Whitener Enterprises Guide : simplebooklet.com

Medical Plan Benefit Summary Whitener Enterprises Inc Effective Date June 1 2025 Benefit items BCBS of TX BCBS of TX BCBS of TX BCBS of TX MTBPA007H Blue Premier HSA OA HMO PCP Required MTBPA042 Blue Premier OA HMO PCP Required MTBEE042 Blue Essentials HMO NO PCP Required MTBCP007H Blue Choice PPO HSA In network Out of network In network Out of network In network Out of network In network Out of network Individual Deductible 5 000 N A 5 000 N A 5 000 N A 5 000 10 000 Family Deductible 10 000 N A 14 700 N A 14 700 N A 10 000 20 000 Individual Out of Pocket Max 5 000 N A 8 150 N A 7 350 N A 5 000 Unlimited Family Out of Pocket Max 10 000 N A 16 300 N A 14 700 N A 10 000 Unlimited Coinsurance Policy Holder 0 N A 20 N A 20 N A 0 30 Primary Care Office 0 After Ded N A 45 N A 45 N A 0 After Ded 30 After Ded Specialist Care 0 After Ded N A 90 N A 90 N A 0 After Ded Emergency Room 0 After Ded 500 20 After Ded 500 20 After Ded 30 After Ded 0 After Ded Urgent Care 0 After Ded N A 75 N A 75 N A 0 After Ded 30 After Ded In Patient Hospital 0 After Ded N A 20 After Ded N A 20 After Ded N A 0 After Ded 30 After Ded Out Patient Hospital 0 After Ded N A 20 After Ded N A 20 After Ded N A 0 After Ded Rx Tiers Preferred Pharmacy 30 After Ded 0 After Ded 0 10 50 100 150 250 0 10 50 100 150 250 0 After Ded Per Pay Period Cost Per Pay Period Cost Per Pay Period Cost Per Pay Period Cost Employee 77 02 123 88 131 73 158 56 Employee Spouse 414 54 533 28 553 15 621 17 Employee Child ren 360 50 467 72 485 68 547 10 Employee Family 698 07 877 18 907 17 1 009 77

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Group Accident Insurance Our coverage includes Premier Plan If 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 benefits 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 benefits can offer financial support when you need it Benefits payable directly to you No medical questions to qualify for coverage Coverage for simple and complex injuries Benefits payable regardless of other insurance Worldwide coverage BENEFITS STORY Works alongside your Health Savings Account HSA Milo was working in his yard when he tripped and injured his hand With Colonial Life accident benefits 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 BENEFITS Milo went to an urgent care facility and received immediate care Treatment in a physician s office or urgent care facility The doctor ordered an X ray and discovered Milo had fractured his hand X ray Fracture hand The doctor also found that Milo had a cut on his hand but did not require stitches Laceration no repair 75 Milo was discharged with a splint Durable medical equipment 65 Over the next several weeks Milo had two follow up appointments with his doctor Physician follow up visits 2 visits For illustrative purposes only Benefit amounts may vary and may not cover all expenses Total 150 60 1 200 50 x 2 100 1 650 GROUP ACCIDENT GAC4100 PREMIER PLAN

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Give your benefits a boost We know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life Group Accident includes a Benefit Booster to provide additional financial support for serious accidents If you have more than 5 000 in payable benefits for a covered accident we will give you a 500 boost to your benefits to help you with whatever expenses you have Payable once per Insured per covered accident BENEFITS STORY Olivia was driving to the store when she got into a car accident Olivia s benefits helped her cover her medical expenses when she was injured in a car accident helping her to focus on her recovery OLIVIA S ACCIDENT BENEFITS 400 250 250 Olivia arrived by ambulance at the nearest emergency room and received immediate care Ambulance Emergency department visit Injury due to auto accident The doctor ordered an X ray and discovered Olivia had fractured her thigh femur He also ordered a CT scan of her head to check for brain injury X ray Medical imaging Fracture thigh 60 400 4 200 Olivia required surgery for her leg Surgical repair thigh fracture General anesthesia 4 200 300 Olivia boarded her pet for two nights after her surgery Pet boarding 2 days 20 x 2 40 Olivia had 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 2 100 Olivia s benefits for this accident totaled more than 5 000 Benefit Booster For illustrative purposes only Benefit amounts may vary and may not cover all expenses Total 500 11 140 Benefits are per covered person per covered accident unless stated otherwise Injury benefits 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

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Fracture benefits Injury 200 5 000 Examples finger 200 wrist 1 200 hip 4 200 Surgical repair of fracture 100 Payable as an additional of the applicable fractures benefit Chip fracture 25 Payable as a of the applicable fractures benefit Dislocation benefits 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 benefit Incomplete dislocation 25 Payable as a of the applicable dislocations benefit Treatment benefits Prosthetic device or artificial limb 1 750 3 500 Skin grafts due to burns 50 Payable as a of the applicable burn benefit Skin grafts not due to burns 375 750 Transfusions 500 Transportation 200 per trip Maximum 6 one way trips Treatment in a physician s office or urgent care facility 150 Maximum 4 per year X ray or ultrasound 60 Surgery benefits Anesthesia 150 300 Connective tissue surgery 150 2 200 Eye surgery 400 General surgery Abdominal thoracic or cranial 2 000 Air ambulance 2 000 Exploratory surgery 275 Ambulance ground or water 400 Hernia surgery 400 Durable medical equipment 65 250 Knee cartilage meniscus surgery 150 1 050 Emergency dental repair 200 600 Outpatient surgical facility 400 Emergency department 250 Maximum 4 per year Ruptured or herniated disc surgery 150 2 000 Family care 50 per day Maximum of one benefit 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 benefit 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 Recovery care benefits At home care 125 per day Maximum 5 days Benefit 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 confinement 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 Gunshot wound benefit Behavioral health therapy 55 per day Maximum 15 days This benefit 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 Post traumatic stress disorder PTSD 200 Prescription drug 25 Additional therapy services chiropractic acupuncture alternative therapy 55 Existing therapy services benefit 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 _________ This benefit covers a non fatal gunshot wound from a conventional firearm 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 benefits only for the first wound

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Contact your Colonial Life benefits counselor to learn more CT We will pay the air ambulance or ambulance benefits directly to the licensed professional ambulance company CT includes a benefit for outpatient emergency medical care for accidental ingestion of a controlled substance The at home care benefit maximum is 80 days KS Chiropractic therapy is not available NH NH includes a burn benefit for 2nd degree burns under 5 of skin surface The minimum benefit for the loss or partial loss of a digit is 1 000 MD The prescription drug benefit is not available PA The pet boarding benefit is not available TN The therapy services benefit includes chiropractic TX The concussion benefit is replaced by the concussion and acquired brain injuries benefit The therapy services benefit 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 COMPATIBLE This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate It may also be offered to employees who do not have HSAs THIS INSURANCE PROVIDES LIMITED BENEFITS This coverage is a supplement to health insurance It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law Insureds in some states must be covered by comprehensive health insurance before applying for this insurance EXCLUSIONS We will not pay benefits for claims that are caused by contributed to by or resulting from elective procedures felonies or illegal occupations hazardous avocations impaired driving incarceration racing semiprofessional or professional sports sickness suicide or self inflicted injuries war or armed conflict ID Semi professional sports or professional sports exclusion is replaced by professional sports exclusion IL We will not pay benefits 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 benefits MI Impaired driving and suicide or self inflicted injuries exclusions do not apply MN Suicide or self inflicted injuries exclusion does not apply NH Incarceration and racing exclusions do not apply UT We will not pay benefits 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 benefits payable Applicable to policy form GAC4100 P and certificate form GAC4100 C including state abbreviations where used for example GAC4100 P TX and GAC4100 CTX For cost and complete details of coverage call or write your Colonial Life benefits counselor or the company 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 ColonialLife com FOR EMPLOYEES 3 23 1212553

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Group Hospital Indemnity Insurance Plan 1 HSA Compliant Group 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 day Maximum of one day per covered person per calendar year Waiver of premium Available after 30 continuous days of a covered confinement of the named insured Daily hospital confinement 100 per day Maximum 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 Health savings account HSA compatible This plan is compatible with HSA guidelines and any other HSA plan that a covered family member may participate in It may also be offered to employees who do not have HSAs For more information talk with your benefits counselor Colonial Life Accident Insurance Company s Group Medical Bridge offers an HSA compatible plan in most states PA Hospital Confinement Admission benefit replaces the Hospital Confinement benefit THIS POLICY PROVIDES LIMITED BENEFITS 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 following exclusions and limitations a alcoholism or drug addiction b dental procedures c elective procedures and cosmetic surgery d felonies or illegal occupations e mental or nervous disorders f pregnancy of a dependent child g suicide or injuries which any covered person intentionally does to himself or herself h war or i giving birth within the first nine months after the effective date of the certificate j 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 k The policy may have additional exclusions and limitations which may affect any benefits payable ColonialLife com PRE EXISTING CONDITION LIMITATIONS l We will not pay benefits for loss during the first 12 months after the certificate effective date due to a pre existing condition m 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 effective date n This limitation applies to the following benefits if applicable Hospital Confinement and Daily Hospital Confinement This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P and certificate form GMB7000 C including state abbreviations where applicable such as policy forms GMB7000 P AU TX and GMB7000 P EE TX and certificate forms GMB7000 C AU TX and GMB7000 C EE TX Coverage may vary by state and may not be available in all states This form is not complete without form 101733 Underwritten by Colonial Life Accident Insurance Company Columbia SC 2018 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company GMB7000 PLAN 1 11 18 101917

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Group Hospital Indemnity Insurance Exclusions and Limitations STATE SPECIFIC EXCLUSIONS AK a Replaced by intoxicants and narcotics CA k Additional exclusions include intoxicants and controlled substances CT a Replaced by intoxication or drug addiction d Replaced by felonies f Exclusion does not apply DE a Exclusion does not apply IL a Replaced by alcoholism intoxication or drug addiction f Exclusion does not apply g Exclusion does not apply KS a Replaced by intoxicants and narcotics h Replaced by war or armed conflict i Exclusion does not apply KY a Replaced by intoxicants narcotics and hallucinogenics LA a Replaced by intoxicants and narcotics MI g Exclusion does not apply MO a Replaced by drug addiction d Replaced by illegal activities MS a Replaced by intoxicants and narcotics NC i Exclusion does not apply ND a Exclusion does not apply e Exclusion does not apply NV a Exclusion does not apply OH f Exclusion does not apply i Replaced by 270 days PA a Replaced by intoxicants and narcotics c Replaced by cosmetic surgery e Replaced by mental nervous or emotional disorders h Replaced by war or armed conflict SD a Exclusion does not apply TN f Exclusion does not apply TX a Replaced by intoxicants and narcotics VA i Pregnancy resulting from the 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 STATE SPECIFIC PRE EXISTING CONDITION LIMITATIONS IN SD and WY m applies within the six months before the certificate effective date CA m A pre existing condition is a sickness or physical condition for which a covered person was diagnosed or treated within 12 months before the coverage effective date FL m 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 six months before the coverage effective date Genetic information is not a pre existing condition in the absence of a diagnosis of the condition related to such information IL m A pre existing condition is a sickness or physical condition whether diagnosed or not for which a covered person was treated had medical testing by a legally qualified physician or received medical advice produced symptoms or had taken medication within 12 months before the coverage effective date KS n Surgical Procedure replaces Outpatient Surgical Procedure ME m A pre existing condition is a sickness or physical condition whether diagnosed or not for which a covered person was treated had medical testing or received medical advice within 12 months before the coverage effective date MI l Applies during the first six months after the certificate effective date m applies within the six months before the certificate effective date MO m A pre existing condition means having 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 12 months before the coverage effective date of this certificate NC m A pre existing condition is those conditions whether diagnosed or not for which a covered person received medical advice diagnosis care or treatment that was received or recommended within the one year period immediately preceding the coverage effective date If you are 65 or older when this certificate is issued preexisting conditions will include only conditions specifically eliminated by a rider ND m 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 12 months before the coverage effective date NV m applies within the six months before the certificate effective date Additionally pre existing condition does not include genetic information in the absence of a diagnosis of the condition related to such information OR m A pre existing condition is a sickness or physical condition whether diagnosed or not for which a covered person was treated by a doctor received advice from a physician or had taken medication prescribed by a doctor within the 12 months period immediately preceding the coverage effective date PA m A pre existing condition is a disease or physical condition for which you received medical advice or treatment within 90 days before the coverage effective date n Hospital Confinement Admission replaces Hospital Confinement CA Lic if applicable _________________ This information is not intended to be a complete description of the insurance coverage available This coverage has exclusions and limitations that may affect benefits payable For cost and complete details see your Colonial Life benefits counselor This brochure is applicable to policy form GMB7000 P and certificate form GMB7000 C including state abbreviations where applicable such as policy forms GMB7000 P AU TX and GMB7000 P EE TX and certificate forms GMB7000 C AU TX and GMB7000 C EE TX Coverage may vary by state and may not be available in all states Underwritten by Colonial Life Accident Insurance Company Columbia SC 2018 Colonial Life Accident Insurance Company All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life Accident Insurance Company 11 18 101733 2 GMB7000 EXCLUSIONS AND LIMITATIONS

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Group Disability Income Insurance Your bills keep coming even when your paycheck doesn t There is a 33 percent chance someone will be disabled for at least six months during their working years 1 Like most of us you likely depend on your paycheck to maintain your current quality of life If you got sick or hurt and couldn t work how long could you go without a paycheck Half of households say they couldn t raise 2 000 within a month if needed 2 Would you be financially prepared Protect your income Colonial Life s Disability Insurance offers a monthly benefit to replace a portion of your income if you are disabled and can t work due to a covered accident or covered sickness You can use this benefit however you need It can help you cover expenses like l Mortgage or rent payments l Credit card bills l Utility bills such as electricity gas water cable TV and Internet l Car payments gas and other transportation costs l Food clothing and other necessities Group Disability Base TX With Colonial Life s Disability Insurance 1 You re paid regardless of any other insurance you may have with other insurance companies 2 Benefits are paid directly to you unless you specify otherwise 3 At enrollment you may choose the amount of your disability benefits to meet your needs subject to income 4 Your coverage is available through convenient payroll deduction 1 Charles River Associates prepared for Unum Financial Security for Working Americans An Economic Analysis of Insurance Products in Workplace Benefits Programs 2011 2 Lusardi Annamarie et al Financially Fragile Households Evidence and Implications National Bureau of Economic Research Working Paper 17072 May 2011 Here s how it works Mark and his wife had a second child and bought a new house to accommodate their growing family Mark s occupation enabled him to pay for his family s expenses such as gas groceries and mortgage payments Then the unexpected happened An accident left Mark disabled and unable to work for several months Before his disability Mark had an annual salary of 50 000 and brought home 2 500 a month after taxes and benefit contributions Fortunately he had disability insurance and received a 2 500 monthly benefit Disability insurance helped Mark cover his family s expenses He was prepared for the unexpected Are you

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Benefits Worksheet Important features For use with your Colonial Life benefits counselor Partial Disability How much coverage do I need Monthly Benefit Amount for Off Job Accident Off Job Sickness ________________ If your plan includes On Job Accident On Job Sickness benefits the benefit is 50 of the Off Job amount If you are able to return to work part time you may be able to still receive 50 percent of your total disability benefit Partial disability is based on your inability to perform your occupation or any other occupation for at least half of your normal working hours and being under the regular and appropriate care of a doctor Waiver of Premium How long will I receive benefits Benefit Period ________ months The Partial Disability Benefit Period is three months When will my benefits start Elimination Period After an accident _______ days We will waive your premium payments after 90 consecutive days of a covered disability Geographical Limitations If you are disabled while outside the United States or covered geographical areas we can pay up to 60 days before you have to return to the U S or a covered geographical area to receive any remainder of your benefits Issue Age Coverage is available from ages 17 to 74 _______ days Portability Elimination Period means a period of total disability during which no benefits are payable Premium After a sickness Product Options Total Disability Benefit Period This is the maximum amount of time you can receive benefits for a covered total disability Totally 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 doctor You may be able to keep your coverage even if you change occupations Your premium is based on your current age and the amount of coverage you are eligible to buy Your premium will not change because you age Talk with a Colonial Life benefits counselor today to learn more about how you can help protect your finances with disability insurance Monthly Benefit Amounts Choose a monthly benefit amount between 400 and 7 500 subject to income requirements Group Disability Base TX EXCLUSIONS We will not pay benefits for losses that are caused by contributed to by or occur as the result of alcoholism or drug addiction felonies or illegal occupations flying hazardous avocations intoxicants and narcotics psychiatric or psychological conditions racing semi professional or professional sports suicide or injuries which you intentionally do to yourself war or armed conflict State versions apply LIMITATIONS We will not pay for losses due to you giving birth within the first nine months after the coverage effective date of the certificate We will not pay for loss when the disability is a pre existing condition as described in the certificate This product is underwritten by Colonial Life Accident Insurance Company For cost and complete details applicable to policy form GDIS P EE TX and certificate form GDIS C EE TX see your Colonial Life benefits counselor This is not an insurance contract and only the actual policy provisions will control Colonial Life 1200 Colonial Life Boulevard Columbia South Carolina 29210 coloniallife com 2013 Colonial Life Accident Insurance Company Colonial Life products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand 6 13 101296

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Deductions per year 12 These rates were prepared on 3 22 2024 and are valid for 90 days Group Accident GAC4100 for TX Applicable to policy forms GAC4100 P GAC4100 C l Additional Benefits On Off Job Accident Coverage BENEFIT LEVEL AD D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENT CHILD REN EMPLOYEE SPOUSE AND DEPENDENT CHILD REN Premier Premier 15 75 24 56 35 18 44 20 17 99 Group Medical Bridge GMB7000 for TX Age Banded Applicable to Policy Forms GMB7000 P GMB7000 C l Without Wellbeing Assistance HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY Level 2 1000 17 49 50 59 60 64 65 99 9 50 12 30 17 20 24 10 17 10 24 40 35 80 50 10 13 55 16 35 21 25 28 15 21 15 28 45 39 85 54 15 HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE SPOUSE ONE PARENT FAMILY TWO PARENT FAMILY Level 4 2000 17 49 50 59 60 64 65 99 18 90 24 50 34 30 48 10 34 00 48 60 71 40 100 00 26 95 32 55 42 35 56 15 42 05 56 65 79 45 108 05 Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD Group Critical Illness GCI6000 for TX l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 50 Benefit Non Tobacco Rates 15 000 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 8 90 11 45 14 15 20 15 26 15 36 05 45 80 59 30 79 85 97 25 97 25 13 05 16 95 20 85 30 00 39 00 54 30 69 60 90 15 121 35 148 05 148 05 8 90 11 45 14 15 20 15 26 15 36 05 45 80 59 30 79 85 97 25 97 25 13 05 16 95 20 85 30 00 39 00 54 30 69 60 90 15 121 35 148 05 148 05 Page 1 of 3 Underwritten by Colonial Life Accident Insurance Company See page 2 for Important Notice

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Continued Applicable to policy forms GCI6000 P GCI6000 C R GCI6000 CB R GCI6000 BB R GCI6000 HB R GCI6000 INF R GCI6000 PD Group Critical Illness GCI6000 for TX l Plan 2 Critical Illness Cancer Wellbeing Assistance Benefit 50 Benefit Non Tobacco Rates 30 000 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 14 90 20 00 25 40 37 40 49 40 69 20 88 70 115 70 156 80 191 60 191 60 21 60 29 40 37 20 55 50 73 50 104 10 134 70 175 80 238 20 291 60 291 60 14 90 20 00 25 40 37 40 49 40 69 20 88 70 115 70 156 80 191 60 191 60 21 60 29 40 37 20 55 50 73 50 104 10 134 70 175 80 238 20 291 60 291 60 ISSUE AGE NAMED INSURED NAMED INSURED AND SPOUSE NAMED INSURED AND DEPENDENT CHILD REN NAMED INSURED SPOUSE AND DEPENDENT CHILD REN 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 17 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 12 50 16 70 20 90 30 50 40 10 55 85 71 45 93 05 125 90 153 80 153 80 22 10 30 50 38 90 58 10 77 30 108 80 140 00 183 20 248 90 304 70 304 70 18 15 24 45 30 75 45 15 59 70 84 15 108 60 141 60 191 55 234 00 234 00 31 80 44 40 57 00 85 80 114 90 163 80 212 70 278 70 378 60 463 50 463 50 12 50 16 70 20 90 30 50 40 10 55 85 71 45 93 05 125 90 153 80 153 95 22 10 30 50 38 90 58 10 77 30 108 80 140 00 183 20 248 90 304 70 305 00 18 15 24 45 30 75 45 15 59 70 84 15 108 60 141 60 191 55 234 00 234 15 31 80 44 40 57 00 85 80 114 90 163 80 212 70 278 70 378 60 463 50 463 80 Tobacco Rates 15 000 30 000 Important Notice Insurance coverage has exclusions and limitations that may affect benefits payable For a complete description of benefits limitations and exclusions please refer to an outline of coverage sample policy certificate proposal description or see your Colonial Life benefits counselor Coverage type benefits and rates vary by state Coverage may not be available in all states Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices Colonial Life products are underwritten by Colonial Life Accident Insurance Company for which Colonial Life is the marketing brand Page 2 of 3 Underwritten by Colonial Life Accident Insurance Company See page 2 for Important Notice

Whitener Enterprises Guide

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