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EMPLOYEE BENEFITS PLAN BEAUFORT COUNTY GOVERNMENT PLAN YEAR: JANUARY 1, 2020 DECEMBER 31, 2020

www.piercegroupbenefits.com

EMPLOYEE BENEFITS GUIDE

TABLE OF CONTENTS Welcome to the Beaufort County Government comprehensive benefits program. This booklet highlights the benefits offered to all eligible employees for the plan year listed below. Benefits described in this booklet are voluntary, employee-paid benefits unless otherwise noted.

ENROLLMENT PERIOD: NOVEMBER 12, 2019 - NOVEMBER 19, 2019 EFFECTIVE DATES: JANUARY 1, 2020 - DECEMBER 31, 2020 Benefits Plan Overview

page

Disability Benefits

page

Online Enrollment Instructions

page

Accident Benefits

page

State Of North Carolina Teachers’ And State Employees’ Health Plan – page Plan Comparison**

Medical Bridge Benefits

page

Dental Benefits

page

Life Insurance

page

Vision Benefits

page

Cobra Continuation Of Coverage Rights

page

Group Term Life Insurance

page

Authorization Form

page

Notice Of Insurance Information Practices

page

Continuation Of Coverage for Benefits Form

page

Flexible Spending Accounts

page

Cancer Benefits

page

Critical Care Benefits

page

** for informational purposes only

Rev. 11/05/2019

PRE-TAX & POST-TAX BENEFITS

BEAUFORT COUNTY GOVERNMENT ENROLLMENT PERIOD: NOVEMBER 12, 2019 - NOVEMBER 19, 2019 EFFECTIVE DATES: JANUARY 1, 2020 - DECEMBER 31, 2020

PRE-TAX BENEFITS Vision Insurance

Dental Insurance

Community Eye Care

Delta

Flexible Spending Accounts*

Flores and Associates • Medical Reimbursement FSA Maximum: $2,700/year • Dependent Care Reimbursement FSA Maximum: $5,000/year

Cancer Benefits

Colonial Life

Accident Benefits

Colonial Life

Medical Bridge Benefits

Colonial Life

*You will need to re-sign for the Flexible Spending Accounts if you want them to continue next year. IF YOU DO NOT RE-SIGN, YOUR CONTRIBUTION WILL STOP EFFECTIVE DECEMBER 31, 2019.

POST-TAX BENEFITS Disability Benefits

Colonial Life

Critical Care Benefits Colonial Life

Group Term Life Insurance

Unum

Life Insurance

Colonial Life • Term Life Insurance • Whole Life Insurance

Please note your insurance products will remain in effect unless you see a representative to change them. 2

QUALIFICATIONS & IMPORTANT INFO

THINGS YOU NEED TO KNOW QUALIFICATIONS: • You must work 1000 hours or more per year. • Employees are eligible for benefits the first of the month following 30 days of employment.

IMPORTANT FACTS: • The plan year for Delta Dental, Community Eye Care Vision, Unum Group Term Life, Colonial Insurance products and Spending Accounts lasts from January 1, 2020 through December 31, 2020. • Deductions for Community Eye Care Vision will begin December 2019. Deductions for Delta Dental, Unum Group Term Life, Colonial Insurance products and Spending Accounts will begin January 2020. • If signing up for any coverage on your spouse and/or children, please have their dates of birth and social security numbers available when meeting with the Benefits Representative. • PLEASE NOTE: Pierce Group Representatives are not authorized to assist employees with their SHP enrollment or make SHP enrollment elections on an employee’s behalf. • If you will be receiving a new debit card, whether you are a new participant or to replace your expired card, please be aware that it may take up to 30 days following your plan effective date for your card to arrive. Your card will be delivered by mail in a plain white envelope. During this time you may use manual claim forms for eligible expenses. Please note that your debit card is good through the expiration date printed on the card. • Elections made during this enrollment period CANNOT BE CHANGED AFTER THE ENROLLMENT PERIOD unless there is a family status change as defined by the Internal Revenue Code. Examples of a family status change are: marriage, divorce, death of a spouse or child, birth or adoption of a child, termination or commencement of a spouse's employment, or the transition of spouse's employment from full-time to part-time, or vice-versa. • Once a family status change has occurred, an employee has 30 days to notify the North Carolina Service Center at 1-888-662-7500 to request a change in elections. • Flexible Spending Account expenses must be incurred during the Plan Year in order to be eligible for reimbursement. • An employee has 90 days after the plan year ends to submit claims for spending account expenses that were incurred during the plan year. Please note that if employment terminates during the plan year, that employee's plan year ends the day employment ends. The employee has 90 days after the termination date to submit claims. • With Dependent Care Flexible Spending Accounts, the maximum reimbursement you can request is equal to the current account balance in your Dependent Care account. You cannot be reimbursed more than has actually been deducted from your pay. • The Colonial Cancer plan and the Health Screening Rider on the Colonial Accident and Colonial Medical Bridge plan have a 30-day waiting period for new enrollees. Coverage, therefore, will not begin until January 31, 2020. • Additionally, some policies may include a pre-existing condition clause. Please read your policy carefully for full details. • Please be aware there are certain coverages that may be subject to federal and state tax when premium is paid by pretax deduction or employee contribution. • An employee taking a leave of absence, other than under the Family & Medical Leave Act, may not be eligible to re-enter the Flexible Benefits Program until the next plan year. Please contact your Benefit Administrator for more information.

EMPLOYEE BENEFITS GUIDE

BEAUFORT COUNTY GOVERNMENT IN PERSON

ONLINE

You may enroll or make changes online to your flexible benefits plan. To enroll online, please visit https://harmonyenroll.coloniallife.com

During your open enrollment period, a Pierce Group Benefits representative will be available by appointment to answer any questions you may have and to assist you in the enrollment process.

ENROLLMENT PERIOD: NOVEMBER 12, 2019 - NOVEMBER 19, 2019 YOU CAN MAKE THE FOLLOWING BENEFIT ELECTIONS ONLINE DURING THE ENROLLMENT PERIOD: • • • •

Enroll, change or cancel your Vision Insurance. Enroll, change or cancel your Dental Insurance. Sign up/re-enroll your Flexible Spending Account (Medical Reimbursement and Dependent Care). Enroll, change or cancel your Colonial products (see the following pages for changes that can be completed online).

THE FOLLOWING BENEFIT ELECTIONS MUST BE MADE WITH YOUR BENEFITS REPRESENTATIVE DURING THE ENROLLMENT PERIOD AND ARE NOT AVAILABLE FOR ONLINE ENROLLMENT. • Enroll, change or cancel your Group Term Life Insurance*. • Enroll, change or cancel your Colonial products (see the following pages for changes that require representative assistance). *Group Term Life Coverage is included in this booklet for information purposes only. Employees needing to make changes to their coverage should contact a Benefit Counselor or the Human Resources Department.

ACCESS YOUR BENEFITS ONLINE WHENEVER, WHEREVER. Benefits Details | Educational Videos | Download Forms | Online Chat with Service Center To view your personalized benefits website, go to:

www.piercegroupbenefits.com/beaufortcountygovernment or piercegroupbenefits.com and click “Find Your Benefits”.

IMPORTANT NOTE & DISCLAIMER

This is neither an insurance contract nor a Summary Plan Description and only the actual policy provisions will prevail. All information in this booklet including premiums quoted is subject to change. All policy descriptions are for information purposes only. Your actual policies may be different than those in this booklet.

Harmony

HARMONY ONLINE ENROLLMENT: COMPLETE THE STEPS BELOW TO BEGIN THE ONLINE ENROLLMENT PROCESS

HELPFUL TIPS:

• If you are a new employee and unable to log into the online system, please see the Benefits Representative at your location. • If you are an existing employee and unable to log into the online system, please contact the Harmony Help Desk at 866-875-4772 between 8:30am and 6:00pm, or speak with your Benefits Representative at your location.

Go to https://harmonyenroll.coloniallife.com

• Enter your User Name: BEA5B5H- and then Last Name and then Last 4 of Social Security Number (BEA5B5H-SMITH6789) • Enter your Password: Four digit Year of Birth and then Last 4 of Social Security Number (19766789)

The screen prompts you to create a NEW password [____________________________].

Choose a security question and enter answer [______________________________________].

Click on ‘I Agree’ and then “Enter My Enrollment”.

The screen shows ‘Me & My Family’. Verify that the information is correct and enter the additional required information (title, marital status, work phone, e-mail address). Click ‘Save & Continue’ twice.

The screen allows you to add family members. It is only necessary to enter family member information if adding or including family members in your coverage. Click ‘Continue’.

The screen shows updated personal information. Verify that the information is correct and make changes if necessary. Click ‘Continue’.

The screen shows ‘My Benefits’. Review your current benefits and make changes/selections for the upcoming plan year. • DENTAL (Choose one of the options and click ‘Save & Continue’):

1. If you have existing coverage and would like to keep it without making changes, click ‘Keep This Benefit’; 2. If you would like to enroll in coverage, or change existing coverage, choose your plan in the Enroll section; 3. If you would like to decline coverage, click ‘Decline/Cancel Coverage’ Select family members that you wish to cover by clicking ‘Add a Family Member’.

• VISION (Choose one of the options and click ‘Save & Continue’):

<<< enrollment instructions continued on next page >>> 5

Harmony

HARMONY ONLINE ENROLLMENT CONT.:

• HEALTH CARE FSA (Choose one of the options and click ‘Save & Continue’): 1. Enter annual amount. MAX $2,700/year • DEPENDENT CARE FSA (Choose one of the options and click ‘Save & Continue’): 1. Enter annual amount. MAX $5,000/year • CANCER ASSIST You may enroll online in Cancer Assist coverage. • DISABILITY 3000 You may enroll online in Disability 3000 – Colonial’s Disability Plan. • ACCIDENT 1.0 You may enroll online in Accident 1.0; however persons over age 64 applying for coverage and employees wishing to purchase an individual policy for their spouse must meet with the Benefits Representative. • MEDICAL BRIDGE You may enroll online in Medical Bridge coverage. • CRITICAL CARE You may enroll online in Critical Care coverage. • TERM LIFE 5000 You may enroll online in Term Life 5000; however, employees wishing to purchase an individual policy for their spouse should meet with the Benefits Representative. • WHOLE LIFE 5000 You may enroll online in Whole Life 5000; however, employees wishing to purchase an individual policy for their spouse should meet with the Benefits Representative.

Click ‘Finish’.

10.

Click ‘I Agree’ to electronically sign the authorization for your benefit elections.

11.

Click ‘Print a copy of your Elections’ to print a copy of your elections. Please do not forget this important step!

12.

Click ‘Log out & close your browser window’ and click ‘Log Out’.

The following summary is included in this booklet for informational purposes only. Open Enrollment for the State of North Carolina Teachers' and State Employees' Health Plan is not part of this benefits plan open enrollment period. Pierce Group Representatives are not authorized to assist employees with their SHP enrollment or make SHP enrollment elections on an employeeâ€™s behalf.

2020 STATE HEALTH PLAN COMPARISON Active and Non-Medicare Subscribers

80/20 PLAN

70/30 PLAN

PLAN DESIGN FEATURES IN-NETWORK

OUT-OFNETWORK

IN-NETWORK

OUT-OFNETWORK

$1,250 Individual $3,750 Family

$2,500 Individual $7,500 Family

$1,500 Individual $4,500 Family

$3,000 Individual $9,000 Family

Coinsurance

20% of eligible expenses after deductible is met

40% of eligible expenses after deductible and the difference between the allowed amount and the charge

30% of eligible expenses after deductible is met

50% of eligible expenses after deductible and the difference between the allowed amount and the charge

Out-of-Pocket Maximum (Combined Medical and Pharmacy)

$4,890 Individual $14,670 Family

$9,780 Individual $29,340 Family

$5,900 Individual $16,300 Family

$11,800 Individual $32,600 Family

Preventive Services

$0 (covered at 100%)

N/A

$0 (covered at 100%)

N/A

$25 for PCP; $10 if you use PCP on ID card; $80 Specialist

40% after deductible is met

$45 for PCP; $30 if you use PCP on ID card; $94 for Specialist

50% after deductible is met

Annual Deductible

Office Visits

Urgent Care

$70

PCP: Primary Care Provider

$100

80/20 PLAN

70/30 PLAN

PLAN DESIGN FEATURES OUT-OFNETWORK

IN-NETWORK Emergency Room (Copay waived w/admission or observation stay)

Inpatient Hospital

$300 copay, then 20% after deductible is met

$300 copay, then 40% after deductible is met

IN-NETWORK

OUT-OFNETWORK

$337 copay, then 30% after deductible is met

$337 copay, then 50% after deductible is met

PHARMACY BENEFITS Tier 1 (Generic)

$5 copay per 30-day supply

$16 copay per 30-day supply

$30 copay per 30-day supply

$47 copay per 30-day supply

Deductible/coinsurance

Tier 4 (Low-Cost Generic Specialty)

$100 copay per 30-day supply

$200 copay per 30-day supply

Tier 5 (Preferred Specialty)

$250 copay per 30-day supply

$350 copay per 30-day supply

Tier 6 (Non-preferred Specialty)

Deductible/coinsurance

Deductible/coninsurance

Preferred Diabetic Testing Supplies**

$5 copay per 30-day supply

$10 copay per 30-day supply

Tier 2 (Preferred Brand & High-Cost Generic) Tier 3 (Non-preferred Brand)

** Preferred Brand is the OneTouch Test Strips. Non-preferred diabetic testing supplies are considered a Tier 3 member copay.

Delta Dental PPO plus Premier Summary of Dental Plan Benefits For Group# 1249-0001, 0999 Beaufort County Government This Summary of Dental Plan Benefits should be read along with your Certificate. Your Certificate provides additional information about your Delta Dental plan, including information about plan exclusions and limitations. If a statement in this Summary conflicts with a statement in the Certificate, the statement in this Summary applies to you and you should ignore the conflicting statement in the Certificate. The percentages below are applied to Delta Dental's allowance for each service and it may vary due to the dentist's network participation.* Control Plan – Delta Dental of North Carolina Benefit Year – January 1 through December 31 Covered Services – Delta Dental PPO Dentist Plan Pays Diagnostic & Preventive Diagnostic and Preventive Services – exams, cleanings, fluoride, and space maintainers Sealants – to prevent decay of permanent teeth Brush Biopsy – to detect oral cancer Radiographs – X-rays

Delta Dental Premier Dentist Plan Pays

Nonparticipating Dentist Plan Pays*

100%

100% 100% 100% Basic Services

100% 100% 100%

Emergency Palliative Treatment – to temporarily 80% 80% 80% relieve pain Minor Restorative Services – fillings and crown repair 80% 80% 80% Periodontal Maintenance – cleanings following 80% 80% 80% periodontal therapy Simple Extractions – non-surgical removal of teeth 80% 80% 80% Other Basic Services – misc. services 80% 80% 80% Major Services Endodontic Services – root canals 50% 50% 50% Periodontic Services – to treat gum disease 50% 50% 50% Other Oral Surgery – dental surgery 50% 50% 50% Major Restorative Services – crowns 50% 50% 50% Relines and Repairs – to bridges, implants, and 50% 50% 50% dentures Prosthodontic Services – bridges, implants, and 50% 50% 50% dentures Orthodontic Services Orthodontic Services – braces 50% 50% 50% Orthodontic Age Limit – up to age 19 up to age 19 up to age 19 * When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. This Nonparticipating Dentist Fee may be less than what your dentist charges, which means that you will be responsible for the difference.      

Oral exams (including evaluations by a specialist) are payable twice per calendar year. Prophylaxes (cleanings) are payable twice per calendar year. Full mouth debridement is payable once per lifetime. People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment. Fluoride treatments are payable twice per calendar year for people up to age 19. Space maintainers are payable once per area per three-year period for people up to age 16. Bitewing X-rays are payable once per calendar year and full mouth X-rays (which include bitewing X-rays) are payable once in any two-year period.

KR#08478772

     

Sealants are payable once per tooth per three-year period for first and second permanent molars up to age 16. The surface must be free from decay and restorations. Composite resin (white) restorations are Covered Services on posterior teeth. Porcelain and resin facings on crowns are Covered Services on posterior teeth. Vestibuloplasty is a Covered Service. Full and partial dentures are payable once in any five-year period. Reline and rebase of dentures are payable once in any two-year period. Implants and implant related services are payable once per tooth in any five-year period.

Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! You can now receive expert dental care when you are outside of the United States through our Passport Dental program. This program gives you access to a worldwide network of dentists and dental clinics. English-speaking operators are available around the clock to answer questions and help you schedule care. For more information, check our Web site or contact your benefits representative to get a copy of our Passport Dental information sheet. Maximum Payment – $1,000 per person total per Benefit Year on all services, except oral exams, preventive services, Xrays, brush biopsy, sealants, and orthodontic services. $1,000 per person total per lifetime on orthodontic services. Maximum Carryover – If at least one Covered Service is applied toward your Maximum Payment in a Benefit Year and the total Benefit paid does not exceed $500.00 in that Benefit Year, up to $250.00 will carry over to the next Benefit Years Maximum Payment. This carryover amount will accumulate from one Benefit Year to the next, but will not exceed $1,000.00. If no Covered Services are paid during a Benefit Year, all accumulated carryover amounts from previous Benefit Years will be forfeited. Deductible – $50 Deductible per person total per Benefit Year limited to a maximum Deductible of $150 per family per Benefit Year. The Deductible does not apply to oral exams, preventive services, X-rays, brush biopsy, sealants, and orthodontic services. Waiting Period – Employees who are eligible for dental benefits are covered on the first of the month following 30 days of employment. Eligible People – All full-time employees of the Contractor working at least 1,000 hours per year who choose the dental plan (0001) and COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) enrollees (0999). The Subscriber pays the full cost of this plan. Also eligible are your legal spouse and your children to the end of the month in which they turn 26, including your children who are married, who no longer live with you, who are not your dependents for Federal income tax purposes, and/or who are not permanently disabled. You and your eligible dependents must enroll for a minimum of 12 months. If coverage is terminated after 12 months, you may not re-enroll prior to the open enrollment that occurs at least 12 months from the date of termination. Your dependents may only enroll if you are enrolled (except under COBRA) and must be enrolled in the same plan as you. Plan changes are only allowed during open enrollment periods, except that an election may be revoked or changed at any time if the change is the result of a qualifying event as defined under Internal Revenue Code Section 125. If you and your spouse are both eligible for coverage under this Contract, you may be enrolled together on one application or separately on individual applications, but not both. Your dependent children may only be enrolled on one application. Delta Dental will not coordinate benefits if you and your spouse are both covered under this Contract. Benefits will cease on the last day of the month in which the employee is terminated.

Customer Service Toll-Free Number: 800-662-8856 (TTY users call 711) https://www.DeltaDentalNC.com

KR#08478772

Beaufort County Vision Plan

PROVIDER SEARCH To locate a provider in your

Beaufort County is pleased to provide this summary of the voluntary vision plan available to our employees. The plan enables employees and their families to significantly reduce their expenditures for routine eye care. Offered through Community Eye Care, the benefit includes the following:

area, go to communityeyecare.net and search by:

COMPREHENSIVE PLAN

 county  doctor’s last name  practice name  zip code

 An eye exam once a year ($15 co-pay)  A $150 allowance for eyewear annually  A contact lens fitting, re-fit or evaluation once a year ($15 co-pay)

CLAIMS

EYEWEAR PLAN

There are no claims to file when you see an in-network provider. Network providers

 A $150 allowance for eyewear annually (no co-pay)

file claims on your behalf. Additionally, most CEC network providers offer discounts on the overage if you exceed your allowance —20% on glasses and 10% on contact lenses.

Maximum coverage for contact lens exams is $100 for fittings and $80 for annual evaluations. If you see a non-network provider, simply submit a

Under each of the above plan options, the $150 eyewear allowance is completely flexible. It can be applied to frames, spectacle lenses, contact lenses, special lens options, or any combination. As long as you select eyewear having a retail price that’s less than or equal to your allowance, you incur no out-of-pocket expense for the eyewear.

HOW TO USE THE BENEFIT 1. Select a provider from the Community Eye Care provider network. 2. Call the provider to make an appointment, and let them know that you have Community Eye Care coverage. 3. See the doctor and select your eyewear. 4. Your only payments to the provider are your co-pays, plus any discounted amount that exceeds the $150 eyewear allowance.

claim form and a receipt to Community Eye Care. CUSTOMER SUPPORT Contact CEC’s helpful Customer Support Team at 1.888.254.4290 with any questions about benefits or providers.

Beaufort County Government

Term Life with Accidental Death & Dismemberment (AD&D) Insurance can provide money for your family if you die or are diagnosed with a terminal illness.

How does it work?

Who can get Term Life coverage?

You keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.

If you are actively at work at least 19.25 hours per week, you can receive coverage for: You

AD&D Insurance is also available, which can pay a benefit if you survive an accident but have certain serious injuries. It can pay an additional amount if you die from a covered accident.

You can receive a benefit amount of $10,000.

Who can get Accidental Death & Dismemberment (AD&D) coverage? You

Why choose Unum? Your employer is offering you this coverage at no cost to you. Unum is the leading provider of employee benefits, with more than 165 years of experience.1 We’ll be there to back our benefits and provide you with the support you need.

You can receive an AD&D benefit amount of $10,000.

No questions or health exams required for AD&D coverage.

What else is included? A “Living” Benefit If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit and may be taxable. Waiver of premium Your cost may be waived if you are totally disabled for a period of time. Portability You may be able to keep coverage if you leave the company, retire or change the number of hours you work. Work-life balance Employee Assistance Program (EAP) Get access to professional help for a range of personal and work-related issues, including counselor referrals, financial planning and legal support.

1 Unum internal data, 2017. EN-2046 (9-18)

FOR EMPLOYEES

662778

Term Life Insurance with Accidental Death & Dismemberment (AD&D) Exclusions and limitations

Actively at work Eligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/ her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off. Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage. Exclusions and limitations Life insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits. AD&D specific exclusions and limitations: Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) • Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or selfinflicted injury while insane • War, declared or undeclared, or any act of war • Active participation in a riot • Committing or attempting to commit a crime under state or federal law • The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your doctor. This exclusion does not apply to you if the chemical substance is ethanol. • Intoxication – “Being intoxicated” means your blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred. Delayed effective date of coverage Employee: Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Age reduction Coverage amounts for Life and AD&D Insurance for you will reduce to 35% of the original amount when you reach age 65, and will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction. Termination of coverage Your coverage under the policy ends on the earliest of: • The date the policy or plan is cancelled • The date you no longer are in an eligible group • The date your eligible group is no longer covered • The last day of the period for which you made any required contributions • The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage 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 benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details. Work-life balance EAP The work-life balance employee assistance program, provided by HealthAdvocate, is available with select unum insurance offerings, Terms and availability of service are subjet to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details. Underwritten by: Unum Life Insurance Company of America, Portland, Maine

EN-2046 (9-18)

662778

FOR EMPLOYEES

Beaufort County Government

Term Life and Accidental Death & Dismemberment (AD&D) Insurance can provide money for your family if you die or are diagnosed with a terminal illness. How does it work?

Who can get Term Life coverage?

You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.

If you are actively at work at least 19.25 hours per week, you may apply for coverage for: You

AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.

Choose from $10,000 to $200,000 in $10,000 increments, up to 5 times your earnings. If you previously purchased coverage, you can increase it up to $200,000, your guaranteed issue amount, with no health questions. If you previously declined coverage, you may have to answer some health questions.

Why is this coverage so valuable? If you previously purchased coverage, you can increase it up to $200,000 to meet your growing needs — with no health questions or exams.

Your Spouse

Get up to $100,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself. If you previously purchased coverage for your spouse, they can increase their coverage up to $50,000, their guaranteed issue amount, with no health questions or exams, if eligible (see delayed effective date). If you previously declined spouse coverage, some health questions may be required.

Your Children

What else is included? A “Living” Benefit If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit. These benefit payments may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlement, and may be taxable. Recipients should consult their tax attorney or advisor before utilizing living benefit payments.

Get up to $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 19th birthday − or until their 26th birthday if they are full-time students. The maximum benefit for children live birth to 6 months is $1,000.

Who can get Accidental Death & Dismemberment (AD&D) coverage? You:

Get up to $200,000 of AD&D coverage for yourself in $10,000 increments to a maximum of 5 times your earnings.

Waiver of premium Your cost may be waived if you are totally disabled for a period of time.

Your Spouse:

Get up to $100,000 of AD&D coverage for your spouse in $5,000 increments, if eligible (see delayed effective date).

Portability You may be able to keep coverage if you leave the company, retire or change the number of hours you work.

Your Get up to $10,000 of coverage for your children in Children: $2,000 increments if eligible (see delayed effective date). No questions or health exams required for AD&D coverage. Delayed Effective Date: If your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.

Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.

EN-1976 (10-18)

FOR EMPLOYEES

662779

Term Life and Accidental Death & Dismemberment (AD&D) Insurance

How much coverage can I get? Calculate your costs 1. Enter the coverage amount you want. 2. Divide by the amount shown. 3. Multiply by the rate. Use the rate table (at right) to find the rate based on age. (Choose the age you will be when your coverage becomes effective on 01/01/2020. To determine your spouse rate, choose the age the employee will be when coverage becomes effective on 01/01/2020.)

4. Enter your cost.

1. Enter the AD&D coverage amount you want. 2. Divide by the amount shown. 3. Multiply by the rate. Use the AD&D rate table (at right) to find the rate.

Employee

$______,000

÷ $10,000 = $________

X $______

= $_______

Spouse

$______,000

÷ $5,000 = $________

X $______

= $_______

Child

$______,000

÷ $2,000 = $________

X $______

= $_______

Total cost

Employee semi-monthly rate Age 15-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Spouse semi-monthly rate

Child semi-monthly rate

Per $5,000 of coverage Cost $0.170 $0.170 $0.198 $0.282 $0.422 $0.647 $1.097 $1.660 $2.223 $3.518 $6.192 $6.192

$0.080 per $2,000 of coverage

Per $10,000 of coverage Cost $0.340 $0.340 $0.395 $0.565 $0.845 $1.295 $2.195 $3.320 $4.445 $7.035 $12.385 $12.385

AD&D

Employee

$______,000

÷ $10,000 = $________

X $0.125

= $_______

Spouse

$______,000

÷ $5,000 = $________

X $0.050

= $_______

Child

$______,000

÷ $2,000 = $________

X $0.040

= $_______

Total cost

4. Enter your cost. AD&D semi-monthly rates Employee Spouse Child

Coverage amount

Rate

per $10,000 of coverage per $5,000 of coverage per $2,000 of coverage

$0.125 $0.050 $0.040

Billed amount may vary slightly. If you apply for coverage above the guaranteed issue amount, you will be asked health-related questions which may affect your ability to get the larger coverage amount. In order to purchase coverage for your dependents, you must buy coverage for yourself. Coverage amounts cannot exceed 100% of your coverage amounts. EN-1976 (10-18)

FOR EMPLOYEES

662779

Term Life and Accidental Death & Dismemberment (AD&D) Insurance Exclusions and limitations

available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details. Unum complies with state civil union and domestic partner laws when applicable.

Underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Exclusions and limitations Life insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits. AD&D specific exclusions and limitations: Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) • Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or selfinflicted injury while insane • War, declared or undeclared, or any act of war • Active participation in a riot • Committing or attempting to commit a crime under state or federal law • The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol. • Intoxication – “Being intoxicated” means your or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred. Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Delayed Effective Date: If your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan. Age reduction Coverage amounts for Life and AD&D Insurance for you and your dependents will reduce to 65% of the original amount when you reach age 65, and will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction. Termination of coverage Your coverage and your dependents’ coverage under the policy ends on the earliest of: • The date the policy or plan is cancelled • The date you no longer are in an eligible group • The date your eligible group is no longer covered • The last day of the period for which you made any required contributions • The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage In addition, coverage for any one dependent will end on the earliest of: • The date your coverage under a plan ends • The date your dependent ceases to be an eligible dependent • For a spouse, the date of a divorce or annulment • For dependents, the date of your death Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan. This information is not intended to be a complete description of the insurance coverage

EN-1976 (10-18)

662779

FOR EMPLOYEES

MEDICAL FLEXIBLE SPENDING ACCOUNT

YOUR STEPS TO SAVINGS!

1 2 3

REALIZE THE TAX SAVINGS You can set aside pre-tax money into an account to be reimbursed for eligible medical expenses. Savings will depend on your tax bracket. ESTIMATE YOUR EXPENSES Plan for your upcoming expenses and include your spouse and dependents, if eligible. A brief list of expenses can be found to the right. A comprehensive list of allowable expenses and an expense worksheet can be found at www.flores247.com. ENROLL AND MANAGE YOUR ACCOUNT Speak with your Benefits Representative during the Enrollment Period, or see the enrollment instructions in this booklet. Flores will mail a custom Participant ID number to your home address to help you manage your account.

THE MEDICAL FLEXIBLE SPENDING ACCOUNT (FSA) CAN REIMBURSE YOU FOR ELIGIBLE EXPENSES YOU OR YOUR ELIGIBLE DEPENDENTS HAVE INCURRED THAT ARE NOT PAID BY YOUR EXISTING HEALTH CARE PLAN.

ELIGIBLE EXPENSES

• Medical co-payments, co-insurance and deductibles • Routine wellness visits • Prescription expenses • Vision expenses (including eye exams, eyeglasses and contact lenses) • LASIK surgery • Dental expenses (excluding cosmetic procedures) • Orthodontia payments • Hearing expenses • Prescribed over-the-counter items

MEDICAL FAQs

FREQUENTLY ASKED QUESTIONS HOW WILL REIMBURSEMENTS BE ISSUED? Reimbursements will be mailed as a check to your home address. If you would like to have your reimbursement issued as a direct deposit, you may add your direct deposit information on the participant website (www.flores247.com) or submit a completed Direct Deposit Information Form. If your plan offers the debit card, you may use this card at the point of purchase to access your FSA dollars.

HOW CAN I SUBMIT A CLAIM? Claims may be uploaded to your account on our participant website, www.flores247.com, or using our e-Receipt mobile application. You may also submit your request for reimbursement via fax or mail, if you prefer. Please note that all claims must be received by the filing deadline for the applicable plan year in which your expenses were incurred. WHAT MUST BE INCLUDED ON RECEIPTS? All receipts for reimbursement must include the following information: Date of service, Description of Service, Out-of-Pocket Cost, Provider Name, and Patient Name.

CAN I CHANGE MY ELECTION DURING THE PLAN YEAR? You may only change your annual election during the plan year if you experience a qualifying status change event. You must notify your employer within 30 days of any status change event in order to change your election. See the Allowable Status Changes Guide on our website (www.flores247.com) for further information.

WILL I HAVE A DEBIT CARD? If your plan offers the debit card, you can use your “Benny Card” at the point of purchase. Remember to keep all of your receipts in case they are requested for review.

CAN I SUBMIT MY SPOUSE’S / DEPENDENT’S MEDICAL EXPENSES TO MY MEDICAL FSA? Regardless of who is covered on your medical insurance, the Medical FSA may reimburse expenses for your spouse, if you file jointly on your federal tax return, or any qualifying tax or adult dependent.

DO I NEED TO RE-ENROLL IN THE MEDICAL FSA EACH YEAR? Yes, you must re-enroll with each new plan year. Elections do not rollover from year to year.

WHAT HAPPENS TO MY MEDICAL FSA IF I TERMINATE FROM THE COMPANY? Any expenses submitted for reimbursement must be incurred prior to your termination date or the benefit end date specified by your company. Claims must be submitted prior to the claims filing deadline for the plan year during which you terminated. In certain situations you may be eligible to continue your participation in the Medical FSA through the election of COBRA. Please contact your Human Resource Department for further information.

WHEN WILL I HAVE ACCESS TO THE FUNDS IN MY MEDICAL FSA? After your first Medical FSA contribution to the plan, you will have access to the total amount you have elected for the plan year, regardless of the current balance in your flexible spending account.

HOW DO I OBTAIN MY ACCOUNT DETAILS?

HOW DO I SUBMIT DOCUMENTS TO FLORES?

WEBSITE Visit www.flores247.com and log in using Participant ID or User Name and password

ONLINE Visit www.flores247.com and upload documents securely MOBILE Download e-Receipt smartphone app Available for Apple or Android devices

MOBILE APP Download our mobile app from your app store

MAIL Flores & Associates, LLC PO Box 31397 Charlotte, NC 28231

PID & PASSWORD ASSISTANCE Dial 800.840.7684

FAX 800.726.9982 or 704.335.0818 Revised 8/15

CUSTOMER SERVICE 1.800.532.3327 The content of this handout has been prepared by Flores & Associates, LLC for informational purposes only and does not constitute legal or tax advice. This information is an interpretation of selected portions of the Internal Revenue Code (IRC) as of 9/1/2015 and is subject to continual revisions.

DEPENDENT CARE

FLEXIBLE SPENDING ACCOUNT

YOUR STEPS TO SAVINGS!

1 2 3

REALIZE THE TAX SAVINGS You can set aside pre-tax money into an account to be reimbursed for eligible dependent childcare expenses. Savings will depend on your tax bracket. For example, if you are taxed at 25% and you enroll for $5,000 you would save $1,250 in taxes. ESTIMATE YOUR EXPENSES Plan for your upcoming expenses. A brief list of expenses can be found to the right. A comprehensive list of allowable expenses and an expense worksheet can be found at www.flores247.com.

THE DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT (FSA) CAN REIMBURSE YOU FOR DAY CARE EXPENSES PROVIDED FOR YOUR DEPENDENTS SO THAT YOU (AND YOUR SPOUSE, IF YOU ARE MARRIED) CAN WORK. CARE MUST BE FOR A DEPENDENT CHILD UNDER AGE 13 OR A DEPENDENT OF ANY AGE THAT LIVES IN YOUR HOUSEHOLD THAT IS INCAPABLE OF SELF-CARE.

ELIGIBLE EXPENSES

• Preschools • Before and after school care • Day camps

ENROLL AND MANAGE YOUR ACCOUNT Speak with your Benefits Representative during the Enrollment Period, or see the enrollment instructions in this booklet. Flores will mail a custom Participant ID number to your home address to help you manage your account.

INELIGIBLE EXPENSES

• Overnight camps • Tuition / kindergarten & educational expenses • Regular fees not applied to care of child

DEPENDENT CARE FAQs FREQUENTLY ASKED QUESTIONS

WHAT EXPENSES ARE ELIGIBLE TO BE REIMBURSED FROM THE DEPENDENT CARE FSA? Your Dependent Care FSA can reimburse you for day care expenses provided for your dependent that allow you (and your spouse, if applicable) to work. Care must be for a dependent child under the age of 13, or a dependent of any age that lives in your household that is incapable of self-care. See the Allowable Dependent Care Expenses Guide on our website (www.flores247.com) for further information.

HOW CAN I SUBMIT A CLAIM? Claims may be uploaded to your account on our participant website, www.flores247.com, or using our e-Receipt mobile application. You may also submit your request for reimbursement via fax or mail, if you prefer. Please note that all claims must be received by the filing deadline for the applicable plan year in which your expenses were incurred. HOW WILL REIMBURSEMENTS BE ISSUED? Reimbursements will be mailed as a check to your home address. If you would like to have your reimbursement issued as a direct deposit, you may add your direct deposit information on the participant website (www.flores247.com) or submit a completed Direct Deposit Information Form.

CAN I CHANGE MY ELECTION DURING THE PLAN YEAR? You may only change your annual election during the plan year if you have a qualifying status change event. You must notify your employer within 30 days of any status change event in order to change your election. See the Allowable Status Changes Guide on our website (www.flores247.com) for further information.

WILL I HAVE A DEBIT CARD? No, there is no debit card associated with the Dependent Care FSA. This is considered a “No-Wait” account and, therefore, as long as you have a pending claim on file with us, we will automatically reimburse you each time you make a contribution to your account.

WHAT HAPPENS TO MY DEPENDENT CARE FSA IF I TERMINATE FROM THE COMPANY? Any expenses submitted for reimbursement must be incurred prior to your termination date or the benefit end date specified by your company. Claims must be submitted prior to the claims filing deadline for the plan year during which you terminated. Please contact your Human Resource Department for further information.

DO I NEED TO RE-ENROLL IN THE DEPENDENT CARE FSA? Yes, you must re-enroll with each new plan year. Elections do not rollover from year to year.

HOW DO I OBTAIN MY ACCOUNT DETAILS?

HOW DO I SUBMIT DOCUMENTS TO FLORES?

WEBSITE Visit www.flores247.com and log in using Participant ID or User Name and password

ONLINE Visit www.flores247.com and upload documents securely MOBILE Download e-Receipt smartphone app Available for Apple or Android devices

MOBILE APP Download our mobile app from your app store

MAIL Flores & Associates, LLC PO Box 31397 Charlotte, NC 28231

PID & PASSWORD ASSISTANCE Dial 800.840.7684

FAX 704.335.0818 or 800.726.9982 Revised 8/15

You can submit ONE claim for a year’s worth

of childcare expenses!

No-Wait Dependent Care FSA You can submit ONE claim for a year’s worth of childcare expenses!

No-Wait Dependent Care FSA 1 2

Download a ‘No‐Wait Dependent Care Reimbursement’ claim form from

Download a ‘No‐Wait Dependent Carethis Reimbursement’ www.flores247.com or obtain form from claim yourform HR Department 2)

from www.flores247.com or obtain this form from your HR Department

Complete the claim form:

a. Service Complete the claim Dates: form: put the entire period in which that provider will care for your

dependent. Forentire example, willthat useprovider the same childcare provider for all of a. Service Dates: put the periodifinyou which will care for your nt. Forlist example, if you will use theas same depende2015, 1/1/2015-12/31/2015 yourchildcare serviceprovide dates.r for all of 2020 list 1/1/2020-12/31/2020 as your service dates. b. Dependent: List the dependent’s name receiving care b. Dependent: List the dependent’s name receiving care c. Service Provider: List the name of the childcare provider and its 9-digit tax ID# c. Service Provider: List the name of the childcare provider and its 9-digit tax ID# amount you will pay for daycare d. request Cost: request total d. Cost: the totalthe amount you will pay for daycare services with this services with this providerprovider for the service dates listed on the form. for the service dates listed on the form.

1/1/2020

12/31/2020

Your Child’s Name

5,000.00

Childcare Provider 9 Digit Tax ID#

To3)Substantiate your claimyour you may claimEITHER: you may EITHER: To Substantiate

a. Ask your childcare provider to sign in the "provider signature" box to verify that you will incur at a. Ask your childcare provider to sign in the “provider signature” box to verify least the amount indicated on the form related to childcare expenses in 2020 OR you willstatement incur at of least the amount on thecare form related to b. Providethat an itemized charges related toindicated your dependent expenses.

childcare expenses in 2015 OR b. Provide an itemized statement of charges related to your dependent care expenses.

PLEASE REMEMBER THAT A NEW DEPENDENT CARE CLAIM FORM MUST BE SUBMITTED EACH NEW PLAN YEAR.

PLEASE800-532-3327 REMEMBER THAT Fax: A NEW DEPENDENT CARE CLAIM FORM MUST BE SUBMITTED EACH NEW PLAN YEAR. 800-726-9982 21

BENNY CARD 1 2 3

ENROLL IN ELIGIBLE BENEFIT PLAN

Your employer offers the Benny Visa debit card to employees that enroll in an eligible benefit plan. The card will allow you to pay for eligible expenses at participating providers at the time services are rendered, thus eliminating or reducing your out-ofpocket cost at the time of the purchase or service.

RECEIVE YOUR SET OF BENNY CARDS

Your Benny Visa cards will be mailed as a set of two cards to your home address in a nondescript envelope upon your enrollment in an eligible benefit plan. No activation is required, but you should review the Cardholder Agreement included in this mailing, and then sign the back of your card.

PROPER USE & ACCOUNT MANAGEMENT

You will be able to view and manage your Benny Card account on the Flores participant website, www.flores247.com. You should keep your receipts and invoices for payments made with your Benny Card, as you may be required to provide documentation to Flores to verify the eligibility of certain transactions. If requested, you may submit your documentation to Flores by uploading it to your online account, uploading using the e-Receipt mobile application, or sending it by fax or mail.

Record‐keeping Tip:

Most payments will be automatically substantiated at the point of the transaction. Flores will only ask you to provide a copy of your receipts when substantiation is required per IRS guidelines. Establish a physical location where you will keep all receipts for your Benny Card purchases. Regardless of your position with your company, every employee will be treated the same in regard to IRS plan administration guidelines. No exceptions will be made.

If you are asked to provide a receipt, it must include: • • • •

name of provider or merchant description of service or item purchased date of service your out-of-pocket responsibility

Items such as handwritten explanations, Card transaction receipts or previous balance receipts cannot be used to verify an expense. If you do not have the receipt, you can contact the provider who can usually supply the receipt from their files.

BENNY CARD FAQs FREQUENTLY ASKED QUESTIONS What expenses are eligible for payment with my Benny Card? You can use your Benny Card to pay for expenses incurred during your active enrollment period in the current plan year. If a provider or merchant does not accept Benny Cards, you do have the option to file a manual request for reimbursement of your eligible out-of-pocket cost. Please visit www.flores247.com for a guide to allowable expenses. If you terminate employment during the plan year, the card will be turned off at that time. Only expenses incurred while you are an active participant will be considered reimbursable.

How should I send my documentation to Flores? Many transactions will be auto-approved at the point of sale and will not require further documentation. Flores will notify you by email or a mailed letter if additional information is needed to verify the eligibility of a particular transaction. You may submit your documentation by upload on the participant website, www.flores247.com, using the e-Receipt mobile application, or by fax or mail. I used my card for an ineligible expense. What do I need to do to correct this? You may send a refund check to Flores for the ineligible amount, which will be credited back to your Benny Card to be used toward other eligible expenses you incur later in the year. You may also submit documentation that verifies you have paid out-of-pocket for an eligible expense, which Flores will use to offset the ineligible amount paid with your Benny Card.

How can I use my Benny Card to pay for my eligible out-of-pocket expenses? Although the Benny Card is a debit card with a cash balance loaded onto it, you should select â€œcreditâ€? as the transaction type, and sign for purchases at authorized merchants. Please keep in mind that the Benny Card will decline if you try to swipe it for an amount greater than your available balance.

Will I receive a new card each plan year? Your Benny Card is valid for three years from its issue date. Do not discard your card prior to its expiration date. At the start of each new plan year, your Benny Card will be reloaded with your new election amount. A new set of cards will be mailed to you when your expiration date is approaching.

HOW DO I OBTAIN MY ACCOUNT DETAILS?

HOW DO I SUBMIT DOCUMENTS TO FLORES?

WEBSITE Visit www.flores247.com and log in using Participant ID or User Name and password

ONLINE Visit www.flores247.com and upload scanned documents securely MOBILE Download e-Receipt smartphone app Available for Apple or Android devices

MOBILE WEBSITE Visit our mobile website at m.flores247.com

MAIL Flores & Associates, LLC PO Box 31397 Charlotte, NC 28231

PID & PASSWORD ASSISTANCE Dial 800.840.7684

FAX 800.726.9982 or 704.335.0818

Cancer Insurance Our Cancer Assist plan helps employees protect themselves and their loved ones through their diagnosis, treatment and recovery journey. This individual voluntary policy pays benefits that can be used for both medical and/or out-of-pocket, non-medical expenses traditional health insurance may not cover. Available exclusively at the workplace, Cancer Assist is an attractive addition to any competitive benefits package that won’t add costs to a company’s bottom line.

Competitive advantages n

Composite rates.

n Four distinct plan levels, each featuring the same benefits with premiums and benefit

amounts designed to meet a variety of budgets and coverage needs (benefits overview on reverse).

Indemnity-based benefits pay exactly what’s listed for the selected plan level.

n The plan’s Family Care Benefit provides a daily benefit when a covered dependent child

receives inpatient or outpatient cancer treatment.

Employer-optional cancer wellness/health screening benefits available:

n Part One covers 24 tests. If selected, the employer chooses one of four benefit amounts for employees: $25, $50, $75 or $100. This benefit is payable once per covered person per calendar year. n Part Two covers an invasive diagnostic test or surgical procedure if an abnormal result from a Part One test requires additional testing. This benefit is payable once per calendar year per covered person and matches the Part One benefit.

Flexible family coverage options n

Individual, Individual/Spouse, One-parent and Two-parent family policies.

n Family coverage includes eligible dependent children (to age 26) for the same rate,

regardless of the number of children covered.

Attractive features n

Available for businesses with 3+ eligible employees.

Broad range of policy issue ages, 17-75.

n Each plan level features full schedule of 30+ benefits and three optional riders

(benefit amounts may vary based on plan level selected).

Benefits don’t coordinate with any other coverage from any other insurer.

HSA compliant.

Guaranteed renewable.

n Portable. n Waiver of premium if named insured is disabled due to cancer for longer than 90

consecutive days and the date of diagnosis is after the waiting period and while the policy is in force.

n Form 1099s may not be issued in most states because all benefits require that a

charge is incurred. Discuss details with your benefits representative, or consult your tax adviser if you have questions.

Talk to your benefits representative today to learn more about this product and how it helps provide extra financial protection to employees who may be impacted by cancer.

Optional riders (available at an additional cost/payable once per covered person) n Initial Diagnosis of Cancer Rider pays a one-time benefit for the initial diagnosis of cancer.

A benefit amount in $1,000 increments from $1,000-$10,000 may be chosen. The benefit for covered dependent children is two and a half times ($2,500-25,000) the chosen benefit amount.

n Initial Diagnosis of Cancer Progressive Payment Rider pays a $50 lump-sum payment

for each month the rider has been in force, after the waiting period, once cancer is first diagnosed. The issue ages for this rider are 17-64.

n Specified Disease Hospital Confinement Rider pays $300 per day for confinement to a

hospital for treatment of one of 34 specified diseases covered under the rider.

INDIVIDUAL CANCER INSURANCE

Cancer Assist Benefits Overview This overview shows benefits available for all four plan levels and the range of benefit amounts payable for most common cancer treatments. Each benefit is payable for each covered person under the policy. Actual benefits vary based on the plan level selected.

Radiation/Chemotherapy

n Injected chemotherapy by medical personnel: $250-$1,000 once per calendar week n Radiation delivered by medical personnel: $250-$1,000 once per calendar week n Self-injected chemotherapy: $150-$400 once per calendar month n Topical chemotherapy: $150-$400 once per calendar month n Chemotherapy by pump: $150-$400 once per calendar month n Oral hormonal chemotherapy (1-24 months): $150-$400 once per calendar month n Oral hormonal chemotherapy (25+ months): $75-$200 once per calendar month n Oral non-hormonal chemotherapy: $150-$400 once per calendar month

Anti-nausea Medication

$25-$60 per day, up to $100-$240 per calendar month

Medical Imaging Studies

$75-$225 per study, up to $150-$450 per calendar year

Outpatient Surgical Center

$100-$400 per day, up to $300-$1,200 per calendar year

Skin Cancer Initial Diagnosis

$300-$600 payable once per lifetime

Surgical Procedures

Inpatient and Outpatient Surgeries: $40-$70 per surgical unit, up to $2,500-$6,000 per procedure

Reconstructive Surgery

$40-$60 per surgical unit, up to $2,500-$3,000 per procedure including 25% for general anesthesia

Anesthesia

General: 25% of Surgical Procedures Benefit Local: $25-$50 per procedure

Hospital Confinement Each benefit requires that charges are incurred for treatment. All benefits and riders are subject to a 30-day waiting period. Waiting period means the first 30 days following the policy’s coverage effective date during which no benefits are payable. States without a waiting period will have a pre-existing condition limitation. Product has exclusions and limitations that may affect benefits payable. Benefits vary by state and may not be available in all states. See your Colonial Life benefits representative for complete details.

30 days or less: $100-$350 per day 31 days or more: $200-$700 per day

Family Care

Inpatient and outpatient treatment for a covered dependent child: $30-$60 per day, up to $1,500-$3,000 per calendar year

Second Medical Opinion on Surgery or Treatment $150-$300 once per lifetime

Home Health Care Services

Examples include physical therapy, speech therapy, occupational therapy, prosthesis and orthopedic appliances, durable medical equipment: $50-$150 per day, up to the greater of 30 days per calendar year or twice the number of days hospitalized per calendar year

Hospice Care

Initial: $1,000 once per lifetime Daily: $50 per day $15,000 maximum for initial and daily hospice care per lifetime

Transportation and Lodging

n Transportation for treatment more than 50 miles from covered person’s home:

$0.50 per mile, up to $1,000-$1,500 per round trip Companion Transportation (for any companion, not just a family member) for commercial travel when treatment is more than 50 miles from covered person’s home: $0.50 per mile, up to $1,000-$1,500 per round trip n Lodging for the covered person or any one adult companion or family member when treatment is more than 50 miles from the covered person’s home: $50-$80 per day, up to 70 days per calendar year

ColonialLife.com © 2014 Colonial Life & Accident Insurance Company Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 1-14 | 101478

Benefits also included in each plan

Air Ambulance, Ambulance, Blood/Plasma/Platelets/Immunoglobulins, Bone Marrow or Peripheral Stem Cell Donation, Bone Marrow Donor Screening, Bone Marrow or Peripheral Stem Cell Transplant, Cancer Vaccine, Egg(s) Extraction or Harvesting/Sperm Collection and Storage (Cryopreservation), Experimental Treatment, Hair/External Breast/Voice Box Prosthesis, Private Full-time Nursing Services, Prosthetic Device/Artificial Limb, Skilled Nursing Facility, Supportive or Protective Care Drugs and Colony Stimulating Factors

INDIVIDUAL CANCER INSURANCE

Cancer Insurance Wellness Benefits

To encourage early detection, our cancer insurance offers benefits for wellness and health screening tests.

For more information, talk with your benefits counselor.

Part One: Cancer Wellness/Health Screening Provided when one of the tests listed below is performed after the waiting period and while the policy is in force. Payable once per calendar year, per covered person.

Cancer Wellness Tests

Health Screening Tests

■

Bone marrow testing

■

Blood test for triglycerides

■

Breast ultrasound

■

Carotid Doppler

■

CA 15-3 [blood test for breast cancer]

■

Echocardiogram [ECHO]

■

CA 125 [blood test for ovarian cancer]

■

Electrocardiogram [EKG, ECG]

■

CEA [blood test for colon cancer]

■

Fasting blood glucose test

■

Chest X-ray

■

Colonoscopy

erum cholesterol test for HDL S and LDL levels

■

Flexible sigmoidoscopy

■

Stress test on a bicycle or treadmill

■

Hemoccult stool analysis

■

Mammography

■

Pap smear

■

PSA [blood test for prostate cancer]

■

erum protein electrophoresis S [blood test for myeloma]

■

Skin biopsy

■

Thermography

■

ThinPrep pap test

■

Virtual colonoscopy

Part Two: Cancer Wellness — Additional Invasive Diagnostic Test or Surgical Procedure Provided when a doctor performs a diagnostic test or surgical procedure after the waiting period as the result of an abnormal result from one of the covered cancer wellness tests in Part One. We will pay the benefit regardless of the test results. Payable once per calendar year, per covered person.

Waiting period means the first 30 days following the policy’s coverage effective date during which no benefits are payable. The policy has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to policy form CanAssist (and state abbreviations where applicable – for example: CanAssist-TX).

CANCER ASSIST WELLNESS – 101486

Group Specified Disease Insurance Plan 3 Full

If you’re diagnosed with a covered specified disease, group specified disease insurance* from Colonial Life can help with your expenses, so you can concentrate on what’s most important – your treatment, care and recovery. *The policy name is Specified Disease Group Insurance.

Face amount: $_______________ Plan features A lump-sum payment that can be used as you see fit Adjustable face amount to best meet your personal needs May pay multiple times for a covered specified disease Guaranteed renewable Portable

Specified disease benefit For the diagnosis of this covered specified disease condition:1

For more information, talk with your benefits counselor.

ColonialLife.com

This percentage of the face amount is payable:

Heart attack (myocardial infarction)

100%

Stroke

100%

End-stage renal (kidney) failure

100%

Major organ failure

100%

Coma

100%

Permanent paralysis due to a covered accident

100%

Blindness

100%

Occupational infectious HIV or occupational infectious hepatitis B, C or D

100%

Coronary artery bypass graft surgery/disease2

25%

Subsequent diagnosis of a different specified disease3 If you receive a benefit for a specified disease, and later you are diagnosed with a different specified disease, the original percentage of the face amount is payable for that particular specified disease. Subsequent diagnosis of the same specified disease3 If you receive a benefit for a specified disease, and later you are diagnosed with the same specified disease, 25% of the original face amount is payable. Specified disease conditions that do not qualify are: coronary artery bypass graft surgery/coronary artery disease2 and occupational infectious HIV or occupational infectious hepatitis B, C or D.

GROUP CRITICAL CARE PLAN 3 FULL - GUARANTEED RENEWABLE

1 Please refer to the certificate for complete definitions of covered conditions.

ColonialLife.com

2 Benefit for coronary artery disease applicable in lieu of benefit for coronary artery bypass graft surgery when health savings account (HSA) compliant plan is selected. 3 Dates of diagnoses of a covered specified disease must be separated by at least 180 days. THIS POLICY PROVIDES LIMITED BENEFITS.

EXCLUSIONS AND LIMITATIONS FOR SPECIFIED DISEASE We will not pay the Specified Disease Benefit or Benefit Payable Upon Subsequent Diagnosis of a Specified Disease that occurs as a result of a covered personâ€™s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; psychiatric or psychological conditions; suicide or injuries which any covered person intentionally does to himself; 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 specified disease. This is not an insurance contract and only the actual certificate provisions will control. Applicable to certificate form GCC1.0-C-GR-NC. Please see your Colonial Life benefits counselor for details.

Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ÂŠ2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

2-17 | NS-15526

Group Specified Disease Insurance First Diagnosis Building Benefit Rider (Specified Disease)

A specified disease can have a big impact on your finances. To help protect your way of life, you can add the first diagnosis building benefit rider to your group specified disease coverage. Available at an additional cost, the rider provides a lump-sum benefit when a covered specified disease* is first diagnosed.

First diagnosis building benefit rider Payable once per covered person per lifetime

¾ Named insured............................................................. Accumulates $1,000 each year ¾ Covered spouse/dependent child. ..................................... Accumulates $500 each year

The rider covers the same family members as your group specified disease insurance. The benefit amount accumulates each year the rider is in force before a diagnosis is made, up to a maximum of 10 years. If you are diagnosed with a covered specified disease before the end of the first rider year, the rider will pay one-half of the annual building benefit amount.

For more information, talk with your benefits counselor.

ColonialLife.com

* Conditions that do not apply to the rider include coronary artery bypass graft surgery/coronary artery disease. Benefit for coronary artery disease applicable in lieu of benefit for coronary artery bypass graft surgery when health savings account (HSA) compliant plan is selected.

The certificate to which the rider is attached has exclusions and limitations. This is not an insurance contract and only the actual certificate provisions will control. Applicable to rider form R-GCC1.0-BB-NC. Please see your Colonial Life benefits counselor for details. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. GROUP CRITICAL CARE FIRST DIAGNOSIS BUILDING BENEFIT RIDER – SPECIFIED DISEASE | 1-17 | 100584-1

Specified Disease Insurance Health Screening Benefit

The optional health screening benefit can help you reduce the risk of serious illness through early detection. Health screening benefit................................................................. $_______________ Maximum of one screening test per covered person per calendar year.

Blood test for triglycerides

Pap smear

Bone marrow testing

PSA (blood test for prostate cancer)

Breast ultrasound

Serum cholesterol test for HDL and LDL levels

CA 15-3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) Carotid Doppler CEA (blood test for colon cancer) Chest X-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG)

For more information, talk with your benefits counselor.

Fasting blood glucose test

Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy

Flexible sigmoidoscopy Hemoccult stool analysis Mammography

ColonialLife.com

For cost and complete details, see your Colonial Life benefits counselor. Applicable to form CI-1.0-NC and GCC1.0-P-NC. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2016 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. GROUP CRITICAL CARE, CRITICAL ILLNESS 1.0 – HEALTH SCREENING BENEFIT | 12-16 | 100595-2

Individual Short-Term Disability Insurance You 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.

Can you afford 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. After calculating your monthly expenses, your benefits counselor can help you complete the benefits worksheet. ESTIMATED MONTHLY EXPENSES

ColonialLife.com

AMOUNT

Mortgage or rent

Utilities (electric/gas, phone, water, TV, Internet)

Transportation costs (gas, car payments)

Food

Health (medical needs and prescription drugs)

Other

TOTAL

Benefits worksheet How much coverage do I need? Monthly benefit amount for off-job accident and off-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 off-job amount.

How long will I receive benefits? Benefit period: _______ months The partial disability benefit period is three months.

When will my total disability benefits start? After an accident: _______ days

After a sickness: _______ days

*Subject to income requirements

ISTD3000 BASE

Product information Total disability definition Totally disabled or total disability means you are: unable to perform the material and substantial duties of your job, not working at any job, and under the regular and appropriate care of a physician. How partial disability works If you are able to return to work part-time after 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 premium We will waive your premium payments after 90 consecutive days of a covered disability. Geographical limitations If 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 age Coverage 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. Premium Your 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.

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, psychiatric or psychological conditions, 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 benefits due to being pregnant before the policy coverage effective date shown in the policy schedule, if medical advice, diagnosis, care or treatment was received or recommended within the one-year period immediately preceding the policy coverage effective date shown on the policy schedule. 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-NC and rider form ISTD3000-ADIB-NC. This is not an insurance contract and only the actual policy and rider provisions will control. ÂŠ2015 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-NC

Individual Short-Term Disability Insurance Health Screening Rider Benefit The optional health screening benefit can help you reduce the risk of serious illness through early detection.

Health screening benefit. ..................................................................................... $50 Maximum of one health screening test per calendar year; subject to a 30-day waiting period following the effective date of the rider

Blood test for triglycerides

Pap smear

Bone marrow testing

PSA (blood test for prostate cancer)

Breast ultrasound

Serum cholesterol test for HDL and LDL levels

For more information, talk with your benefits counselor.

Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy

Flexible sigmoidoscopy Hemoccult stool analysis Mammography

With the health screening benefit: You’re paid regardless of any insurance you have with other companies. You can keep coverage to age 75 as long as premiums are paid when they are due.

ColonialLife.com

Waiting period means the first 30 days following the rider coverage effective date, during which time no benefits are payable. For cost and complete details, see your Colonial Life benefits counselor. Applicable to rider form ISTD3000-HS (including state abbreviations where used, for example: ISTD3000-HS-TX). Coverage may vary by state and may not be available in all states. This is not an insurance contract and only the actual rider provisions will control. ©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.

ISTD3000 – HEALTH SCREENING BENEFIT | 7-16 | 101634-1

Group Disability Insurance Psychiatric and Psychological Benefit

Although injuries and accidents are often associated with disabilities, mental disorders can also leave you unable to earn an income. If you’re disabled with a covered psychiatric or covered psychological condition, disability insurance from Colonial Life & Accident Insurance Company pays a monthly benefit that can help provide financial support while you focus on recovery.

Psychiatric and psychological benefit There is a maximum six-month benefit period limitation for any one occurrence of a psychiatric or psychological condition. There is a three-month benefit period limitation if you have a three-month benefit period.

For more information, talk with your benefits counselor.

There is a 24-month cumulative lifetime maximum benefit period for all psychiatric or psychological conditions. This maximum includes a combination of total disability and partial disability occurrences.

ColonialLife.com

The psychiatric and psychological benefit is only applicable when combined with the group disability base policy. The exclusions listed on the group disability base policy apply, except for the psychiatric or psychological conditions exclusion. For cost and complete details, talk with your Colonial Life benefits counselor. Applicable to policy form GDIS-P and certificate form GDIS-C (plus state abbreviations where applicable, for example: GDIS-P-EE-TX and GDIS-C-EE-TX). ©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.

6-15 | 101137-2

Accident Insurance

Accidents 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 injury Broken bone Burn Concussion Laceration

Back or knee injuries

l l l

Car accidents l Falls & spills l Dislocation l Accidental injuries that send you to the Emergency Room, Urgent Care or doctor’s office

Accident 1.0-Preferred with Health Screening Benefit

Colonial Life’s Accident Insurance is designed to help you fill some of the gaps caused by increasing deductibles, co-payments and out-of-pocket costs related to an accidental injury. The benefit 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 financial security.

What additional features are included? l

Worldwide coverage

Portable

Compliant with Healthcare Spending Account (HSA) guidelines

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?

Will my accident claim payment be reduced if I have other insurance?

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.

You’re paid regardless of any other insurance you may have with other insurance companies, and the benefits are paid directly to you (unless you specify otherwise).

How do I file a claim? Visit coloniallife.com or call our Customer Service Department at 1.800.325.4368 for additional information.

Benefits listed are for each covered person per covered accident unless otherwise specified.

Initial Care l

Accident Emergency Treatment........... $150

Ambulance........................................$400

X-ray Benefit....................................................$50

l Air

Ambulance.............................. $2,000

Common Accidental Injuries Dislocations (Separated Joint) Hip Knee (except patella) Ankle â€“ Bone or Bones of the Foot (other than Toes) Collarbone (Sternoclavicular) Lower Jaw, Shoulder, Elbow, Wrist Bone or Bones of the Hand Collarbone (Acromioclavicular and Separation) One Toe or Finger Fractures Depressed Skull Non-Depressed Skull Hip, Thigh Body of Vertebrae, Pelvis, Leg Bones of Face or Nose (except mandible or maxilla) Upper Jaw, Maxilla Upper Arm between Elbow and Shoulder Lower Jaw, Mandible, Kneecap, Ankle, Foot Shoulder Blade, Collarbone, Vertebral Process Forearm, Wrist, Hand Rib Coccyx Finger, Toe

Non-Surgical

Surgical

$6,600 $3,300 $2,640 $1,650 $990 $990 $330 $330

$13,200 $6,600 $5,280 $3,300 $1,980 $1,980 $660 $660

Non-Surgical

Surgical

$5,500 $2,200 $3,300 $1,650 $770 $770 $770 $660 $660 $660 $550 $440 $220

$11,000 $4,400 $6,600 $3,300 $1,540 $1,540 $1,540 $1,320 $1,320 $1,320 $1,100 $880 $440

Your Colonial Life policy also provides benefits for the following injuries received as a result of a covered accident. l

Burn (based on size and degree).....................................................................................$1,000 to $12,000

Coma..............................................................................................................................................................$10,000

Concussion........................................................................................................................................................$150

Emergency Dental Work........................................$75 Extraction, $300 Crown, Implant, or Denture l Lacerations (based on size)............................................................................................................$50 to $800 l

Requires Surgery l

Eye Injury............................................................................................................................................................$300

Tendon/Ligament/Rotator Cuff...........................................................$500 - one, $1,000 - two or more

Ruptured Disc...................................................................................................................................................$500

Torn Knee Cartilage........................................................................................................................................$500

Surgical Care Surgery (cranial, open abdominal or thoracic)................................................................................. $1,500

l l

Surgery (hernia)...............................................................................................................................................$150

Surgery (arthroscopic or exploratory).....................................................................................................$250

Blood/Plasma/Platelets.................................................................................................................................$300

Transportation/Lodging Assistance If injured, covered person must travel more than 50 miles from residence to receive special treatment and confinement in a hospital. Transportation..............................................................................$500 per round trip up to 3 round trips

Lodging (family member or companion)................................................$125 per night up to 30 days for a hotel/motel lodging costs

Accident Hospital Care Hospital Admission*......................................................................................................... $1,500 per accident

Hospital ICU Admission*................................................................................................. $3,000 per accident * We will pay either the Hospital Admission or Hospital Intensive Care Unit (ICU) Admission, but not both. l

Hospital Confinement.......................................................... $250 per day up to 365 days per accident

Hospital ICU Confinement ....................................................$500 per day up to 15 days per accident

Accident Follow-Up Care l

Accident Follow-Up Doctor Visit........................................................... $50 (up to 3 visits per accident)

Medical Imaging Study.......................................................................................................$250 per accident (limit 1 per covered accident and 1 per calendar year)

Occupational or Physical Therapy...................................................... $35 per treatment up to 10 days

Appliances ........................................................................................... $125 (such as wheelchair, crutches)

Prosthetic Devices/Artificial Limb .....................................................$500 - one, $1,000 - more than 1

Rehabilitation Unit..................................................$100 per day up to 15 days per covered accident, and 30 days per calendar year. Maximum of 30 days per calendar year

Accidental Dismemberment l

Loss of Finger/Toe..................................................................................$750 – one, $1,500 – two or more

Loss or Loss of Use of Hand/Foot/Sight of Eye......................$7,500 – one, $15,000 – two or more

Catastrophic Accident For severe injuries that result in the total and irrecoverable: l

Loss of one hand and one foot

Loss of the sight of both eyes

Loss of both hands or both feet

Loss of the hearing of both ears

Loss or loss of use of one arm and one leg or

Loss of the ability to speak

Loss or loss of use of both arms or both legs

Named Insured................. $25,000 Spouse...............$25,000 Child(ren)..........$12,500 365-day elimination period. Amounts reduced for covered persons age 65 and over. Payable once per lifetime for each covered person.

Accidental Death Accidental Death

Common Carrier

Named Insured

$25,000

$100,000

Spouse

$25,000

$100,000

Child(ren)

$5,000

$20,000

Health Screening Benefit

$50 per covered person per calendar year

Provides a benefit if the covered person has one of the health screening tests performed. This benefit is payable once per calendar year per person and is subject to a 30-day waiting period.

Tests include: l.

Blood test for triglycerides

Hemoccult stool analysis

Bone marrow testing

Mammography

Breast ultrasound

Pap smear

CA 15-3 (blood test for breast cancer)

PSA (blood test for prostate cancer)

CA125 (blood test for ovarian cancer)

Carotid doppler

Serum cholesterol test to determine level of HDL and LDL

CEA (blood test for colon cancer)

Chest x-ray

Serum protein electrophoresis (blood test for myeloma)

Colonoscopy

Stress test on a bicycle or treadmill

Echocardiogram (ECHO)

Skin cancer biopsy

Electrocardiogram (EKG, ECG)

Thermography

Fasting blood glucose test

ThinPrep pap test

Flexible sigmoidoscopy

Virtual colonoscopy

My Coverage Worksheet (For use with your Colonial Life benefits counselor) Who will be covered? (check one) Employee Only

Spouse Only

One-Parent Family, with Employee

One Child Only

One-Parent Family, with Spouse

Employee & Spouse Two-Parent Family

On and Off -Job Benefits

Off -Job Only Benefits

EXCLUSIONS We will not pay benefits 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-inflicted injuries; war or armed conflict; in addition to the exclusions listed above, we also will not pay the Catastrophic Accident benefit for injuries that are caused by or are the result of: birth; intoxication. For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form Accident 1.0-HS-NC. This is not an insurance contract and only the actual policy provisions will control.

Colonial Life 1200 Colonial Life Boulevard Columbia, South Carolina 29210 coloniallife.com

71740-NC

Accident 1.0-Preferred with Health Screening Benefit

When are covered accident benefits available? (check one)

Hospital Confinement Indemnity Insurance Plan 2

Our Individual Medical BridgeSM insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement. ......................................................................... $_______________ Maximum of one benefit per covered person per calendar year

Observation room................................................................................... $100 per visit Maximum of two visits per covered person per calendar year

Rehabilitation unit confinement.................................................................. $100 per day Maximum of 15 days per confinement with a 30-day maximum per covered person per calendar year

Waiver of premium Available after 30 continuous days of a covered hospital confinement of the named insured

Outpatient surgical procedure Tier 1.. . . . . .......................................................................................... .. $_______________ Tier 2.. . . . . .......................................................................................... .. $_______________ Maximum of $________________ per covered person per calendar year for all covered outpatient surgical procedures combined

For more information, talk with your benefits counselor.

The 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

Gynecological

– Axillary node dissection – Breast capsulotomy – Lumpectomy

– Dilation and curettage (D&C) – Endometrial ablation – Lysis of adhesions

Cardiac

Liver

– Pacemaker insertion

– Paracentesis

Digestive

Musculoskeletal system

– Colonoscopy – Fistulotomy – Hemorrhoidectomy – Lysis of adhesions

– 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 grafting

Ear, nose, throat, mouth – Adenoidectomy – Removal of oral lesions – Myringotomy – Tonsillectomy – Tracheostomy – Tympanotomy

IMB7000 – PLAN 2

Tier 2 outpatient surgical procedures Breast

Gynecological

– Breast reconstruction – Breast reduction

– Hysterectomy – Myomectomy

Cardiac

Musculoskeletal system

– Angioplasty – Cardiac catheterization

Digestive – Exploratory laparoscopy – Laparoscopic appendectomy – Laparoscopic cholecystectomy

Ear, nose, throat, mouth – Ethmoidectomy – Mastoidectomy – Septoplasty – Stapedectomy – Tympanoplasty

– 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

Eye – Cataract surgery – Corneal surgery (penetrating keratoplasty) – Glaucoma surgery (trabeculectomy) – Vitrectomy

– Lithotripsy

ColonialLife.com THIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONS We will not pay benefits for losses which are caused by: alcoholism or drug addiction, dental procedures, elective procedures and cosmetic surgery, felonies or illegal occupations, pregnancy of a dependent child, psychiatric or psychological conditions, suicide or injuries which any covered person intentionally does to himself or herself, or war. 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 after the effective date due to a pre-existing condition. Pre-exisiting conditions are those conditions whether diagnosed or not, for which a covered person received medical advice, diagnosis or care, or treatment was received or recommended within the one-year period immediately preceding the effective date of the policy. If a covered person is 65 or older when the policy is issued, pre-existing conditions will include only conditions specifically eliminated by rider. For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number IMB7000-NC. This is not an insurance contract and only the actual policy provisions will control. 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.

5-18 | 101578-1-NC

Hospital Confinement Indemnity Insurance Plan 3 Our Individual Medical BridgeSM insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement. ......................................................................... $_______________ Maximum of one benefit per covered person per calendar year

Observation room................................................................................... $100 per visit Maximum of two visits per covered person per calendar year

Rehabilitation unit confinement. ................................................................. $100 per day Maximum of 15 days per confinement with a 30-day maximum per covered person per calendar year

Waiver of premium

Available after 30 continuous days of a covered hospital confinement of the named insured

Diagnostic procedure Tier 1. . . . . .......................................................................................... ................. $250 Tier 2. . . . . .......................................................................................... ................. $500 Maximum of $500 per covered person per calendar year for all covered diagnostic procedures combined

Outpatient surgical procedure Tier 1. . . . . .......................................................................................... . $_______________ Tier 2. . . . . ............................................................................................ $_______________

For more information, talk with your benefits counselor.

Maximum of $___________ per covered person per calendar year for all covered outpatient surgical procedures combined

The following is a list of common diagnostic procedures that may be covered.

Tier 1 diagnostic procedures Breast – Biopsy (incisional, needle, stereotactic) Diagnostic radiology – Nuclear medicine test Digestive – Barium enema/lower GI series – Barium swallow/upper GI series – Esophagogastroduodenoscopy (EGD) Ear, nose, throat, mouth – Laryngoscopy Gynecological – Hysteroscopy – Amniocentesis – Loop electrosurgical – Cervical biopsy excisional procedure – Cone biopsy (LEEP) – 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

Tier 2 diagnostic procedures Cardiac – Angiogram – Arteriogram – Thallium stress test – Transesophageal echocardiogram (TEE)

Diagnostic radiology – Computerized tomography scan (CT scan) – Electroencephalogram (EEG) – Magnetic resonance imaging (MRI) – Myelogram – Positron emission tomography scan (PET scan) IMB7000 – PLAN 3

Tier 1 outpatient surgical procedures Breast

Gynecological

Cardiac

Liver

Digestive

Musculoskeletal system

– Axillary node dissection – Breast capsulotomy – Lumpectomy

– Dilation and curettage (D&C) – Endometrial ablation – Lysis of adhesions

– Pacemaker insertion

– Paracentesis

– Colonoscopy – Fistulotomy – Hemorrhoidectomy – Lysis of adhesions

– 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 grafting

Ear, nose, throat, mouth – Adenoidectomy – Removal of oral lesions – Myringotomy – Tonsillectomy – Tracheostomy – Tympanotomy

Tier 2 outpatient surgical procedures Breast

Gynecological

Cardiac

Musculoskeletal system

– Breast reconstruction – Breast reduction

– Hysterectomy – Myomectomy

– Angioplasty – Cardiac catheterization

Digestive

– Exploratory laparoscopy – Laparoscopic appendectomy – Laparoscopic cholecystectomy

Ear, nose, throat, mouth – Ethmoidectomy – Mastoidectomy – Septoplasty – Stapedectomy – Tympanoplasty

Thyroid

– Excision of a mass

Eye

ColonialLife.com

– Cataract surgery – Corneal surgery (penetrating keratoplasty) – Glaucoma surgery (trabeculectomy) – Vitrectomy

Urologic

– Lithotripsy

EXCLUSIONS We will not pay benefits for losses which are caused by: alcoholism or drug addiction, dental procedures, elective procedures and cosmetic surgery, felonies or illegal occupations, pregnancy of a dependent child, psychiatric or psychological conditions, suicide or injuries which any covered person intentionally does to himself or herself, or war. 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 after the effective date due to a pre-existing condition. Pre-exisiting conditions are those conditions whether diagnosed or not, for which a covered person received medical advice, diagnosis or care, or treatment was received or recommended within the one-year period immediately preceding the effective date of the policy. If a covered person is 65 or older when the policy is issued, pre-existing conditions will include only conditions specifically eliminated by rider. For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number IMB7000-NC. This is not an insurance contract and only the actual policy 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 | 101581-NC

Hospital Confinement Indemnity Insurance Health Screening Individual Medical BridgeSM insurance’s health screening benefit can help pay for health and wellness tests you have each year.

Health screening. .............................................................................. $_____________ Maximum of one health screening test per covered person per calendar year; subject to a 30-day waiting period

Blood test for triglycerides Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) CEA (blood test for colon cancer) Carotid Doppler

Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy

Chest X-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy

For more information, talk with your benefits counselor.

Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels

ColonialLife.com

Waiting period means the first 30 days following any covered person’s policy coverage effective date, during which no benefits are payable. For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number IMB7000 (including state abbreviations where used, for example: IMB7000-TX). Coverage may vary by state and may not be available in all states. This is not an insurance contract and only the actual policy 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.

IMB7000 – HEALTH SCREENING BENEFIT | 2-15 | 101579

Hospital Confinement Indemnity Insurance Medical Treatment Package The medical treatment package for Individual Medical BridgeSM coverage can help pay for deductibles, co-payments and other out-of-pocket expenses related to a covered accident or covered sickness.

The medical treatment package paired with Plan 3 provides the following benefits: Air ambulance. ............................................................................................. $1,000 Maximum of one benefit per covered person per calendar year

Ambulance. .................................................................................................... $100 Maximum of one benefit per covered person per calendar year

Appliance. ...................................................................................................... $100 Maximum of one benefit per covered person per calendar year

Doctorâ€™s office visit. ................................................................................... $25 per visit Maximum of three visits per calendar year for named insured coverage or maximum of five visits per calendar year for all covered persons combined

Emergency room visit. ............................................................................. $100 per visit

For more information, talk with your benefits counselor.

Maximum of two visits per covered person per calendar year

X-ray. ................................................................................................ $25 per benefit Maximum of two benefits per covered person per calendar year

THIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONS

ColonialLife.com

Hospital Confinement Indemnity Insurance Optional Riders Individual Medical BridgeSM offers two optional benefit riders – the daily hospital confinement rider and the enhanced intensive care unit confinement rider. For an additional cost, these riders can help provide extra financial protection to help with out-of-pocket medical expenses.

Daily hospital confinement rider. ................................................................. $100 per day Per covered person per day of hospital confinement Maximum of 365 days per covered person per confinement

Enhanced intensive care unit confinement rider............................................... $500 per day Per covered person per day of intensive care unit confinement Maximum of 30 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.

For more information, talk with your benefits counselor.

EXCLUSIONS

ColonialLife.com

We will not pay benefits for losses which are caused by: alcoholism or drug addiction, dental procedures, elective procedures and cosmetic surgery, felonies or illegal occupations, pregnancy of a dependent child, psychiatric or psychological conditions, suicide or injuries which any covered person intentionally does to himself or herself, or war. 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 after the effective date due to a pre-existing condition. Pre-exisiting conditions are those conditions whether diagnosed or not, for which a covered person received medical advice, diagnosis or care, or treatment was received or recommended within the one-year period immediately preceding the effective date of the policy. If a covered person is 65 or older when the policy is issued, pre-existing conditions will include only conditions specifically eliminated by rider. For cost and complete details, see your Colonial Life benefits counselor. Applicable to rider numbers R-DHC7000-NC and R-EIC7000-NC. This is not an insurance contract and only the actual policy or 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.

IMB7000 – DAILY HOSPITAL CONFINEMENT AND ENHANCED INTENSIVE CARE UNIT CONFINEMENT RIDERS | 7-15 | 101582-NC

Term Life Insurance Life insurance protection when you need it most Life insurance needs change as life circumstances change. You may need different coverage if you’re getting married, buying a home or having a child. Term life insurance from Colonial Life provides protection for a specified period of time, typically offering the greatest amount of coverage for the lowest initial premium. This fact makes term life insurance a good choice for supplementing cash value coverage during life stages when obligations are higher, such as while children are younger. It’s also a good option for families on a tight budget — especially since you can convert it to a permanent cash value plan later.

With this coverage: n A beneficiary can receive a benefit that is typically free from income tax. n The policy’s accelerated death benefit can pay a percentage of the death benefit if the covered person is diagnosed with a terminal illness. n You can convert it to a Colonial Life cash value insurance plan, with no proof of good health, to age 75. n Coverage is guaranteed renewable up to age 95 as long as premiums are paid when due. n Portability allows you to take it with you if you change jobs or retire.

Talk with your Colonial Life benefits counselor to learn more.

ColonialLife.com

Spouse coverage options

Dependent coverage options

Two options are available for spouse coverage at an additional cost:

You may add a Children’s Term Life Rider to cover all of your eligible dependent children with up to $20,000 in coverage each for one premium.

1. Spouse Term Life Policy: Offers guaranteed premiums and level death benefits equivalent to those available to you –whether or not you buy a policy for yourself. 2. Spouse Term Life Rider: Add a term rider for your spouse to your policy, up to a maximum death benefit of $50,000; 10-year and 20-year are available (20-year rider only available with a 20- or 30-year term policy).

The Children’s Term Life Rider may be added to either the primary or spouse policy, not both.

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 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. Colonial Life insurance products are 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. 7-19 | NS-16570-1

Whole Life Insurance Life insurance that comes with guarantees — because life doesn’t You can’t predict the future, but you can rest easier knowing you have life insurance with lifelong guarantees. Whole life insurance provides guaranteed features – cash value accumulation, premium rates and a death benefit (minus any loans and loan interest) – that help ensure those benefits will be there to help protect your family’s way of life.

With this coverage: n Life insurance benefits for the beneficiary are typically tax-free. n You have three opportunities to purchase additional coverage with no proof of good health required if you are 50 or younger with the Guaranteed Purchase Option Rider. n The policy’s built-in terminal illness accelerated death benefit provides up to 75% of the policy’s death benefit (up to $150,000) if you’re diagnosed with a terminal illness.1 n A $3,000 immediate claim payment that can help your designated beneficiary pay for funeral costs or other expenses.

Talk with your Colonial Life benefits counselor to learn more.

ColonialLife.com

n You can take the policy with you even if you change jobs or retire; with no increase in premium.

n Paid-Up at Age 70 or Paid-Up at Age 100

These two plan options allow you to select what age your premium payments will end. You can choose to have your policy paid up when you reach age 70 or 100.

1 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. 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 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. Colonial Life insurance products are 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. 7-19 | NS-16576-1

General Notice of COBRA Continuation Coverage Rights ** Continuation Coverage Rights Under COBRA** Introduction You are receiving this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: • The parent-employee dies; • The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.” Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to Beaufort County Government, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan. When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: • The end of employment or reduction of hours of employment; • Death of the employee; • Commencement of a proceeding in bankruptcy with respect to the employer; or • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to Deloris Creasman at Beaufort County Government. Applicable documentation will be required i.e. court order, certificate of coverage etc.

How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan contact information: Beaufort County Government Deloris Creasman 121 W 3rd Street Washington, NC 27889 P: 252.946.0079 E: deloris.creasman@co.beaufort.nc.us Delta Dental Attn: COBRA Administrator 240 Venture Circle Nashville, TN 37228 P: 800-926-5530 Note: Community Eye Care vision coverage is portable; COBRA is not applicable

Authorization for Colonial Life & Accident Insurance Company For the purpose of evaluating my application(s) for insurance submitted during the current enrollment and eligibility for benefits under any insurance issued including checking for and resolving any issues that may arise regarding incomplete or incorrect information on my application(s), I hereby authorize the disclosure of the following information about me and, if applicable, my dependents, from the sources listed below to Colonial Life & Accident Insurance Company (Colonial) and its duly authorized representatives. Health information may be disclosed by any health care provider or institution, health plan or health care clearinghouse that has any records or knowledge about me including prescription drug database or pharmacy benefit manager, or ambulance or other medical transport service. Health information may also be disclosed by any insurance company, Medicare or Medicaid agencies or the Medical Information Bureau (MIB). Health information includes my entire medical record, but does not include psychotherapy notes. Non-health information including earnings or employment history deemed appropriate by Colonial to evaluate my application may be disclosed by any person or organization that has these records about me, including my employer, employer representative and compensation sources, insurance company, financial institution or governmental entities including departments of public safety and motor vehicle departments. Any information Colonial obtains pursuant to this authorization will be used for the purpose of evaluating my application(s) for insurance or eligibility for benefits. Some information obtained may not be protected by certain federal regulations governing the privacy of health information, but the information is protected by state privacy laws and other applicable laws. Colonial will not disclose the information unless permitted or required by those laws. This authorization is valid for two (2) years from its execution and a copy is as valid as the original. A copy will be included with my contract(s) and I or my authorized representative may request access to this information. This authorization may be revoked by me or my authorized representative at any time except to the extent Colonial has relied on the authorization prior to notice of revocation or has a legal right to contest coverage under the contract(s) or the contract itself. If revoked, Colonial may not be able to evaluate my application(s) for insurance or eligibility for benefits as necessary to issue my contract(s). I may revoke this authorization by sending written notice to: Colonial Life & Accident Insurance Company, Underwriting Department, P.O. Box 1365, Columbia, SC 29202. You may refuse to sign this form; however, Colonial may not be able to issue your coverage. I am the individual to whom this authorization applies or that personâ€™s legal Guardian, Power of Attorney Designee, or Conservator. ________________________ (Printed name of individual subject to this disclosure)

_____________ (Social Security Number)

___________________ (Signature)

________________ (Date Signed)

If applicable, I signed on behalf of the proposed insured as __________________________ (indicate relationship). If legal Guardian, Power or Attorney Designee, or Conservator.

________________________________ (Printed name of legal representative)

_____________________________ (Signature of legal representative)

___________ (Date Signed)

I’m Leaving, Now What? State Health Insurance Under certain qualifying events, employees and dependents have the opportunity to continue coverage for 18-36 months under the COBRA Act. Please contact the State Health Plan at 1-888-234-2416. If you are retiring, you must either log in to www.myncretirement.com or call 1-888-234-2416.

Other Benefits If you wish to continue coverage of any of the following benefits, Pierce Group Benefits will be happy to serve you:

• • • •

Dental and Vision Insurance Group Term Life Insurance Supplemental/Voluntary Insurances - Cancer, Disability, Life, etc. Flexible Spending Accounts

Please visit

www.piercegroupbenefits.com/individualfamily

or call 888-662-7500 for more information on these policies, as well as to enroll/continue your benefits. You may also click on the “Individual & Family” button on the Pierce Group Benefits homepage, www.piercegroupbenefits.com to access this information.

Transferring from one Employer to Another? If you are transferring from a current PGB client to another, some benefits may be eligible for transfer. Please call 888-662-7500 and a Service Specialist will be glad to help you.

CONTACT INFORMATION: FLORES & ASSOCIATES FLEXIBLE SPENDING ACCOUNTS

COMMUNITY EYE CARE - VISION INSURANCE • Customer Service: 1-888-254-4290 • Website: www.communityeyecare.net

Website: www.flores247.com Log in using Participant ID or User Name and password Interactive Voice System Dial 800-331-9610 or 704-333-6890 Enter your Participant ID when prompted by the system

NORTH CAROLINA STATE HEALTH PLAN

HOW TO SUBMIT DOCUMENTS Online: www.flores247.com Upload scanned documents securely

• Customer Service: 1-888-234-2416 • Website: http://shpnc.org

Mobile: Download e-receipt for Apple or Android devices

UNUM - TERM LIFE INSURANCE

Mail: Flores & Associates, PO Box 31397, Charlotte, NC 28231 Fax: 704-335-0818 or 800-726-9982

• Customer Service: 1-888-729-5433 • Website: www.unum.com

CUSTOMER SERVICE: 1-800-532-3327

DELTA - DENTAL INSURANCE • Customer Service: 1-800-662-8856 • Website: www.DeltaDentalNC.com

HARMONY ONLINE ENROLLMENT • See pages 5-6 for online enrollment instructions • Technical Help Desk: 1-866-875-4772

COLONIAL LIFE VISIT COLONIALLIFE.COM TO SET UP YOUR PERSONAL ACCOUNT • Website: www.coloniallife.com • Claims Fax: 1-800-880-9325

• Customer Service & Wellness Screenings: 1-800-325-4368 • TDD for hearing impaired customers call: 1-800-798-4040

If you wish to file a Wellness/Cancer Screening claim for a test performed within the past 18 months, you need the name and date of the test performed as well as your doctor’s name and phone number. Colonial also needs to know if this is for you or another covered individual and their name and social security number. You may: • FILE BY PHONE! Call 1-800-325-4368 and provide the information requested by Colonial’s Automated Voice Response System, 24 hours per day, 7 days a week, or • SUBMIT ON THE INTERNET using the Wellness Claim Form at www.coloniallife.com, or • Write your name, address, social security number and/or policy/certificate number on your bill and indicate “Wellness Test.” Fax this to Colonial at 1-800-880-9325 or MAIL to PO Box 100195, Columbia, SC 29202 If your Wellness/Cancer Screening test was more than 18 months ago, you must fax or mail Colonial a copy of the bill or statement from your doctor indicating the type of procedure performed, the charge incurred and the date of service. Please write your full name, social security number, and current address on the bill. Please Note: If your cancer policy includes a second part to the screening benefit, bills for tests covered and a copy of the diagnostic report (reflecting the abnormal reading of your first test) must be mailed or faxed to us for benefits to be provided.

When you terminate employment, you have the opportunity to continue your Colonial coverage either through direct billing or automatic payment through your bank account. Please contact Colonial at 1-800-325-4368 to request the continuation of benefits form.

TO VIEW YOUR BENEFITS ONLINE Visit www.piercegroupbenefits.com/

beaufortcountygovernment

For additional information concerning plans offered to employees of Beaufort County Government, please contact our North Carolina Service Center at 1-888-662-7500, ext. 100