on/off-job coverage.• Gunshot wound .............................$_________This benet covers a non-fatal gunshot wound from a conventional rearm that requires treatment by a doctor and overnight hospitalization within 24 hours of the injury. If you are shot more than once in a 24-hour period, we can pay benets only for the rst wound.

Page 17

Contact your Colonial Life benets counselor to learn more.CT: We will pay the air ambulance or ambulance benets directly to the licensed professional ambulance company. CT includes a benet for “outpatient emergency medical care for accidental ingestion of a controlled substance.” The at-home care benet maximum is 80 days. KS: Chiropractic therapy is not available. NH: NH includes a burn benet for 2nd degree burns under 5% of skin surface. The minimum benet for the loss or partial loss of a digit is $1,000.MD: The prescription drug benet is not available.PA: The pet boarding benet is not available. TN: The therapy services benet includes chiropractic. TX: The concussion benet is replaced by the “concussion and acquired brain injuries” benet. The therapy services benet includes the following services: 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.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis 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 coverage is a supplement to health insurance. It is not a substitute for essential health benets or minimum essential coverage as dened in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONSWe will not pay benets for claims that are caused by, contributed to by, or resulting from elective procedures, felonies or illegal occupations, hazardous avocations, impaired driving, incarceration, racing, semi-professional or professional sports, sickness, suicide or self-inicted injuries, war, or armed conict. ID: ”Semi-professional sports or professional sports” exclusion is replaced by “professional sports” exclusion. IL: We will not pay benets for claims that are caused by or resulting from Exclusions.MD: Includes an exclusion for “Prohibited referrals.” The “felonies or illegal occupations” and “impaired driving” exclusions apply only to Accidental Death and Dismemberment benets.MI: “Impaired driving” and “suicide or self-inicted injuries” exclusions do not apply. MN: “Suicide or self-inicted injuries” exclusion does not apply.NH: “Incarceration” and “racing” exclusions do not apply.UT: We will not pay benets for claims that are caused by or resulting from Exclusions.VT: “Impaired driving” exclusion does not apply. 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 benets payable. Applicable to policy form GAC4100-P and certicate form GAC4100-C (including state abbreviations where used, for example: GAC4100-P-TX and GAC4100-C-TX). For cost and complete details of coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 3-23 | 1212553ColonialLife.com

Page 18

For more information, talk with your benefits counselor.Group Hospital Indemnity InsurancePlan 2ColonialLife.comGroup Medical BridgeSM insurance can help with medical costs associated with a hospital stay that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children.Hospital confinement ............................................................... $_______________ per dayMaximum of one day per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered confinement of the named insured£ Daily hospital confinement ................................................................... $100 per dayMaximum of 365 days per covered person per confinement. Re-confinement for the same or related condition within 90 days of discharge is considered a continuation of a previous confinement.£ Diagnostic procedure .................................................................. $_______________ per dayMaximum of one day per covered person per calendar year£ Outpatient surgical procedure¾ Tier 1 .................................................................................... $_______________ per day¾ Tier 2 .................................................................................... $_______________ per dayMaximum of $________________ per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedureGMB7000 – PLAN 2Diagnostic proceduresThe following is a list of common diagnostic procedures that may be covered if the diagnostic procedure benefit is selected.  Breast– Biopsy (incisional, needle, stereotactic)  Cardiac– Angiogram– Arteriogram– Thallium stress test– Transesophageal echocardiogram (TEE)  Diagnostic radiology– Computerized tomography scan (CT scan)– Electroencephalogram (EEG)– Magnetic resonance imaging (MRI)– Myelogram– Nuclear medicine test– Positron emission tomography scan (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  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– Hysteroscopy– Loop electrosurgical excisional procedure (LEEP)1,000 or 2,0005001,0001,500

Page 19

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 | 101732* Colonoscopy must result in polyp removal or be recommended by a physician for the purposes of treating or diagnosing a sickness.If a covered family member has a qualified high deductible health plan (HDHP) and actively contributes to a health savings account (HSA), their HSA can be disqualified with this coverage. THIS POLICY PROVIDES LIMITED BENEFITS.PRE-EXISTING CONDITION LIMITATION We will not pay benefits for loss during the first 12 months aer the certificate eective date due to a pre-existing condition. A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the certificate eective date.This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy forms GMB7000-P and GMB7000-P-TX. Coverage may vary by state and may not be available in all states.  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– LithotripsyThe procedures listed below are only a sampling of the procedures that may be covered if the outpatient surgical procedure benefit is selected. Procedures must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, refer to your certificate.Tier 1 outpatient surgical procedures Breast– Axillary node dissection– Breast capsulotomy– Lumpectomy  Cardiac– Pacemaker insertion  Digestive– Colonoscopy* – Fistulotomy– Hemorrhoidectomy– Lysis of adhesions  Ear, nose, throat, mouth– Adenoidectomy– Removal of oral lesions– Myringotomy– Tonsillectomy– Tracheostomy– Tympanotomy  Gynecological– Dilation and curettage (D&C)– Endometrial ablation– Lysis of adhesions  Liver– Paracentesis  Musculoskeletal system– Carpal/cubital repair or release– Foot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair)– Removal of orthopedic hardware– Removal of tendon lesion  Skin– Laparoscopic hernia repair– Skin graing

Page 20

ColonialLife.comGroup Hospital Indemnity InsuranceExclusions and LimitationsGMB7000 – EXCLUSIONS AND LIMITATIONSGeneral 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:  Addiction to alcohol or drugs, except for drugs taken as prescribed by his 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 related to a covered sickness or injuries received in a covered accident.  Committing or attempting to commit a felony, or engaging in an illegal occupation.  Having a disorder including but not limited to aective 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 inpatient mental and nervous benefit, if included.  Dependent child’s pregnancy, including services rendered to her child aer 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 suered the loss committed the act of terrorism or nuclear release.Hospital confinement limitationsWe will not pay benefits for hospital confinement or daily hospital confinement, if included, due to any covered person giving birth within the first nine (9) months aer the coverage eective 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.KS – no birth limitation. TN – adds that complications of pregnancy are those conditions, requiring treatment, whose diagnoses are distinct from pregnancy but are adversely aected by pregnancy or caused by pregnancy. These include, but are not limited to, acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity. This does not include false labor, morning sickness, hyperemesis gravaidarum, and similar conditions associated with the management of a diicult pregnancy.VA – adds that pregnancy resulting from the act of rape of any covered person, which was reported to the police within seven days following its occurrence, will be covered to the same extent as any other covered accident. The seven-day requirement will be extended to 180 days in the case of an act of rape or incest of a female under 13 years of age. 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.AR – no well baby care limitation.CA – well baby care limitation has special wording that diers from language above. MD – no well baby care limitation.

Page 21

12-16 | 101733-1©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.This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy forms GMB7000-P (including state abbreviations, where used, for example: GMB7000-P-TX). Coverage may vary by state and may not be available in all states.Additional state-specific exclusions and limitationsIn the following states, we will not pay any benefits for injuries or sicknesses which are caused by, contributed to by or occur as a result of the covered person’s:AK, LA, MS and TX – being intoxicated or under the influence of any narcotic unless administered on the advice of his doctor/physician. This replaces the alcoholism or drug addiction exclusion above.AR – having a disorder including neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder of any kind. Alzheimer’s disease and other organic senile dementias are not considered mental or nervous disorders. This exclusion does not apply to inpatient mental and nervous benefit, if included. CA – We will not pay any benefits for injuries or sicknesses which are caused by, contributed to by or occurs as a result of the covered person’s: having a treatment for dental care or dental procedures, unless treatment is the result of a covered injury. Intoxicants and Controlled Substances exclusion has been added and means any covered person being intoxicated or under the influence of any controlled substance unless administered on the advice of a physician. Suicide exclusion has special language. DE – no alcoholism or drug addiction exclusion. KS – being intoxicated or under the influence of any narcotic unless administered on the advice of his physician. This replaces the alcoholism or drug addiction exclusion above. The war or armed conflict exclusion is defined as: being exposed to war or any act of war, declared or undeclared, or serving in the armed forces of any country or authority. KY – being intoxicated or under the influence of any narcotic or any hallucinogenic unless administered on the advice of his physician. This replaces the alcoholism or drug addiction exclusion above.MD – no alcoholism or drug addiction exclusion; no felonies or illegal occupations exclusions; no birth limitation. MD’s elective procedures and cosmetic surgery adds the treating provider, acting inde-pendently from us, shall determine whether a procedure is elective or cosmetic. Pregnancy or a depen-dent child adds: However, complications of pregnancy of a dependent child will be covered to the same extent as any other covered sickness. Prohibited Practitioner Referral means the policy will not provide payment of any claim, bill, or other demand or request for payment for health care service provided as a result of a referral prohibited by the Health Occupation Article. MD’s suicide exclusion is defined as com-mitting or trying to commit suicide or his injuring himself intentionally, while sane or insane. The war or armed conflict exclusion is defined as: being exposed to war or any act of war, declared or undeclared, or serving in the armed forces of any country or authority.MO – addiction to drugs, except for drugs taken as prescribed by his physician; and participating or attempting to participate in illegal activities. This replaces the alcoholism and drug addiction, and felonies or illegal occupations exclusions above. MO’s pregnancy of a dependent child exclusion adds that complications of pregnancy will be covered to the same extent as any other covered sickness. MO’s suicide exclusion is defined as committing or trying to commit suicide or his injuring himself intentionally, while sane.NE – commission of or attempting to commit a felony or to which a contributing cause was the covered person engaging in an illegal occupation. This replaces the felonies or illegal occupations exclusion aboveOH – no pregnancy of a dependent child exclusion. The birth limitation is the first 270 days aer the chronic energy deficiency (CED), rather than the first nine months.OK – being exposed to war or any act of war, declared or undeclared, while serving in the military or an auxiliary unit attached to the military or working in an area of war whether voluntarily or as required by an employer. This replaces the war exclusion above. OK’s pregnancy of a dependent child exclusion adds complications of pregnancy, including cesarean births, will be covered to the same extent as any other sickness. SD – committing a felony, or engaging in an illegal occupation. In SD, there’s no alcoholism or drug addiction exclusion. This replaces the felonies or illegal occupations exclusion above.TN – treatment for dental care or dental procedures, unless treatment is the result of a covered accident, except for covered expenses for procedures performed on a minor, eight years or younger, that cannot be safely performed in a dental oice setting. There’s no pregnancy of a dependent child exclusion. UT – being addicted to alcohol or drugs that contribute to, cause the loss, or are over the legal limit, unless you are addicted to a narcotic taken on the advice of a physician; voluntarily participating in, committing or attempting to commit a felony, or engaging in an illegal occupation; having a neurosis, psychoneurosis, psychopathy, psychosis, or any other mental or emotional disease or disorder which does not have a demonstrable organic cause. This exclusion does not apply to inpatient mental and nervous benefit, if included.

Page 22

Group Critical Illness InsurancePlan 2GCI6000 – PLAN 2 – CRITICAL ILLNESS AND CANCERWhen life takes an unexpected turn, your focus should be on recovery — not finances. Colonial Life’s group critical illness insurance helps relieve financial worries by providing a lump-sum benefit payable directly to you to use as needed.Coverage amount: ____________________________COVERED CRITICAL ILLNESS CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTBenign brain tumor100%Coma100%End stage renal (kidney) failure100%Heart attack (myocardial infarction)100%Loss of hearing100%Loss of sight100%Loss of speech100%Major organ failure requiring transplant100%Occupational infectious HIV or occupational infectious hepatitis B, C or D100%Stroke100%Sudden cardiac arrest 100%Coronary artery disease25%COVERED CANCER CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTInvasive cancer (including all breast cancer)100%Non-invasive cancer25%Skin cancer initial diagnosis ............................................................ $400 per lifetimeCritical illness and cancer benefitsSpecial needs daycareA hospital stay and treatment for corrective heart surgeryPhysical therapy to build muscle strengthFor illustrative purposes only.Preparing for a lifelong journeyRebecca 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 HELPEDThe lump-sum amount from the family coverage benefit helped pay for:5,000 - 50,000

Page 23

ColonialLife.com6-20 | 387100-TX1. Refer 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.THIS INSURANCE PROVIDES LIMITED BENEFITS.EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benefit, Benefits Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person’s: doctor or physician relationship; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Invasive Cancer (including all Breast Cancer) Benefit, Non-Invasive Cancer Benefit, Benefit Payable Upon Reoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benefit for a covered person’s invasive cancer or non-invasive cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having invasive or non-invasive cancer. No pre-existing condition limitation will be applied for dependent children who are born or adopted while the named insured is covered under the certificate, and who are continuously covered from the date of birth or adoption.PRE-EXISTING CONDITION LIMITATION We will not pay a benefit for a pre-existing condition that occurs during the 12-month period aer the coverage eective date. Pre-existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage eective date.This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy forms GCI6000-P-EE-TX and GCI6000-P-AU-TX and certificate forms GCI6000-C-EE-TX and GCI6000-C-AU-TX. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.COVERED CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTCerebral palsy 100%Cle lip or palate 100%Cystic fibrosis 100%Down syndrome 100%Spina bifida 100%KEY BENEFITSAdditional covered conditions for dependent childrenSubsequent diagnosis of a dierent critical illnessIf you receive a benefit for a critical illness and are later diagnosed with a dierent critical illness, 100% of the coverage amount may be payable for that particular critical illness.Subsequent diagnosis of the same critical illness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.For more information, talk with your benefits counselor.Preparing for the unexpected is simpler than you think. With Colonial Life, youʼll have the support you need to face lifeʼs toughest challenges.  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

Page 24

Group Critical Illness InsuranceWellbeing Assistance BeneﬁtThe wellbeing assistance benefit can help reduce the risk of serious illness through early detection of disease or risk factors.Wellbeing assistance benefit ............................................................. $_____________ 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 aer the waiting period.  Blood test for triglycerides  Bone marrow testing  BRCA1 or BRCA2 testing (genetic test for breast cancer)  Breast ultrasound  CA 15-3 (blood test for ovarian cancer)  CA 125 (blood test for breast 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 colonoscopyFor more information, talk with your benefits counselor.ColonialLife.comGCI6000 – WELLBEING ASSISTANCE BENEFIT | 5-20 | 387307Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.THIS INSURANCE PROVIDES LIMITED BENEFITS.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.50

Page 25

Whole Life Plus InsuranceOur individual whole life plan offers dependable lifetime coverage and guaranteed cash value to help employees during challenging times.Whether employees want the nancial security of a predictable death benet or access to the plan’s cash value through a policy loan for emergency situations, Whole Life Plus insurance has the exibility to provide both.1Product guarantees(as long as premiums are paid and no loans are taken)Competitive features• Death benet stays the same2• Choice of two plan designs based on length of time premiums are paid (Paid-Up at Age 70 and Paid-Up • Accumulates cash value based on a nonforfeiture at Age 100)interest rate of 3.75%1 • Coverage for broad issue age ranges, up to 79 on • Premiums remain the samePaid-Up at Age 100 plan• Tobacco-distinct, unisex ratesAttractive underwriting• Accelerated death benet due to terminal illness2• Face amounts up to $500,000• $3,000 advance claim payment from the death benet2• Guaranteed issue available• Policy loans available ($250 minimum)1• Nonmedical underwriting (no blood proles or examinations) available for certain age bands and face amounts• Spouse signature not required for spouse term rider or spouse whole life plus policy with face • Policy pays cash surrender value at age 100 (when the policy endows)• Portability that enables employees to take coverage with them if they change jobs or retireamounts up to $50,000, except in states that require applicant to signOptional riders• Accidental death benet riderFamily coverage options• Chronic care accelerated death benet rider• Stand-alone spouse and juvenile policies available with no employee policy required• Spouse term rider (10- and 20-year) available on • Critical illness accelerated death benet rider• Guaranteed purchase option rider• Waiver of premium benet rideremployee policy • Children’s term rider available on employee or spouse policyWHOLE LIFE PLUS (IWL5000)

Page 26

Why choose Colonial Life?Life is full of unexpected moments. Colonial Life offers an unexpected approach to benets. Service at every step: We make account setup, enrollment, billing and claims easy. And we have a team ready to help when you need it.Personalized benets counseling: Our benets counselors can meet with employees individually to create a personalized benets solution that ts their needs now and in the future. A trusted partnership: As business and employees’ needs change, we ensure that the support we provide changes and adapts, too. One in four employers indicated life insurance is now more important and they are considering changes to their plans, such as adding supplemental life.3Contact your Colonial Life representative to learn more about Whole Life Plus.ColonialLife.com1. Accessing the accumulated cash value reduces the death benet by the amount accessed, unless the loan is repaid. Cash value will be reduced by any outstanding loans against the policy.2. Any accelerated benet payout would reduce the death benet. Benets may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benets.3. LIMRA, 2021 Insurance Barometer Study. https://www.limra.com/en/research/research-abstracts-public/2021/2021-insurance-barometer-study. Accessed July 2021.EXCLUSIONS AND LIMITATIONS: If the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage effective date or the date of reinstatement, we will not pay the death benet. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benets payable. Applicable to policy forms ICC19-IWL5000-70/IWL5000-70, ICC19-IWL5000-100/IWL5000-100, ICC19-IWL5000J/IWL5000J and rider forms ICC19-R-IWL5000-STR/R-IWL5000-STR, ICC19-R-IWL5000-CTR/R-IWL5000-CTR, ICC19-R-IWL5000-WP/R-IWL5000-WP, ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD, ICC19-R-IWL5000-CI/R-IWL5000-CI, ICC19-R-IWL5000-CC/R-IWL5000-CC, ICC19-R-IWL5000-GPO/R-IWL5000-GPO. For cost and complete details of the coverage, call or write your Colonial Life benets counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC© 2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR BROKERS AND EMPLOYERS 7-21 | 642200