Skip to main content

Lincoln Charter School Benefits Guide 27PY

Page 1

EMPLOYEE BENEFITS GUIDE 2027 PLAN YEAR:

JANUARY 1, 2027 - DECEMBER 31, 2027

LINCOLN CHARTER SCHOOL

WWW.PIERCEGROUPBENEFITS.COM

EMPLOYEE SERVICES: 888-662-7500


TABLE OF CONTENTS

EMPLOYEE BENEFITS GUIDE Welcome to Lincoln Charter School’s comprehensive benefits program. This guide highlights the benefits offered to all eligible employees for the plan year listed below. Benefits described in this guide are voluntary, employeepaid benefits unless otherwise noted.

ENROLLMENT DATES: October 12, 2026 - October 23, 2026 PLAN YEAR & EFFECTIVE DATES: January 1, 2027 - December 31, 2027

Click on the video below to help you prepare for annual enrollment and learn about the benefits available to you!

Important Contact Information............................... 3 Eligibility Requirements......................................... 4 Overview Of Benefits............................................. 5 Important Notices................................................. 6 Qualifying Life Events............................................ 7 Enrollment Information.......................................... 9 BenSelect Enrollment Instructions......................... 10 Flexible Spending Account..................................... 12 The FSA Store....................................................... 15 Dependent Care Account....................................... 16 Telemedicine Benefits........................................... 19 Dental Insurance................................................... 26 Vision Insurance.................................................... 36 Group Term Life Insurance..................................... 40 Employee Assistance Program............................... 45 Cancer Benefits..................................................... 50 Critical Illness Benefits.......................................... 57 State Of NC Disabilities At A Glance**.................... 70 Disability Benefits................................................. 71 Accident Benefits.................................................. 78 NC State Health Plan Comparison**....................... 90 Medical Bridge Benefits......................................... 92 Term Life Insurance............................................... 101 Whole Life Insurance............................................. 105 Legal & ID Theft Benefits....................................... 109 Colonial Life Policyholder Service Guide................. 114 Authorization For Colonial Life Insurance Form....... 115 COBRA Continuation Of Coverage.......................... 116 Privacy Notices..................................................... 118 Continuation Of Coverage...................................... 119

IMPORTANT NOTE & DISCLAIMER This is neither an insurance contract nor a Summary Plan Description and only the actual policy provisions will prevail.

LINCOLN CHARTER SCHOOL 2027 Benefits Plan

January 1, 2027 - December 31, 2027

All information in this guide, including premiums quoted, is subject to change. All policy descriptions are for informational purposes only. Your actual policies may be different from those in this guide. Rev: 9/23/2026 **For informational purposes only


IMPORTANT CONTACT INFORMATION CARRIER

PHONE/FAX

EMAIL

WEBSITE

Flexible Spending Accounts

Ameriflex

P: 888-868-3539​

service@​myameriflex.com

www.myameriflex.com

Dental Insurance

Delta Dental of NC

P: 800-662-8856​

customersupport@​ deltadentalcoversme.com

www.deltadentalnc.com

Vision Insurance

EyeMed Vision

P: 866-939-3633​

-​

www.eyemed.com

Employee Assistance Program

McLaughlin Young

P: 800-633-3353​ F: 704-529-5917

-​

www.mygroup.com

Legal & ID Theft Benefits

MetLife

P: 800-638-5433​

-​

www.metlife.com

Telemedicine Benefits

Call A Doctor Plus

P: 800-835-2362​

help@​teladochealth.com

www.teladoc.com

North Carolina State Health Plan

SHPNC

P: 888-234-2416​ F: 919-765-2322

-​

www.shpnc.org

BenSelect Online Enrollment

BenSelect

P: 888-662-7500​

-​

harmony.benselect.com/ lincolncharter

Custom Benefits Website

Pierce Group Benefits

P: 1-888-662-7500 F: 984-225-2605

service@ piercegroupbenefits.com

www.PierceGroupBenefits.com/ LincolnCharterSchool

-

www.coloniallife.com

Customer Service & Wellness Screenings

Supplemental Benefits

Colonial Life

1-800-325-4368 F:1-800-880-9325 TDD For Hearing Impaired Customers

1-800-798-4040

NC State Health Plan: 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 1-877-679-6272. If you are retiring, you must either log in to www.myncretirement.com or call 1-877-679-6272.

3


ELIGIBILITY REQUIREMENTS CURRENT EMPLOYEE? ANNUAL ENROLLMENT DATES:

October 12, 2026 - October 23, 2026

PLAN YEAR & EFFECTIVE DATES: January 1, 2027 - December 31, 2027​​

ELIGIBILITY • Employees working 30 hours or more per week are eligible for benefits.

NEW HIRE? Congratulations on your new employment! Your employment means more than just a paycheck. Your employer also provides eligible employees with a valuable benefits package. Above you will find eligibility requirements and below you will find information about how to enroll in these benefits as a new employee. Telemedicine - Please contact the provider within 30 days of your hire date. Additional enrollment instructions and contact information can be found within this guide. All Other Benefits - Please call PGB’s Employee Services within 30 days of your date of hire and a PGB Benefits Representative will help you enroll in benefits. The Employee Services number is located in the contact section of this guide. You also have the option to self-enroll, if you choose, within 30 days of your date of hire. Please see the self-enrollment instructions in this guide for more information. Be sure to also review your group’s custom benefits website, that allows for easy, year-round access to benefit information, live chat support, benefit explainer videos, plan certificates and documents, and carrier contacts and forms.

www.PierceGroupBenefits.com/LincolnCharterSchool 4


OVERVIEW OF BENEFITS PRE – TAX BENEFITS Flexible Spending Accounts Ameriflex

POST – TAX BENEFITS Disability Benefits Colonial Life

- Medical Reimbursement: $3,400/year Max - Dependent Care Reimbursement: $7,500/year Max​​

*You will need to re-enroll in the Flexible Spending Accounts if you want them to continue next year. If you do not re-enroll, your contribution will stop effective December 31, 2026.

Dental Insurance Delta Dental

Vision Insurance EyeMed Vision

Critical Illness Benefits Colonial Life

Group Term Life Insurance Colonial Life - Supplemental Group Term Life Insurance - Including EAP + Work/Life Programs

Life Insurance Colonial Life

- Term Life Insurance - Whole Life Insurance

Legal & ID Theft Benefits MetLife Cancer Benefits Colonial Life

ADDITIONAL BENEFITS Accident Benefits Colonial Life

Medical Bridge Benefits Colonial Life

Telemedicine Benefits Call A Doctor Plus

Employee Assistance Program McLaughlin Young

Please note your insurance products will remain in effect unless you speak with a representative to change them. 5


IMPORTANT NOTICES When do my benefits start? The plan year for Colonial Life Insurance Products and Group Term Life, Ameriflex Flexible Spending Accounts, Delta Dental, EyeMed Vision, and MetLife Legal & ID Theft Plan runs from January 1, 2027, through December 31, 2027. When do my deductions start? Deductions for Delta Dental and EyeMed Vision start December 2026 for all enrolled employees. Deductions for Colonial Life Insurance Products and Group Term Life, Ameriflex Flexible Spending Accounts, and MetLife Legal & ID Theft Plan start January 2027 for all enrolled employees. The Call A Doctor Plus Telemedicine plan is available by Direct Billing only. No deductions will be taken via payroll deduction. Why have my Cancer, Accident, or Medical Bridge benefits not started yet? 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, 2027. What is an EAP? Your employer offers an Employee Assistance Program (EAP) for you and your eligible family members. An EAP is an employer-sponsored benefit that offers confidential support and resources for personal or work-related challenges and concerns. Please see the EAP pages of this benefit guide for more details and contact information. How do Flexible Spending Account (FSA) funds work, and do my FSA funds have to be used by a specific deadline? Flexible Spending Account expenses must be incurred during the plan year to be eligible for reimbursement. After the plan year ends, an employee has 3 months to submit claims for incurred qualified spending account expenses (or 3 months after employment termination date). If employment is terminated before the plan year ends, the spending account also ends. Failure to use all allotted funds in the FSA account will result in a “Use It or Lose It” scenario. Your plan also includes a rollover provision! This means that if you have any money left in your FSA at the end of the plan year, you can carryover up to $680 into the new plan year. Any remaining funds beyond $680 are forfeited under the “Use It or Lose It” rule. Please note: Participants must re-enroll in their FSA account for any rollover funds to be rolled into the new plan year. Failure to re-enroll will result in a “Use It or Lose It” scenario. My spouse is enrolled in a Health Savings Account (HSA), am I eligible for an FSA? As a married couple, one spouse cannot be enrolled in a Medical Reimbursement FSA at the same time the other opens or contributes to an HSA. How do Dependent Care Account (DCA) funds work and when do they need to be used? Dependent Care Accounts are like FSA accounts and allow you to request reimbursement up to your current balance. However, you cannot receive more reimbursement than what has been deducted from your pay. Any remaining funds in your DCA account must be utilized before the deadline. Failure to use all allotted funds in the DCA account will result in a “Use It or Lose It” scenario. When will I get my card? 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. I want to sign my family up for benefits as well, what information will I need? If signing up for any coverage on your spouse and/or children, please have their dates of birth and social security numbers available when speaking with the Benefits Representative. Can I sign up for Health Insurance as well? No, Pierce Group Representatives are not authorized to assist employees with their SHP enrollment or make SHP enrollment elections on an employee’s behalf. What does Pre-Tax vs. Post-Tax Change? Pre-Tax benefits take funds directly from your paycheck to cover benefits before going through State and Federal taxing process. Post-Tax collects funds for benefits after taxes have been taken out. 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. Can I change my benefit elections outside of the enrollment period? Elections made during this enrollment period CANNOT BE CHANGED AFTER THE ENROLLMENT PERIOD unless there is a family status change, otherwise known as a qualifying life event (QLE), as defined by the Internal Revenue Code. Examples of a QLE can be found in the chart on the next page. Once a QLE has occurred, an employee has 30 days to notify PGB’s Employee Services at 1-888-662-7500 to request a change in elections. I have a pre-existing condition. Will I still be covered? Some policies may include a pre-existing condition clause. Please read your policy carefully for full details. Employee Services: 888-662-7500

www.PierceGroupBenefits.com/ LincolnCharterSchool 6

Effective Dates: January 1, 2027 - December 31, 2027


QUALIFYING LIFE EVENTS The benefit elections you make during Annual Enrollment or as a New Hire will remain in effect for the entire plan year. You will not be able to change or revoke your elections once they have been made unless a Qualifying Life Event (status change) occurs. The summary of events that allow an employee to make benefit changes and instructions for processing those life event changes can be reviewed in the chart below.

QUALIFYING LIFE EVENT

ACTION REQUIRED

RESULT IF ACTION IS NOT TAKEN

New Hire

Make elections within 30 days of hire date. Documentation is required.

You and your dependents are not eligible until the next Annual Enrollment period.

Marriage

Add your new spouse to your elections within 30 days of the marriage date. A copy of the marriage certificate must be presented.

Your spouse is not eligible until the next Annual Enrollment period.

Divorce

Remove the former spouse within 30 days of the divorce. Proof of the divorce will be required. A copy of the divorce decree must be presented.

Benefits are not available for the divorced spouse and will be recouped if paid erroneously.

Enroll the new dependent in your elections within 30 days of the birth or adoption date, even if you already have family coverage. A copy of the birth certificate, mother’s copy of birth certificate, or hospital discharge papers must be presented. Once you receive the child’s Social Security Number, don’t forget to update your child’s insurance information record.

The new dependent will not be covered until the next Annual Enrollment period.

Remove or update dependent elections within 30 days of the dependent aging out. For more information and assistance, please call PGB Employee Services at 888-662-7500.

Coverage for the dependent will end at the time of the dependent aging out and the policyholder must remove/update the dependent elections in order for the change to be reflected in the employee’s deductions.

Death of a Spouse or Dependent

Remove the dependent from your elections within 30 days from the date of death. Death certificate must be presented.

You could pay a higher premium than required and you may be overpaying for coverage required.

Change in Spouse’s Employment or Coverage

Add or drop benefits from your elections within 30 days of the event date. A letter from the employer or insurance company must be presented.

You will not be able to make changes until the next Annual Enrollment period.

Birth or Adoption of a Child

Dependent Aging Out

The examples included in this chart are not all-inclusive. Please speak to a Benefits Representative to learn more. 7


QUALIFYING LIFE EVENTS QUALIFYING LIFE EVENT

ACTION REQUIRED

RESULT IF ACTION IS NOT TAKEN

Part-Time to Full-Time or Vice Versa

Change your elections within 30 days from the employment status change to receive COBRA information or to enroll in benefits as a full-time employee. Documentation from the employer must be provided.

Benefits may not be available to you or your dependents if you wait to enroll in COBRA. Full-time employees will have to wait until the next Annual Enrollment period.

Transferring Employers

If you are transferring from one PGB client to another, some benefits may be eligible for transfer. Please call PGB Employee Services at 888-662-7500 for more information and assistance.

You may lose the opportunity to transfer benefits.

Loss of Government or Education Sponsored Health Coverage

If you, your spouse, or a dependent loses coverage under any group health coverage sponsored by a governmental or educational institution, you may be eligible to add additional coverage for eligible benefits.

You and your dependents are not eligible until the next Annual Enrollment period.

Entitlement to Medicare or Medicaid

If you, your spouse, or dependent becomes entitled to or loses coverage under Medicare or Medicaid, you may be able to change coverage under the accident or health plan.

You and your dependents are not eligible until the next Annual Enrollment period.

Non-FMLA Leave

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 next plan year. Please contact your Benefit Administrator for more information.

You and your dependents are not eligible until the next Annual Enrollment period.

Retiring

Your individual supplemental/voluntary policies through Colonial Life are portable! To move them from payroll deduction to direct billing, please complete and submit the Payment Method Change Form to Colonial Life within 30 days of retiring. You are also eligible for post-employment Dental, Vision, and Telemedicine benefits through PGB. Please visit: www.piercegroupbenefits.com/ individualcoverage or call our Employee Services at 888-662-7500 for more information and assistance.

If you do not transfer your policies from payroll deduction to direct billing, Colonial Life will terminate your policies resulting in a loss of coverage.

The examples included in this chart are not all-inclusive. Please speak to a Benefits Representative to learn more. 8


ENROLLMENT INFORMATION IN-PERSON, VIRTUAL & SELF-ENROLL During the enrollment period, you can meet one-on-one with a PGB Benefits Representative via in-person or virtual appointment to review your benefits, get answers to your questions, and receive enrollment assistance. You may also choose to self-enroll online using the instructions provided in this guide.

ANNUAL ENROLLMENT PERIOD:

OCTOBER 12, 2026 - OCTOBER 23, 2026 BENEFITS AVAILABLE TO YOU YOU CAN MAKE THE FOLLOWING BENEFIT ELECTIONS DURING THE ENROLLMENT PERIOD: •

Enroll/Re-Enroll in Flexible Spending Accounts.+

•

Enroll in, change, or cancel Dental Insurance.

•

Enroll in, change, or cancel Vision Insurance.

•

Enroll in, change, or cancel Group Term Life Insurance.

•

Enroll in, change, or cancel Legal & ID Theft Benefits.

•

Enroll in, change, or cancel Colonial coverage. +You will need to re-enroll in the Flexible Spending Accounts if you want them to continue each year.

THE FOLLOWING BENEFITS AND RESOURCES ARE ALSO AVAILABLE: • •

Enroll in Telemedicine coverage (DIRECT BILLING ONLY*).** Sign up for the Employee Assistance Program. *The Telemedicine plan is available by Direct Billing only. No deductions will be taken via payroll deduction. **Please see the coordinating pages of your Benefits Guide for enrollment instructions for the Telemedicine plan.

ACCESS YOUR BENEFIT OPTIONS WHENEVER, WHEREVER www.PierceGroupBenefits.com/LincolnCharterSchool 9


BENSELECT ENROLLMENT INSTRUCTIONS

• • • •

Below is a series of instructions outlining the enrollment process. Please have the following information available before you begin: Username, pin, and enrollment website URL from this page Social security numbers of the spouse or any dependents you wish to enroll Dates of birth for the spouse and any dependents you wish to enroll Beneficiary names and social security numbers

HELPFUL TIPS : • If you are a new employee, please refer to the New Hire information on the Eligibility Requirements page of this guide or contact PGB Employee Services at 888-6627500 between 8:30am and 5:00pm for assistance. • If you are an existing employee and unable to log into the online system, please contact PGB Employee Services at 888-662-7500, or speak with the Benefits Representative assigned to your location.

1. LOGGING IN Enter your Username: Social Security Number with or without dashes (ex. 123-45-6789 or 123456789) Enter your Pin: Last 4 numbers of your Social Security Number followed by last 2 numbers of your Date of Birth year (ex. 678970)

To login, visit: harmony.benselect.com/lincolncharter

1. 2. NEW PIN The screen prompts you to create a NEW PIN.

3. SECURITY QUESTIONS Choose a security question and enter answer.

4. CONFIRM Confirm (or enter) an email address.

NEXT

5. SAVE NEW PIN Click on ‘Save New PIN’ to continue to the enrollment welcome screen.

6. CLICK NEXT

7. PERSONAL INFORMATION

From the welcome screen click ‘Next’.

10

The screen shows ‘Personal Information’. Verify that the information is correct and enter the additional required information (marital status, work phone, e-mail address). Click ‘Next’.

Enrollment instructions continued on next page


BENSELECT ENROLLMENT INSTRUCTIONS

8. ADDING FAMILY MEMBER

9. BENEFIT SUMMARY

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 ‘Next’.

The screen shows ‘Benefit Summary’. Review your current benefits and make changes, and selections for the upcoming plan year.

11. REVIEW

10. SIGN & SUBMIT Click ‘Sign & Submit’ once you have decided which benefits to enroll in.

Review your coverage. If any items are ‘Pending’, you will need to decide whether to enroll or decline this benefit.

NEXT

13. SIGN FORM

12. NEXT Click ‘Next’ to review and electronically sign the authorization for your benefit elections.

Review the confirmation, then if you are satisfied with your elections, enter your PIN and click ‘Sign Form’.

14. DOWNLOAD & PRINT Click ‘Download & Print’ to print a copy of your elections, or download and save the document. Please do not forget this important step! Click ‘Log Out’. 11


Click on the video below to learn more about Flexible Spending Accounts!

FLEXIBLE SPENDING ACCOUNT


Flexible Spending Account An account for setting aside tax-free money for healthcare expenses Use the below information to determine if a Flexible Spending Account (FSA) is right for you and how to best take advantage of an FSA account.

How It Works When you enroll in a Flexible Spending Account (FSA) you get to experience tax savings on qualified expenses such as copays, deductibles, prescriptions, over-the-counter drugs and medications, and thousands of other everyday items. Can I have an FSA and an HSA? You can’t contribute to an FSA and HSA within the same plan year. However, you can contribute to an HSA and a limited purpose FSA, which only covers dental and vision expenses. As per IRS Publication 969, an employee covered by an HDHP and a health FSA or an HRA that pays or reimburses qualified medical expenses generally can’t make contributions to an HSA. An employee is also not HSA-eligible during an FSA Grace Period. An employee enrolled in a Limited Purpose FSA is HSA-eligible. As a married couple, one spouse cannot be enrolled in an FSA at the same time the other is contributing to an HSA. FSA coverage extends tax benefits to family members allowing the FSA holder to be reimbursed for medical expenses for themselves, their spouse, and their dependents.

The Value & Perks • Election Accessibility: You will have access to your entire election on the first day of the plan year. • Save On Eligible Expenses: You can save up to 40% on thousands of eligible everyday expenses such as prescriptions, doctor’s visits, dental services, glasses, over-the-counter medicines, and copays.

• Keep More Money: The funds are taken out of your paycheck "pre-tax" (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. Let’s say you earn $40,000 a year and contribute $1,500 to an FSA; so, only $38,500 of your income gets taxed. That means you are increasing your take-home pay simply by participating!

• Easy Spending and Account Management: You will receive an Ameriflex Debit Mastercard linked to your FSA. You can use your card for eligible purchases everywhere Mastercard is accepted. Account information can be securely accessed 24/7 online and through the mobile app.

Learn more at myameriflex.com | 844.423.4636 | info@myameriflex.com 13


Eligible FSA Expenses The IRS determines what expenses are eligible under an FSA. Below are some examples of common eligible expenses.

Copays, deductibles, and other payments you are responsible for under your health plan.

Routine exams, dental care, prescription drugs, eye care, hearing aids, etc.

Prescription glasses and sunglasses, contact lenses and solution, LASIK, and eye exams.

Certain OTC expenses such as Band-aids, medicine, First Aid supplies, etc. (prescription required).

Diabetic equipment and supplies, durable medical equipment, and qualified medical products or services.

For a full list of eligible expenses, go to myameriflex.com/eligibleexpenses.

The “Use-or-Lose” Rule If you contribute dollars to a reimbursement account and do not use all the money you deposit, you will lose any remaining balance in the account at the end of the eligible claims period. This rule, established by the IRS as a component of tax-advantaged plans, is referred to as the “use-or-lose” rule. To avoid losing any of the funds you contribute to your FSA, it’s important to plan ahead as much as possible to estimate what your expenditures will be in a given plan year. Modification to the Health FSA "Use-or-Lose" Rule:

• FSA plan participants should note that up to $680 of any unused funds from the current plan year will be rolled over into your FSA balance for the new plan year.

• The rollover modification applies to Health FSA plans only (and not to other types of FSA plans such as dependent care).

• The rollover does not affect the maximum contribution amount for the new plan year. In other words, even if you roll over the entire $680 from the previous plan year, you may still elect up to the maximum contribution limit allowed under your employer’s plan.

Learn more at myameriflex.com | 844.423.4636 | info@myameriflex.com 14


THE FSA STORE Resources Available Through The FSA Store

• The largest selection of guaranteed FSAeligible products • Phone and live chat support available 24 hours a day / 7 days a week

Eligibility List

FSA Calculator

Search comprehensive list of eligible products and services.

Estimate how much you can save with an FSA.

Learning Center

Savings Center

• Fast and free shipping on orders over $50 • Use your FSA card or any other major credit card for purchases

Easy tips and resources for living with an FSA.

Your funds go further with the FSA Store rewards program.

Your Health, Your Funds, Your Choice Take control of your health and wellness with guaranteed FSA-eligible essentials. Pierce Group Benefits partners with the FSA store to provide one convenient location for Flexible Spending Account holders.

Click or Scan to Shop Now 15


Click on the video below to learn more about Dependent Care Accounts!

DEPENDENT CARE ACCOUNT


Dependent Care Account Set aside tax-free money for daycare and dependent care services Use the below information to determine if a Dependent Care Account (DCA) is right for you and how to best take advantage of an DCA account.

How It Works When you enroll in a Dependent Care Account (DCA) you get to experience tax savings on expenses like daycare, elderly care, summer day camp, preschool, and other services that allow you to work full time.

The Value & Perks • Save On Eligible Expenses: You can use a DCA to pay for qualifying expenses such as daycare, summer day care, elder care, before and after school programs, and pre-school.

• Keep More Money: The funds are taken out of your paycheck "pre-tax" (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. Let’s say you earn $40,000 a year and contribute $1,500 to an DCA; so, only $38,500 of your income gets taxed. That means you are increasing your take-home pay simply by participating!

• Easy Spending and Account Management: You will receive an Ameriflex Debit Mastercard linked to your DCA. You can use your card for eligible purchases everywhere Mastercard is accepted. Account information can be securely accessed 24/7 online and through the mobile app.

Eligible DCA Expenses The IRS determines what expenses are eligible under a DCA. Below are some examples of common eligible expenses:

Private sitter

Daycare and elder care

Before- and after-school care

Summer day camp

Nanny service

Nursery school & Pre-school

For a full list of eligible expenses, go to myameriflex.com/eligibleexpenses.

Learn more at myameriflex.com | 844.423.4636 | info@myameriflex.com 17


www.myameriflex.com

Online Account Instructions How to Access Your Ameriflex Account: Go to MyAmeriflex.com and click “Login” from the upper right hand corner. When prompted, select “Participant.”

How to Register Online For Your Ameriflex Spending Account: Click the register button atop the right corner of the home screen. 1. As the primary account holder, enter your personal information. • Choose a unique User ID and create a password (if you are told that your username is invalid or already taken, you must select another). • Enter your first and last name. • Enter your email address. • Enter your Employee ID, which in most cases, will be the account holder’s Social Security Number(no dashes or spaces needed). 2. Check the box if you accept the terms of use. 3. Click 'register'. This process may take a few seconds. Do not click your browser’s back button or refresh the page. 4. Last, you must complete your Secure Authentication setup. Implemented to protect your privacy and help us prevent fraudulent activity, setup is quick and easy. After the registration form is successfully completed, you will be prompted to complete the secure authentication setup process: Step 1: Select a Security Question option, and type in a corresponding answer. Step 2: Repeat for the following three Security Questions, then click next. Step 3: Verify your email address, and then click next. Step 4: Verify and submit setup information, 5. The registration process is complete! Should you receive an information error message that does not easily guide you through the information correction process, please feel free to contact our dedicated Member Services Team at 888.868.FLEX (3539).

18

Want to Manage Your Account on the go? Download the MyAmeriflex mobile app, available through the App Store or Google Play. Your credentials for the MyAmeriflex Portal and the MyAmeriflex Mobile App are the same; there is no need for separate login information!


Click on the video below to learn more about Telemedicine Benefits!

TELEMEDICINE BENEFITS


24/7 access to quality care... on your schedule!

Complete

Teladoc



Connect in under 10 minutes to US-based, board certified physicians who can answer questions, diagnose and even prescribe when necessary.

Pharmacy Discount Card



Save up to 75% on your prescription medication using our pharmacy discount card. It’s easy to use and accepted at over 50,000 pharmacies nationwide!

Life Assistance



Access to professional Life Counselors and specialists who can help you achieve balance in your personal, family and work life is just a call away.

Bill Saver



Our Bill Saver program can help reduce the amount you owe for medical and dental bills over $400, often resulting in savings between 25-50%.

Please use link below to enroll: http://www.getcadrplus.com/index.cfm?id=355696 20

We Win When You Win.


Talk to a doctor

anytime

Teladoc® gives you 24/7/365 access to U.S. board-certified doctors through the convenience of phone, video or mobile app visits. It's an affordable alternative to costly urgent care and ER visits when you need care now.

MEET OUR DOCTORS

GET THE CARE YOU NEED

WHEN CAN I USE TELADOC?

Teladoc is simply a new way to access

Teladoc doctors can treat many

Teladoc does not replace your primary

qualified doctors. All Teladoc doctors:

medical conditions, including:

physician it is a convenient and

•

Are practicing PCPs,

•

Cold & flu symptoms

pediatricians, and family

•

Allergies

•

When you need care now

medicine physicians

•

Sinus problems

•

If you're considering the

•

Average 20 years experience

•

Sore Throat

ER or urgent care for a

•

Are U.S. board-certified and

•

Respiratory infection

non-emergency issue

licensed in your state

•

Skin problems

Are credentialed every three

•

And more!

•

affordable option for quality care.

•

or away from home •

years, meeting NCQA standards

On vacation, on a business trip, For short term prescription refills

Talk to a doctor anytime for free! Teladoc.com 1-800-TELADOC (835-2362)

21

© 2019 Teladoc Health, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc Health, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.

04042016 10E-100B


So many reasons to use Teladoc ® Teladoc gives you access 24 hours, 7 days a week to a U.S. board-certified doctor through the convenience of phone, video or mobile app visits. It's an affordable option for quality medical care. 1

2

3

GET THE CARE YOU NEED Teladoc doctors can treat many medical conditions, including: Talk to a doctor anytime, anywhere you happen to be

4

Prompt treatment, talk to a doctor in minutes

Receive quality care via phone, video or mobile app

5

6

• Cold & flu symptoms • Allergies • Pink Eye • Respiratory infection • Sinus problems • Skin problems • And more! With your consent, Teladoc is

A network of doctors that can treat every member of the family

Prescriptions sent to pharmacy of choice if medically necessary

Teladoc is less expensive than the ER or urgent care

happy to provide information about your Teladoc visit to your primary care physician

Talk to a doctor anytime for free! Teladoc.com 1-800-TELADOC (835-2362) 22

© 2019 Teladoc Health, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc Health, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.

03302016 10E-103B


Register Your Account Follow these simple steps to set up your Teladoc Health account and access your available services.

1. Get Started

Visit TeladocHealth.com or open the Teladoc Health app and select Register Now.

2. Create Your Login

Enter your email address, create a password, and follow the prompts to verify your email.

3. Verify Your Eligibility Enter your: • • •

First and last name Date of birth ZIP code

Make sure this information matches the information provided by your employer or organization. When prompted, do not check the box indicating that you do not have benefits through an employer or organization.

4. Confirm Your Benefits

Once your information is matched, you'll see your employer or organization and the Teladoc Health services available to you. Confirm your information and continue.

5. Complete Your Account

Follow the remaining prompts to finish setting up your account. That's it! You're ready to access care with Teladoc Health.

Can't Find Your Coverage?

If Teladoc can't find your information or asks you to enter your health insurance information, STOP and contact your HR team as soon as possible. This means Teladoc was unable to match you to your employer-sponsored benefits.

Access Teladoc 24/7 via the app, online at TeladocHealth.com or by calling (800) 835-2362. 23


24


EAP+Work/Life Program Compassionate and confidential support for employees and their families Problem-solving for personal, relationship and work issues • In-person, telephonic, text and video counseling • Help for stress, anxiety, depression, family issues, substance abuse and more • Referrals for long-term counseling or specialized care

Support for Supervisors and HR • Sensitive employee issues; conflict resolution • Critical events • Disability management

Help achieving work/life balance • Locate childcare, legal and financial experts

Emotional distress can reduce a worker’s capacity by

• Webinars, articles, budgeting calculators

Friendly awareness communications • Emails, posters, flyers, monitor screens and more • Monthly electronic member newsletter • News alerts

50% Source: Milenkovic, M (2019, September). 42 Worrying Workplace Stress Statistics. Retrieved from https://www.stress.org/42-worrying-workplace-stress-statistics

Combine with Health Advocacy for greater impact and support.

Tom called because he was stressed about his wife’s cancer diagnosis and related unpaid medical bills.

His Counselor addressed his emotional concerns and connected him to a Personal Health Advocate who:  Reviewed his wife’s diagnosis and treatment plan  Connected them to a Center of Excellence  Reviewed their benefifs coverage, and negotiated medical bills  Made the appointment and transferred medical records

866.799.2655 | info@HealthAdvocate.com | HealthAdvocate.com Health Advocate makes healthcare easier for over 12,500 organizations and their members by leveraging a combination of personal support, data and technology to engage people in their health and well-being. ©2020 Health Advocate HA-B-1906040-1.2FLY

25


Click on the video below to learn more about Dental Insurance!

DENTAL INSURANCE


Delta Dental of North Carolina Dental Benefit Highlights for

Lincoln Charter School #10807 Delta Dental Premier® Dentist Plan Pays

Non‐ participating Dentist Plan Pays*

100%

100%

100%

100%

100%

100%

100%

100%

100%

100% 100%

100% 100%

100% 100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

60% 60%

60% 60%

60% 60%

60%

60%

60%

60% 60%

60% 60%

60% 60%

With our quick and accurate claims processing, we pay more than 90% of claims in 10 days or less. Delta Dental also offers world‐class customer service from our BenchmarkPortal Certified Center of Excellence call center.

60%

60%

60%

Online Access

Delta Dental PPO Dentist

Delta Dental PPOTM plus Premier Coverage effective January 1, 2025

Plan Pays

Diagnostic & Preventive Diagnostic and Preventive Services –exams, cleanings, fluoride, and space maintainers Emergency Palliative Treatment – to temporarily relieve pain Sealants – to prevent decay of permanent teeth Brush Biopsy – to detect oral cancer Radiographs – X‐rays

Basic Services Minor Restorative Services – fillings and crown repair Periodontal Maintenance – cleansing following periodontal therapy Relines and Repairs – to bridges, implants, and dentures

Welcome to North Carolina's largest dental benefits family! As a member of Delta Dental of North Carolina, you have access to the nation's largest dental networks: Delta Dental PPO and Delta Dental Premier.  It's easy to find a dentist! Four out of five dentists nationwide participate in our network.  You have superior access to care and fee savings because of our agreements with participating dentists.  Our dentists cannot balance bill you, which means more money in your pocket!  No troublesome paperwork! Network dentists will fill out and file your claims.  Pay only your copayments and/or deductibles when you receive care from network dentists ‐‐ there are no hidden fees.  You can still visit nonparticipating dentists, but you may be billed the full amount at the time of service and then have to wait to be reimbursed.

Major Services Endodontic Services – root canals Periodontic Services – to treat gum disease Oral Surgery Services – extractions and dental surgery Major Restorative Services – crowns Other Basic Services ‐ misc. services Prosthodontic Services – bridges, implants, dentures, and crowns over implants

* 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. The Nonparticipating Dentist Fee may be less than what your dentist charges and you are responsible for that difference. Maximum Payment – $1,250 per person total per calendar year on diagnostic & preventive, basic services, and major services. Deductible – $50 deductible per person total per calendar year limited to a maximum deductible of $100 per family per calendar year on all services except diagnostic and preventive services, emergency palliative treatment, sealants, brush biopsy, and X‐rays. Note ‐ This document is only intended to provide a brief description of your benefits. Please refer to your Certificate and summary for a complete description of benefits, exclusions, and limitations.

Quality Dental Program

Our online Member Portal lets you access your dental plan securely over the Internet. You can find a dentist, check benefits, select paperless notices, review claims and amounts used toward maximums, print ID cards, and more ‐‐ all at your own convenience. A Healthy Smile Keep your smile healthy with dental benefits from Delta Dental. Your smile is a good indicator of your health. Did you know that your dentist can detect up to 120 different diseases, including diabetes and heart disease? Early detection is one of the best ways to prevent further complications. Questions? If you have questions, call our Customer Service team at 800‐662‐8856 or visit our website at www.DeltaDentalNC.com.

09/03/2024

27


 

28

PA 05/2021


29


www.deltadentalnc.com/findadentist

Find a Delta Dental Participating Dentist Your Delta Dental PPO plus Premier™ plan allows you to visit any dentist you like. However, there are advantages to choosing a dentist who belongs to one of Delta Dental’s two dentist networks. You can save the most money and receive the highest levels of coverage when you visit a Delta Dental PPO™ dentist. If you visit a dentist who does not participate in Delta Dental PPO™, you can still save money if that dentist participates in Delta Dental Premier®. To find a participating dentist in your area, follow the simple steps below.

» Step 1 Visit www.deltadentalnc.com. Scroll down on the homepage to the “Find a Dentist” tool. You may also go directly to www.deltadentalnc.com/findadentist.

1

OVER

30


» Step 2 The Specialty menu defaults to any dentist. If you want to search for a specific specialty, select the specialty from the drop-down menu. Then, select the Your plan menu and choose the appropriate network option for you.

2

•

Delta Dental PPO™—all providers who participate in Delta Dental PPO.

•

Delta Dental Premier®—all providers who participate in Delta Dental Premier.

•

Delta Dental PPO plus Premier™—all providers who participate in both Delta Dental PPO and Delta Dental Premier.

The search will display results that fit your criteria, and whether or not those providers also participate in other networks. Next, select Yes to search by current location or No to search by address or ZIP code. Choosing “Yes” may require you to change a location setting or you may need to go back and select “No” and manually enter your physical address if you receive an error message. Select Find a Dentist to begin search.

3

» Step 3 Your results will be displayed. Optional: You can filter your search results by distance, number of results, dental specialty, languages spoken and gender. You can also search for a specific dentist by name or office name. In addition to viewing your search results online, you can print or email your results, or view your results as a PDF under My list. To add dentists to your list, select the Add to my list or Add all to my list checkboxes. Once you have added results to your list, select the down arrow to save as a PDF, print or email your list.

Unsure of your plan type or looking for additional information? Register or log in to the Consumer Toolkit®, Delta Dental’s secure online tool for access to eligibility information, current benefits information, claims information and more. Learn more at www.deltadentalnc.com/consumertoolkit.

www.deltadentalnc.com/findadentist FLI-6299-NC v3

31

PA 2/19


GROUP

Stay Informed About Your Dental Benefits With Member Portal

Get started today Visit www.memberportal.com Log in using your existing Consumer Toolkit® credentials

Member Portal gives you 24/7 access to important information about your dental benefits.

OR If you do not have existing credentials, click “Sign up” Complete the required fields and follow the on-screen instructions to register as a new user

With Member Portal, you can: •

See which members are covered on your plan, now and in the future

•

Find an in-network dentist

•

See common procedures

•

Access an online ID card

•

View the status of all claims and toggle between different family member claims

•

View and print Explanation of Benefits (EOBs)

NOTE: You will need the subscriber’s ID (the person whose name is on the benefit package). The member ID is an assigned number unique to the subscriber. In many cases, the member ID is the same as the subscriber’s Social Security number.

Questions? Call Toolkit Support at 866-356-0301 Privacy of your online benefit information is assured through highly secure encryption technology.

NOTE: Member Portal has replaced Consumer Toolkit.

FLI-6592 v1

Delta Dental of Arkansas, Indiana, Kentucky, Michigan, New Mexico, North Carolina, Ohio, and Tennessee

32

PA 1/21


Delta Dental Mobile App

Manage your oral health anytime, anywhere

Your oral health is important to Delta Dental — and to your overall health! We’ve designed our mobile app to make it easy for you to make the most of your dental benefits. Maximize your health, wherever you are! Search for a dentist near you, view ID cards and more, right on your mobile device.

Getting started The Delta Dental Mobile App is optimized for iOS (Apple) and Android devices. To download our app on your device, visit the App Store (Apple) or Google Play (Android) and search for Delta Dental Mobile App. Or, scan the QR code below. You will need an internet connection in order to download and use most features of our free app. Logging in to view benefits Delta Dental members can sign in using the username and password they use to sign in to our website. If you haven’t registered for an account yet, you can do that within the app. If you’ve forgotten your username or password, you can also retrieve these via the Delta Dental Mobile App.

SCAN TO DOWNLOAD DELTA DENTAL MOBILE APP

33


Delta Dental Mobile App features Sign in to access the full range of tools and resources

Mobile ID card No need for a paper card. View and share your ID card from your phone, and easily save it to your device for quick access, including Apple Passbook and Google Wallet.

Find a dentist It’s easy to find a dentist near you. Search and compare dental offices to find one that suits your needs. Save your family’s preferred dentists to your account for easy access. Dental Care Cost Estimator Find out what to expect with our Dental Care Cost Estimator. Our easy to use tool provides estimated cost ranges on common dental care needs for dentists in your area, now with the option to select your dentist for tailored cost estimates.

Save your preferred dentist for quick access Save your favorite dentists using the Delta Dental Mobile App for quick access to contact information making it easy to schedule your routine cleaning.

Secure access to your benefits You must sign in each time you access the secure portion of the mobile app. No personal health information is ever stored on your device. For more details on security, our Privacy Policy can be viewed by clicking the lock icon on the main menu.

Please note information displayed may vary based on your particular coverage. For more information on your coverage, contact your Delta Dental company. “Delta Dental” refers to the national network of 39 independent Delta Dental companies that provide dental benefits and is a registered trademark of Delta Dental Plans Association.

www.deltadentalnc.com Copyright © 2021 by Delta Dental Plans Association. All rights reserved.

34


Stay in network and save As a Delta Dental PPO plus Premier™ member, you may see any dentist you like. However, there are advantages to choosing a dentist who belongs to one of Delta Dental’s two dentist networks. Delta Dental PPO™ dentists

• • •

No balance billing on covered services Most significant network discounts with more than 2,681 dentists in North Carolina1 Dentists file claims for member

Delta Dental Premier® dentists

• • •

No balance billing on covered services Significant network discounts with more than 3,705 dentists in North Carolina**1 Dentists file claims for member

Out-of-network dentists

• • •

May be balance billed No network discounts May need to file own claims

1 Delta Dental of North Carolina internal data, 2021.

How it works—As shown below, your lowest out-of-pocket costs result from going to a Delta Dental PPO™ dentist.

Example savings for a crown by network

Estimated Maximum charge allowed fees

Percentage Amount Amount Total paid by Delta dentist can amount Delta Dental Dental pays balance bill you pay

Your total cost savings 600

Delta Dental PPO™

$

1,500

$

900

50%

$

450

$

0

$

450

$

Delta Dental Premier®

$

1,500

$

1,000

50%

$

500

$

0

$

500

$

Out-of-network

$

1,500

$

1,200

50%

$

300

$

600

$

900

500 0

$

Delta Dental PPO™ dentists

Delta Dental Premier® dentists

Out-of-network dentists

Delta Dental PPO™ dentists have agreed to charge $900 for the $1,500 service, a savings of $600. Your Delta Dental plan covers 50 percent of the cost. Assuming you’ve already met your deductible for the year, Delta Dental will pay $450 and you’ll pay $450.

Delta Dental Premier dentists have agreed to charge $1,000—a savings of $500 compared to the fee the dentist usually charges. Assuming you’ve met your deductible, Delta Dental will cover 50 percent of that $1,000, paying $500. You’ll also pay $500. That’s an extra $50 tacked on to your share of the bill when compared to what you would have paid with a Delta Dental PPO™ dentist.

Out-of-network dentists have not agreed to charge lower fees and can bill the full $1,500. Delta Dental has set a limit on the accepted amount at $1,200, which means Delta Dental’s share of the tab is $600. The dentist can bill you the difference between Delta Dental’s payment and what they charge. This leaves you with a bill of $900, which includes the $300 the out-of-network dentist can “balance bill.”

* This number is inclusive of the PPO network. NOTE: Payment examples above are illustrative only. Fees and reimbursements can vary by location and dentist. They do however represent how payment is determined.

Find Delta Dental participating dentists near you by using the search feature on our website at www.deltadentalnc.com/findadentist, or by calling Delta Dental toll-free at 800-662-8856. FLI-6241-NC v5

35

PA 8/21


Click on the video below to learn more about Vision Insurance!

VISION INSURANCE


a h

40

% OFF

additional complete pair of prescription eyeglasses

20%

Lincoln Charter School Insight network VISION CARE SERVICES

SCHEDULE OF BENEFITS

EXAM SERVICES Exam Retinal Imaging

CONTACT LENS FIT AND FOLLOW-UP Fit and Follow-up - Standard Fit and Follow-up - Premium

FRAME

OFF

non-covered items, including nonprescription sunglasses

Frame

STANDARD PLASTIC LENSES

Single Vision Bifocal Trifocal/Lenticular Progressive - Standard Progressive - Premium Tier 1 - 4

LENS OPTIONS

Frequency Exam

once every plan year

Frame

once every plan year

Lens

once every plan year

Contact Lens

once every plan year (Plan allows member to receive either contacts and frame, or frames and lens services)

Anti Reflective Coating - Standard Anti Reflective Coating - Premium Tier 1 - 3 Photochromic - Non-Glass Polycarbonate - Standard Scratch Coating Tint UV Treatment All Other Lens Options

CONTACT LENSES

Contacts - Conventional Contacts - Disposable Contacts - Medically Necessary

OTHER

Hearing Care from Amplifon Network Lasik or PRK from U.S. Laser Network

IN-NETWORK MEMBER COST

OUT-OF-NETWORK MEMBER REIMBURSEMENT

$20 copay Up to $39

Up to $40 Not covered

Up to $40; contact lens fit and two follow-up visits 10% off retail price

Not covered

$0 copay; 20% off balance over $200 allowance

Up to $140

$0 copay $0 copay $0 copay $55 copay $85 - 215

Up to $30 Up to $50 Up to $70 Up to $50 Up to $50

$45 copay $57 - 100 $75 $40 $15 $15 $15 20% off retail price

Up to $23 Up to $23 Not covered Not covered Not covered Not covered Not covered Not covered

$0 copay; 15% off balance over $200 allowance $0 copay; 100% of balance over $200 allowance $0 copay; paid-in-full

Up to $140

Discounts on hearing aids; call 1.877.203.0675 15% off retail or 5% off promo price; call 1.800.988.4221

Not covered

Up to $140 Up to $300 Not covered Not covered

Log into eyemed.com/member to see all plans included with your benefits. EyeMed reserves the right to make changes to the products available on each tier. All providers are not required to carry all brands on all tiers. For current listing of brands by tier, call 866-939-3633. No benefits will be paid for services or materials connected with or charges arising from: medical or surgical treatment, services or supplies for the treatment of the eye, eyes or supporting structures; Refraction, when not provided as part of a Comprehensive Eye Examination; services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; any Vision Examination or any corrective Vision Materials required by a Policyholder as a condition of employment; safety eyewear; solutions, cleaning products or frame cases; non-prescription sunglasses plano (non-prescription) lenses; plano (non-prescription) contact lenses; two pair of glasses in lieu of bifocals; electronic vision devices; services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order; or lost or broken lenses, frames, glasses, or contact lenses that are replaced before the next Benefit Frequency when Vision Materials would next become available. Fees charged by a Provider for services other than a covered benefit and any local, state or Federal taxes must be paid in full by the Insured Person to the Provider. Such fees, taxes or materials are not covered under the Policy. Some provisions, benefits, exclusions or limitations listed herein may vary by state. Plan discounts cannot be combined with any other discounts or promotional offers. In certain states members may be required to pay the full retail rate and not the negotiated discount rate with certain participating providers. Please see online provider locator to determine which participating providers have agreed to 37of Kansas City, Missouri, except in New York. Fidelity Security Life Policy number the discounted rate. Underwritten by Fidelity Security Life Insurance Company® VC-146, form number M-9184. This is a snapshot of your benefits. The Certificate of Insurance is on file with your employer.


Ready to live your best EyeMed life? There’s so much more to your vision benefits than copays and coverage. Get ready to see the good stuff for yourself.

Your network is the place to start See who you want, when you want. You have thousands of providers to choose from — independent eye doctors, your favorite retail stores, even online options.

Keep your eyes open for extra discounts Members already save an average 76% off retail using their EyeMed benefits, 1 but our long list of special offers takes benefits even further.

Remember, you’re never alone We’re always here to help you use your benefits like a pro. Stay in-the-know with text alerts or healthy vision resources from the experts. If it can make benefits easier for you, we do it.

a

1 Based on weighted average of sample transactions: EyeMed Insight network/$10 exam copay/$10 materials copay/$150 frame or contact lens allowance. 2021 EyeMed Commercial BOB stats.

Create a member account at eyemed.com/member Everything is right there in one spot. Check claims and benefits, see special offers and find an eye doctor — search for one with the hours, location and brands you want. For maximum mobility, try the EyeMed Members App (Google Play or App Store).

38


VISION INSURANCE PREMIUMS 24 Month Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

39

Cost $5.07 $10.14 $8.62 $14.71


Click on the video below to learn more about Group Term Life Insurance!

GROUP TERM LIFE INSURANCE


GROUP TERM LIFE INSURANCE LINCOLN CHARTER SCHOOL

How secure is your family’s future without you? Losing a loved one is always difficult. The last thing you need to worry about is the financial cost. Funeral expenses, medical bills and taxes are just the tip of the iceberg. Do you know how you would cover ongoing living expenses, such as the mortgage, health care and utilities? Plan for the future with Colonial Life’s Group Term Life insurance.

My Coverage Worksheet WHAT IS GROUP TERM LIFE INSURANCE? • Death benefit protection • Lower cost option • Provides coverage for specified periods of time, which can be during high-need years • Benefit is typically paid tax-free to your beneficiaries

HOW MUCH COVERAGE DO I NEED? n YOU

n YOUR SPOUSE*

$

$

• Available in $1,000 increments

• Available in $1,000 increments

• Minimum of $10,000 to a maximum of 5 times your 1 salary to $200,000

• Minimum of $5,000 to a 1 maximum of $200,000

n YOUR DEPENDENT CHILDREN* (Up to age 26) $ • Available in $1,000 increments to a maximum of $10,000.

• Spouse coverage cannot exceed your coverage amount2

• Each dependent child is covered for the same amount, except childrenfrom live birth to 6 months for whom the death benefit is $1,000

24 MONTH RATES $0.115 PER $1,000

24 MONTH RATES $0.115 PER $1,000

24 MONTH RATES $0.115 PER $1,000

AD&D - 24 month rates $0.010

AD&D - 24 month rates $0.010

AD&D - 24 month rates $0.010

*Dependent coverage must be sold in conjunction with supplemental coverage for the employee. **The children’s term rider rates are per thousand per dependent unit. The children’s term rider is a blanket rider that covers all dependent children; therefore, one premium covers all children.

41


WHAT OTHER BENEFITS ARE INCLUDED? • Accelerated death benefit: An advance of up to 75% the death benefit, to a maximum of $150,000, if the covered person is diagnosed with a terminal illness. Terminal illness means an injury or sickness that results in the covered person having a life expectancy of 12 months or less and from which there is no reasonable prospect of recovery.3 • Health Advocate Employee Assistance Program: Provides 24-hour confidential personal support and referral service, including a medical bill saver service. Face-to-face sessions and video counseling with mental health professionals are available.4 ONLINE ColonialLife.com/EAP TELEPHONE 1-888-645-1772 • Life Planning Services: offer financial and legal counseling services, as well as grief support and referral for up to 12 months after a claim.4 ONLINE HealthAdvocate.com/members ColonialLife-lifeplanning TELEPHONE 1-800-422-5142

WHAT FEATURES ARE INCLUDED? • Portability: All ported insureds will continue to pay at the active group rates.

CAN I APPLY FOR GUARANTEED-ISSUE COVERAGE FOR MY SPOUSE OR DEPENDENT CHILDREN AT THE INITIAL ENROLLMENT? Yes, but their coverage will not be effective if they are currently totally disabled. Being totally disabled5 means the inability to perform two or more activities of daily living, being confined in a hospital or similar institution, or being unable to attend school outside the home (for a dependent child ages age 5 to 26). The ability to work does not determine disability. You can pay premiums on insurance for your dependents with no health questions asked. However, coverage isn’t effective until the earlier of the date they are no longer totally disabled or two years after the date that coverage would have otherwise become effective for the spouse or dependent child. This provision does not apply to newborn children born while dependent insurance is in effect. This policy has exclusions and limitations. For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number GTL1.0-P and certificate number GTL 1.0-C (including state abbreviations where used). 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.

1 In WA, minimum face amount available is $25,000. 2 The maximum benefit is 50% of your benefit, up to $250,000 in NE. 3 A life expectancy of 24 months or less in IL, KS, MA, TX and WA. 4 The Employee Assistance Program and Life Planning Services, provided by Health Advocate, are available with Colonial Life & Accident Insurance Company’s Group Term Life offering. Terms and availability of service are subject to change. The service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact the company for full details. 5 In ID, NH and TX, the definition of total disability does not include Activities of Daily Living (ADL) requirements.

• Conversion: You may be eligible to convert your coverage to a cash value policy without proof of good health when coverage ends under the group certificate. • Waiver of premium: If included in your plan, premium payments are waived if you become disabled.

The policies, their names or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. Policy forms marketed by the company vary by product and are too numerous to list in the advertisement, but a list can be provided upon request.

ColonialLife.com

Colonial Life Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

42

9-24 | NS-2277500


Summary of Voluntary Group Term Life Benefits for Lincoln Charter School Eligibility Guidelines All active employees working a minimum of 30 hours or more per week on a regular basis. Eligible spouses and dependent children (up to age 26) also qualify for coverage if employee purchases coverage.

Built-in-Benefits Accelerated Death Benefit

An insured can advance up to 75% of their death benefit to a maximum of $150,000 if diagnosed with a terminal illness and given 12 months or less to live. Benefit amount discounted for 12 months.

Employee Assistance Program

Provides online, telephonic, and in-person services to all employees with GTL 1.0 coverage and includes will preparation assistance

Life Planning Financial and Legal Service

Provides terminally ill employees and designated beneficiaries financial, legal, and emotional support in dealing with death and loss.

Portability

Employees and their spouse and dependent children may continue coverage when the employee leaves his job, reduces hours below the minimum required or retires. All ported insurance will continue to pay the active group rates. Evidence of insurability is not required at time of port.

Conversion

Right to convert to an individual level premium whole life plan then in use by us without proof of good health.

Waiver of Premium

Included for all coverages purchased. Based on employee’s total disability that occurs before age 65, lasts to age 65 or retirement with a 270 day elimination period. Total disability means unable to perform any occupation.

Benefit Reduction Due to Age

When an employee turns 70, coverage reduces to 65% of the face amount in effect just prior to age 70. When an employee turns 75, coverage reduces to 50% of the face amount in effect just prior to age 70. Policies issued to individuals over age 70 initially are automatically reduced in accordance with the schedule above. Spouses experience the same reduction schedule, but it is based on the spouse's age.

43


Group Term Life Exclusions Insurance delayed for employees not in active employment because of injury, sickness, temporary layoff, or leave of absence on date of insurance otherwise effective. 24 month suicide exclusion applies to initial amounts of insurance and any increases.

Voluntary Term Life Insurance 24 Monthly Premiums per $1,000 of covered volume. Age Band

Employee*

Spouse*

0-99

$0.115

$0.115

AD&D

$0.010

$0.010

$0.115

N/A

$0.010

N/A

Voluntary Life – Child* Child AD&D * Rates per $1,000 of covered volume.

Guaranteed Issue Underwriting for New Hires For You: You must enroll within 30 days of being eligible. If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of the lesser of 5x your salary or $125,000, you will need to provide evidence of insurability. For Your Spouse: If you elect coverage for yourself, you can elect up to $25,000 with no medical questions asked. The amount you select for your spouse cannot exceed 100% of your coverage amount. For Your Child(ren): If you elect coverage for yourself, you can elect up to $10,000 with no medical questions asked. The amount you select for your child(ren) cannot exceed 100% of your coverage amount. If you were previously eligible and are electing coverage for the first time, or electing to increase current coverage, you will need to provide evidence of insurability.

44


Click on the video below to learn more about Employee Assistance Programs!

EMPLOYEE ASSISTANCE PROGRAM


EAP & Work-Life Services An EAP is a company-sponsored benefit that offers the support and resources you need to address personal or work-related challenges and concerns. It’s confidential and free to you and your household family members. Help is available 24/7/365 at 800.633.3353. Access Your EAP & Work-Life Services There are two ways to access your EAP and work-life services: Call 800.633.3353 or Visit mygroup.com I Click on My Portal Login I Work-Life | Username: lincolncharter I Password: guest Assessment and Counseling Reasons to use the EAP include marital difficulties, parenting, stress, depression, work-related concerns, alcohol and drug use/abuse, grief and loss, or preventative. When employees and family members call the EAP, they are offered face-to-face, telephonic, or virtual counseling sessions in which a thorough assessment can be conducted by a licensed, experienced clinician in their area. EAP is short-term, solution-focused therapy so not all issues will be resolved within the EAP model and may need to be referred to other resources. Online Services • 7 content divisions: Parenting, Aging, Balancing, Thriving, Living, Working, and International • Monthly Online Seminars and eLearning courses with certificates of completion • Searchable databases and resource links for child care providers, elder care and related services, adoption resources, attorneys, certified financial planners, pet sitting, private and public high schools and colleges, and volunteer opportunities • Over 100 streaming audio files and 100 video files covering a range of health topics • Savings Center: discount shopping program offering up to 25% discounts on name-brand items • Relocation Center: an interactive program that allows users to preview communities across the U.S. Legal Services Free telephonic legal advice • Free 30-minute appointment for legal consultation with a local attorney • In most cases, 25% discount on ongoing legal services • Legal forms available to download (such as wills, request for death certificate, etc.) • Online legal encyclopedia • Does not cover disputes or actions involving employer, EAP or business issues • Financial Services Free financial counseling appointments • • Issues addressed include bankruptcy, budgeting, buying a home, college savings, retirement planning • Educational materials and financial worksheets provided prior to appointments • 40 financial calculators available online • ID theft recovery through credit monitoring • Discounted credit reports

mygroup.com | 800.633.3353

46


MYgroup EAP: Summary Plan Description MYgroup (Legal name: McLaughlin Young Employee Services) was found in 1987 in Charlotte, NC as an external provider of Employee Assistance Program services. Our EAP counselors all have master’s degrees and take a lead position in all calls for assistance, whether they are for EAP or Work-Life. The training and clinical credentials of our EAP counselors give them the background and flexibility to assess the widest spectrum of employee needs. Our EAP counselors' roles include case management from entry to follow-up. There are three ways an employee/client can access the EAP – (1) self-referral where the employee/client contacts the EAP on his/her own initiative, (2) when a supervisor or co-worker informally suggests getting help and reminds him/her to call the EAP, (3) mandatory or formal referral by management when counseling is a condition for continued employment. ǫ Employees, their dependents and/or their household members are eligible. Our EAP professionals are trained to deal with the following problems and more: Depression Alcohol abuse and alcoholism Grief Drug use and addiction Legal concerns Other addictions Financial issues DOT assessment and intervention Work-related problems Family/marital – adult relationship Stress Family – adult/child relationships Physical or sexual abuse Emotional problems Childcare concerns Eldercare challenges

mygroup.com | 800.633.3353 | 5925 Carnegie Blvd. Charlotte NC 28209

47


Ǧ Employees, their dependents and/or their household members are eligible. Our EAP services provide face-to-face, virtual or telephonic assessments and counseling for all clients regardless of the nature of the problem. Short-term counseling for employees and their household members can include up to six sessions per issue. There is no limit to the number of issues per employee per year. In some cases, the counselor may find it necessary to recommend a specialized care facility, medical doctor, or community resource for evaluation, treatment or long-term counseling. In all cases we will refer a client to the most effective resource in conjunction with the client’s insurance provisions. Supervisors and managers have unlimited access to our professionals for consultation on confronting and referring troubled employees to the EAP. Our counselors assist supervisors in developing action plans and coaching them toward successful interventions. Systematic feedback on the progress of supervisory referrals is provided. This feedback includes notification of compliance with appointments, treatment status and recommendations to management. Help is available 24 hours a day, 7 days a week, and 365 days a year through MYgroup’s toll-free 1-800 number. Our clients experience the same level of service after hours and on weekends. All calls, including after hours, weekends and holidays, are answered live by master’s level professional counselors. All callers are given the opportunity to address any immediate or urgent concerns with a counselor. When locating a network provider for a client, we take into consideration the nature of the problem, level of seriousness of the problem, location of the client, appropriateness of male or female counselor, and availability of appointments that best meet the needs of the client. A critical incident could be an accident, medical emergency, death, school violence, terrorism, natural disaster, robbery, closings and layoff or an act of violence that impacts the workplace. In such an event, we respond promptly to plan and conduct all on-site activities relating to the company’s crisis. Our professionals are available to provide guidance and assistance in effectively managing threats of violence. We also assist in developing violence policies and procedures. Ǧ To help employees deal with the trauma of being laid off or terminated, we offer up to three counseling sessions at no charge within 30 to 90 days of the final date of employment. At no additional charge, we provide counseling to retirees for an additional three months after retirement begins. mygroup.com | 800.633.3353 | 5925 Carnegie Blvd. Charlotte NC 28209

48


Our EAP services are extended for an additional three months, at no additional charge, for families of employees who have died. We adhere to all state and federal laws governing privacy and confidentiality including HIPAA regulations. Quarterly utilization reports are prepared that summarize the services provided. The statistics contain necessary demographics for monitoring program activity, without compromising the identities of the clients. To maintain important ongoing awareness and usage of our services, we provide promotional materials. Among the materials we provide are brochures, posters, wallet cards, and electronic newsletters.

We teach managers the best methods for spotting difficulties, approaching employees, and encouraging them to get help. Our counselors are always available to coach supervisors in dealing with troubled employees. Supervisor training is available on our website or for a company’s Intranet. This Intranet training module maximizes learning and allows managers to learn at their own pace. To familiarize employees with our services, we provide orientations on our website as well as via webinars and onsite programs.

Ǧ Our work-life services provide comprehensive resources for supporting the needs of families and dependent caregivers, healthy lifestyles at home and work, and one's physical health. Our web-based work-life services contain a full collection of informational tools and resources that support all lifecycle and daily living categories. legal and financial services are available online, telephonically, and face-to-face. For additional information, please contact: MYgroup 5925 Carnegie Blvd. Suite 350 Charlotte, NC 28209 800.633.3353 mygroup.com

mygroup.com | 800.633.3353 | 5925 Carnegie Blvd. Charlotte NC 28209

49


Click on the video below to learn more about Cancer Benefits!

CANCER BENEFITS


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).

n 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.

n Employer-optional cancer wellness/health screening benefits available: n

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. 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. n 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).

n Benefits don’t coordinate with any other coverage from any other insurer. n HSA compliant. n 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. 51

INDIVIDUAL CANCER INSURANCE


Cancer Assist Benefits Overview

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

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.

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

n 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 52 INDIVIDUAL CANCER INSURANCE


Cancer Insurance Wellness Benefits

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

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

■ Serum cholesterol test for HDL

and LDL levels

■ Colonoscopy ■ Flexible sigmoidoscopy

■ Stress test on a bicycle or treadmill

■ Hemoccult stool analysis ■ Mammography ■ Pap smear ■ PSA [blood test for prostate cancer] ■ Serum protein electrophoresis

[blood test for myeloma]

■ Skin biopsy ■ Thermography ■ ThinPrep pap test ■ Virtual colonoscopy

For more information, talk with your benefits counselor.

©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

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).

53

CANCER ASSIST WELLNESS – 101486


Individual Cancer Insurance Description of Benefits 7KH SROLF\ DQG LWV ULGHUV PD\ KDYH DGGLWLRQDO H[FOXVLRQV DQG OLPLWDWLRQV )RU FRVW DQG FRPSOHWH GHWDLOV RI WKH FRYHUDJH VHH \RXU &RORQLDO /LIH EHQHILWV FRXQVHORU &RYHUDJH PD\ YDU\ E\ VWDWH DQG PD\ QRW EH DYDLODEOH LQ DOO VWDWHV &RYHUDJH LV GHSHQGHQW RQ DQVZHUV WR KHDOWK TXHVWLRQV $SSOLFDEOH WR SROLF\ IRUPV &DQ$VVLVW 1& DQG ULGHU IRUPV 5 &DQ$VVLVW,QG[ 1& 5 &DQ$VVLVW3URJ 1& DQG 5 &DQ$VVLVW6S'LV 1& Cancer Insurance Benefits $LU $PEXODQFH SHU WULS Maximum trips per confinement $PEXODQFH SHU WULS Maximum trips per confinement $QHVWKHVLD *HQHUDO $QHVWKHVLD /RFDO SHU SURFHGXUH $QWL 1DXVHD 0HGLFDWLRQ SHU GD\ Maximum per month %ORRG 3ODVPD 3ODWHOHWV ,PPXQRJOREXOLQV SHU GD\ Maximum per year %RQH 0DUURZ RU 3HULSKHUDO 6WHP &HOO 'RQDWLRQ SHU OLIHWLPH %RQH 0DUURZ RU 3HULSKHUDO 6WHP &HOO 7UDQVSODQW SHU WUDQVSODQW Maximum transplants per lifetime &RPSDQLRQ 7UDQVSRUWDWLRQ SHU PLOH Maximum per round trip (JJ V ([WUDFWLRQ RU +DUYHVWLQJ RU 6SHUP &ROOHFWLRQ SHU OLIHWLPH (JJ V RU 6SHUP 6WRUDJH SHU OLIHWLPH ([SHULPHQWDO 7UHDWPHQW SHU GD\ Maximum per lifetime )DPLO\ &DUH SHU GD\ Maximum per year +DLU ([WHUQDO %UHDVW 9RLFH %R[ 3URVWKHVLV SHU \HDU +RPH +HDOWK &DUH 6HUYLFHV SHU GD\ Maximum per year +RVSLFH ,QLWLDO SHU OLIHWLPH +RVSLFH 'DLO\ Maximum combined Initial and Daily per lifetime +RVSLWDO &RQILQHPHQW GD\V RU OHVV SHU GD\ +RVSLWDO &RQILQHPHQW GD\V RU PRUH SHU GD\ /RGJLQJ SHU GD\ Maximum days per year 0HGLFDO ,PDJLQJ 6WXGLHV SHU VWXG\ Maximum per year 2XWSDWLHQW 6XUJLFDO &HQWHU SHU GD\ Maximum per year 3ULYDWH )XOO WLPH 1XUVLQJ 6HUYLFHV SHU GD\ 3URVWKHWLF 'HYLFH $UWLILFLDO /LPE SHU GHYLFH RU OLPE Maximum per lifetime

54

Level 1 Level 2 Level 3 Level 4 2 2 2 2 2 2 2 2 RI 6XUJLFDO 3URFHGXUHV %HQHILW $100 $160 $200 $240 $10,000 $10,000 $10,000 $10,000 2 2 2 2 $1,000 $1,000 $1,200 $1,500 $10,000 $12,500 $15,000 $15,000 $1,500 $2,000 $2,500 $3,000 30 days or twice the days confined $15,000 $15,000 $15,000 $15,000 70 70 70 70 $150 $250 $350 $450 $300 $600 $900 $1,200 $2,000 $3,000 $4,000 $6,000


Individual Cancer Insurance Description of Benefits 7KH SROLF\ DQG LWV ULGHUV PD\ KDYH DGGLWLRQDO H[FOXVLRQV DQG OLPLWDWLRQV )RU FRVW DQG FRPSOHWH GHWDLOV RI WKH FRYHUDJH VHH \RXU &RORQLDO /LIH EHQHILWV FRXQVHORU &RYHUDJH PD\ YDU\ E\ VWDWH DQG PD\ QRW EH DYDLODEOH LQ DOO VWDWHV &RYHUDJH LV GHSHQGHQW RQ DQVZHUV WR KHDOWK TXHVWLRQV $SSOLFDEOH WR SROLF\ IRUPV &DQ$VVLVW 1& DQG ULGHU IRUPV 5 &DQ$VVLVW,QG[ 1& 5 &DQ$VVLVW3URJ 1& DQG 5 &DQ$VVLVW6S'LV 1& Cancer Insurance Benefits Level 1 Level 2 Level 3 Level 4 5DGLDWLRQ &KHPRWKHUDS\ ,QMHFWHG FKHPRWKHUDS\ E\ PHGLFDO SHUVRQQHO SHU ZHHN 5DGLDWLRQ GHOLYHUHG E\ PHGLFDO SHUVRQQHO SHU ZHHN 6HOI ,QMHFWHG &KHPRWKHUDS\ SHU PRQWK 3XPS &KHPRWKHUDS\ SHU PRQWK 7RSLFDO &KHPRWKHUDS\ SHU PRQWK 2UDO +RUPRQDO &KHPRWKHUDS\ PRQWKV SHU PRQWK 2UDO +RUPRQDO &KHPRWKHUDS\ PRQWKV SHU PRQWK 2UDO 1RQ +RUPRQDO &KHPRWKHUDS\ SHU PRQWK 5HFRQVWUXFWLYH 6XUJHU\ SHU VXUJLFDO XQLW Maximum per procedure, including 25% for general $2,500 $2,500 $3,000 $3,000 6HFRQG 0HGLFDO 2SLQLRQ SHU OLIHWLPH 6NLOOHG 1XUVLQJ &DUH )DFLOLW\ SHU GD\ XS WR GD\V FRQILQHG 6NLQ &DQFHU ,QLWLDO 'LDJQRVLV SHU OLIHWLPH 6XSSRUWLYH 3URWHFWLYH &DUH 'UXJV &RORQ\ 6WLPXODWLQJ )DFWRUV SHU Maximum per year $400 $800 $1,200 $1,600 6XUJLFDO 3URFHGXUHV SHU VXUJLFDO XQLW Maximum per procedure $2,500 $3,000 $5,000 $6,000 7UDQVSRUWDWLRQ SHU PLOH Maximum per round trip $1,000 $1,000 $1,200 $1,500 :DLYHU RI 3UHPLXP <HV <HV <HV <HV Policy-Wellness Benefits %RQH 0DUURZ 'RQRU 6FUHHQLQJ SHU OLIHWLPH &DQFHU 9DFFLQH SHU OLIHWLPH 2QH DPRXQW SHU DFFRXQW RU 3DUW &DQFHU :HOOQHVV +HDOWK 6FUHHQLQJ SHU \HDU 3DUW &DQFHU :HOOQHVV +HDOWK 6FUHHQLQJ SHU \HDU 6DPH DV 3DUW Additional Riders may be available at an additional cost :$,7,1* 3(5,2' 7KH SROLF\ DQG LWV ULGHUV PD\ KDYH D ZDLWLQJ SHULRG :DLWLQJ SHULRG PHDQV WKH ILUVW GD\V IROORZLQJ WKH SROLF\¶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Ŷ ,I WKH GLDJQRVLV RU WUHDWPHQW RI FDQFHU LV UHFHLYHG RXWVLGH RI WKH WHUULWRULDO OLPLWV RI WKH 8QLWHG 6WDWHV DQG LWV SRVVHVVLRQV RU Ŷ )RU RWKHU FRQGLWLRQV RU GLVHDVHV H[FHSW ORVVHV GXH GLUHFWO\ IURP FDQFHU &RORQLDO /LIH $FFLGHQW ,QVXUDQFH &RPSDQ\ &ROXPELD 6& _ &RORQLDO /LIH LQVXUDQFH SURGXFWV DUH XQGHUZULWWHQ E\ &RORQLDO /LIH $FFLGHQW ,QVXUDQFH &RPSDQ\ IRU ZKLFK &RORQLDO /LIH LV WKH PDUNHWLQJ EUDQG 55


CANCER BENEFIT PREMIUMS LEVEL 1 - Composite Rates Employee

Employee/Spouse

One-Parent Family

Two-Parent Family

$9.13

$14.38

One-Parent Family

Two-Parent Family

$10.98

$17.08

One-Parent Family

Two-Parent Family

$13.55

$22.43

One-Parent Family

Two-Parent Family

$18.10

$30.00

One-Parent Family

Two-Parent Family

$0.88

$0.63

$0.88

$1.25

$0.80

$1.30

$3.90

$8.53

Level 1 with $100 Cancer Wellness/Health Screening 24-Pay Premium

$9.05

$14.30 LEVEL 2 - Composite Rates

Employee

Employee/Spouse

Level 2 with $100 Cancer Wellness/Health Screening 24-Pay Premium

$10.83

$16.93 LEVEL 3 - Composite Rates

Employee

Employee/Spouse

Level 3 with $100 Cancer Wellness/Health Screening 24-Pay Premium

$13.33

$22.20 LEVEL 4 - Composite Rates

Employee

Employee/Spouse

Level 4 with $100 Cancer Wellness/Health Screening 24-Pay Premium

$17.80

$29.70 OPTIONAL RIDERS

Employee

Employee/Spouse

Specified Disease Hospital Confinement Rider 24-Pay Premium

$0.63

Initial Diagnosis of Cancer Rider (per $1,000) 24-Pay Premium

$0.75

Initial Diagnosis of Cancer Progressive Payment Rider 24-Pay Premium

$3.90

$8.53

Sample rates only. Multiple choices and options available and rates may vary.

56


Click on the video below to learn more about Critical Illness Benefits!

CRITICAL ILLNESS BENEFITS


Critical Illness Insurance*

When life takes an unexpected turn due to a critical illness diagnosis, your focus should be on recovery — not finances. Our critical illness insurance helps provide financial support with a lump-sum benefit that you can use where you need it the most. Coverage amount: ____________________________

COVERED CRITICAL ILLNESS CONDITIONS

1

BENEFITS STORY

Sudden health crisis Chris was mowing the lawn when he suffered a stroke. His recovery will be challenging, and he’s worried since his family relies on his income.

How Chris’ coverage helped

PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

Coma

100%

End stage renal (kidney) failure

100%

Heart attack (myocardial infarction)

100%

Major organ failure requiring transplant

100%

Occupational human immunodeficiency virus (HIV) or hepatitis

100%

Permanent paralysis

100%

Stroke2

100%

Sudden cardiac arrest

100%

Coronary artery disease (major)

50%

Coronary artery disease (minor)

10%

Transient ischemic attack (TIA)

25%

58

The lump-sum payment from his critical illness insurance helped pay for: Co-payments and hospital bills not covered by his medical insurance Physical therapy to get back to doing what he loves Household expenses while he was unable to work For illustrative purposes only.

ICI6000 - CRITICAL ILLNESS


Reoccurrence of the same covered critical illness condition Key benefits

If you receive a benefit for the diagnosis of a critical illness and are later diagnosed with the same condition,3 25% of the coverage amount may be payable for that reoccurrence. Dates of diagnoses must be separated by more than 180 days.

• Available coverage for spouse and eligible dependents at 50% of your coverage amount 4

• Receive coverage regardless of medical history, within specified limits

Diagnosis of a different covered critical illness condition

• Works alongside your health savings account (HSA)

If you receive a benefit for the diagnosis of a critical illness and are later diagnosed with a different condition, 100% of the coverage amount may be payable for the subsequent condition. Dates of diagnoses must be separated by more than 180 days.

• Benefits payable regardless of other insurance

For more information about critical illness coverage, talk with your benefits counselor.

59


Covered conditions for dependent children 1

COVERED CONDITIONS

Behavioral health therapy benefit When recovering from a critical illness diagnosis, mental wellbeing can be as important as physical wellbeing. A benefit may be payable each day you receive behavioral health therapy for a covered loss.

PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

Cerebral palsy

100%

Cleft lip or palate

100%

Congenital heart disease

100%

Cystic fibrosis

100%

Down syndrome

100%

Sickle cell anemia

100%

Spina bifida

100%

Type 1 diabetes

100%

• $50 payable up to a maximum of 15 days per insured per covered loss (up to two times per insured per calendar year). • Therapy must begin within 90 days after the covered loss, and all sessions must be received within 365 days of the covered loss.

An insured has a pre-existing condition if, within the 12 months just prior to the insured’s coverage effective date, they have an injury or sickness, whether diagnosed or not, for which:

* Critical Illness Insurance (ICI6000) is the marketing name of the insurance policy filed as “Individual Critical Illness Insurance Policy.” 1 Please refer to the policy for complete definitions of covered conditions.

• medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; or

2 In NH, the covered condition is called Severe Stroke. 3 Covered conditions that do not qualify include permanent paralysis, occupational human immunodeficiency virus (HIV) or hepatitis.

• drugs or medications were taken, or prescribed to be taken during that period; or

4 In LA and VA, includes domestic partner.

• symptoms existed. Pre-existing condition requirements are not applicable to children who are born or adopted while you are covered under this policy, and who are continuously covered from the date of birth or adoption.

THIS POLICY PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.

The pre-existing condition provision applies to any insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date initial coverage becomes effective.

EXCLUSIONS AND LIMITATIONS

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. Applicable to policy form ICI6000 (including state abbreviations where used, for example: ICI6000-AL). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.

We will not pay benefits for any covered loss that is caused by, contributed to by, or occurs as a result of felonies; intoxicants and narcotics; or war or combat. PRE-EXISTING CONDITION LIMITATION We will not pay benefits for a claim when the covered condition occurs in the first 12 months following an insured’s coverage effective date if the covered condition is caused by, contributed to by, or occurs as a result of any of the following: • a pre-existing condition; or • complications arising from treatment or surgery for, or medications taken for, a pre-existing condition.

60


Critical Illness and Cancer Insurance*

When life takes an unexpected turn due to a critical illness or cancer diagnosis, your focus should be on recovery — not finances. Our critical illness and cancer insurance helps provide financial support with a lump-sum benefit that you can use where you need it the most.

BENEFITS STORY

Support for care

Coma

100%

Rebecca was born with Down syndrome. Her parents’ critical illness and cancer coverage provided a benefit that can help cover expenses related to Rebecca’s care and her changing needs.

End stage renal (kidney) failure

100%

How their coverage helped

Heart attack (myocardial infarction)

100%

Major organ failure requiring transplant

100%

Occupational human immunodeficiency virus (HIV) or hepatitis

100%

Permanent paralysis

100%

Stroke

100%

Coverage amount: ____________________________ COVERED CRITICAL ILLNESS CONDITIONS

2

1

PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

Sudden cardiac arrest

100%

Coronary artery disease (major)

50%

Coronary artery disease (minor)

10%

Transient ischemic attack (TIA)

25%

COVERED CANCER CONDITIONS

1

PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

Invasive cancer (including all breast cancer)

100%

Non-invasive cancer

25%

A hospital stay and treatment for corrective heart surgery Physical therapy to build muscle strength Daycare program

For illustrative purposes only.

Skin cancer initial diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500 per lifetime

61

ICI6000 - CRITICAL ILLNESS AND CANCER


Reoccurrence of the same covered critical illness condition If you receive a benefit for the diagnosis of a critical illness and are later diagnosed with the same condition,3 25% of the coverage amount may be payable for that reoccurrence. Dates of diagnoses must be separated by more than 180 days.

Key benefits • Available coverage for spouse5 and eligible dependents at 50% of your coverage amount • Receive coverage regardless of medical history, within specified limits • Works alongside your health savings account (HSA) • Benefits payable regardless of other insurance

Diagnosis of a different covered condition If you receive a benefit for the diagnosis of a covered condition and are later diagnosed with a different condition, 100% of the coverage amount may be payable for the subsequent condition. Dates of diagnoses must be separated by more than 180 days.4

Reoccurrence of invasive cancer (including all breast cancer) If you receive a benefit for the diagnosis of an invasive cancer, an additional benefit of 25% may be payable upon reoccurrence if: • the new date of diagnosis is more than 180 days after the first diagnosis, and • there is no evidence of disease or treatment for at least 180 days immediately prior to the subsequent diagnosis.

Reoccurrence of non-invasive cancer If you receive a benefit for the diagnosis of a non-invasive cancer, an additional benefit of 25% may be payable upon reoccurrence if: • the new date of diagnosis is more than 180 days after the first diagnosis, and • there is no evidence of disease or treatment for at least 180 days immediately prior to the subsequent diagnosis.

62


Covered conditions for dependent children COVERED CONDITIONS 1

PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

Cerebral palsy

100%

Cleft lip or palate

100%

Congenital heart disease

100%

Cystic fibrosis

100%

Down syndrome

100%

Sickle cell anemia

100%

Spina bifida

100%

Type 1 diabetes

100%

For more information, talk with your benefits counselor.

Behavioral health therapy benefit When recovering from a critical illness or cancer diagnosis, mental wellbeing can be as important as physical wellbeing. A benefit may be payable each day you receive behavioral health therapy for a covered loss. • $50 payable up to a maximum of 15 days per insured per covered loss (up to two times per insured per calendar year). • Therapy must begin within 90 days after the covered loss, and all sessions must be received within 365 days of the covered loss.

PRE-EXISTING CONDITION LIMITATION

*Critical Illness Insurance (ICI6000) is the marketing name of the insurance policy filed as “Individual Critical Illness Insurance Policy.”

We will not pay benefits for a claim when the covered condition occurs in the first 12 months following an insured’s coverage effective date if the covered condition is caused by, contributed to by, or occurs as a result of any of the following:

1 Please refer to the policy for complete definitions of covered conditions. 2 In NH, the covered condition is called Severe Stroke.

• a pre-existing condition; or

3 Covered conditions that do not qualify include permanent paralysis, occupational human immunodeficiency virus (HIV) or hepatitis. In addition, in GA, end stage renal (kidney) failure does not qualify.

• complications arising from treatment or surgery for, or medications taken for, a pre-existing condition. An insured has a pre-existing condition if, within the 12 months just prior to the insured’s coverage effective date, they have an injury or sickness, whether diagnosed or not, for which:

4 There is no required separation period between the date of diagnosis of invasive cancer (including all breast cancer), non-invasive cancer or skin cancer and any of the critical illnesses.

• medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; or

5 In LA and VA, includes domestic partner. THIS POLICY PROVIDES LIMITED BENEFITS.

• drugs or medications were taken, or prescribed to be taken during that period; or

This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.

• symptoms existed. Pre-existing condition requirements are not applicable to children who are born or adopted while you are covered under this policy, and who are continuously covered from the date of birth or adoption.

EXCLUSIONS AND LIMITATIONS We will not pay benefits for any covered loss that is caused by, contributed to by, or occurs as a result of felonies; intoxicants and narcotics; or war or combat.

The pre-existing condition provision applies to any insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date initial coverage becomes effective.

GEOGRAPHICAL LIMITATION FOR CANCER

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. Applicable to policy form ICI6000 (including state abbreviations where used, for example: ICI6000-AL). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.

We will not pay the invasive cancer (including all breast cancer) benefit, non-invasive cancer benefit, or skin cancer benefit if the cancer is diagnosed or treated outside of the territorial limits of the United States, its possessions, or the countries of Canada and Mexico.

63


Critical Illness Insurance* Infectious Diseases Rider

The sudden onset of an infectious or contagious disease can create unexpected circumstances for you or your family. The infectious diseases rider provides a lump sum that can be used toward health care expenses or meeting day-to-day needs. Payable for each covered infectious disease, once per covered person per lifetime, if hospital confined for seven or more consecutive days for treatment of the infectious disease. These benefits are for you as well as your covered family members. PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

COVERED INFECTIOUS DISEASES** Antibiotic-resistant bacteria (including MRSA)

50%

Cerebrospinal meningitis (bacterial)

50%

Diphtheria

50%

Encephalitis

50%

Legionnaires’ disease

50%

Lyme disease

50%

Malaria

50%

Necrotizing fasciitis

50%

Osteomyelitis

50%

Poliomyelitis

50%

Rabies

50%

Sepsis

50%

Tetanus

50%

Tuberculosis

50%

Coronavirus disease 2019 (COVID-19)

50%

64

ICI6000 – INFECTIOUS DISEASES RIDER


Critical Illness Insurance* Progressive Diseases Rider

The debilitating effects of a progressive disease not only impact you physically, but financially as well. Changes in lifestyle may require home modification, additional medical treatment and other expenses. Payable for each covered progressive disease if the covered person is unable to perform two or more activities of daily living1 or totally disabled2 for 90 or more continuous days. This benefit is for you as well as your covered family members. COVERED PROGRESSIVE DISEASES3

PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

Amyotrophic lateral sclerosis (ALS)

50%

Addison’s disease

50%

Dementia (including Alzheimer’s disease)

50%

Functional loss4

50%

Huntington’s disease

50%

Lupus

50%

Multiple sclerosis (MS)

50%

Muscular dystrophy

50%

Myasthenia gravis (MG)

50%

Parkinson’s disease

50%

Systemic sclerosis (scleroderma)

50%

65

ICI6000 - PROGRESSIVE DISEASES RIDER


Critical Illness Insurance* Supplemental Conditions Rider

A critical illness can have life-altering effects that not only impact you physically, but financially as well. This rider provides a lump-sum benefit if you are diagnosed with a covered supplemental condition, so you can focus on your treatment, care and recovery. We will pay a benefit for each condition only once per covered person per lifetime. This benefit is for you as well as your covered family members. PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

COVERED SUPPLEMENTAL CONDITIONS** Aggressive Crohn’s disease or severe ulcerative colitis

25%

Benign brain tumor

100%

Loss of hearing

100%

Loss of sight

100%

Loss of speech

100%

Pulmonary embolism

25%

Severe endometriosis

25%

66

ICI6000 - SUPPLEMENTAL CONDITIONS RIDER


Critical Illness Insurance* Wellbeing Assistance Benefit – Max

This benefit can help reduce the risk of serious illness through early detection of disease or other risk factors, giving you more protection from the unexpected. The wellbeing assistance benefit is available to you with critical illness coverage, as well as all your covered family members. Wellbeing assistance benefit . . . . . . . . . . . . . . . . . . . .$ ____________________ Payable once per covered person per calendar year • Annual physical (e.g., annual exams, sports physicals and well child visits) • Blood test for triglycerides • Bone marrow testing • BRCA1 or BRCA2 testing • Breast ultrasound • CA 15-3 (blood test for breast cancer) • CA 125 (blood test for ovarian cancer) • Carotid Doppler • CEA (blood test for colon cancer) • Chest X-ray • Colonoscopy • Echocardiogram (ECHO) • Electrocardiogram (EKG, ECG)

• Fasting blood glucose test • Flexible sigmoidoscopy • Hemoccult stool analysis • Immunizations • Mammography • Pap smear • PSA (blood test for prostate cancer)

To learn more, talk with your Colonial Life benefits counselor.

• Serum cholesterol test for HDL and LDL levels • Serum protein electrophoresis (blood test for myeloma) • Skin cancer biopsy • Stress test on a bicycle or treadmill • Thermography • ThinPrep pap test • Virtual colonoscopy

67

ICI6000 – WELLBEING ASSISTANCE BENEFIT - MAX


CRITICAL ILLNESS BENEFIT PREMIUMS Plan 1- Critical Illness Benefits Rates illustrated per unit. Named Insured unit value = $1000

Issue Age

Deduction

Named Insured

Employee & Spouse

One-Parent Family

Two Parent Family

Non-Tobacco 17-24

24-Pay Premium

$0.11

$0.17

$0.11

$0.17

25-29

24-Pay Premium

$0.14

$0.22

$0.15

$0.23

30-34

24-Pay Premium

$0.19

$0.28

$0.20

$0.30

35-39

24-Pay Premium

$0.30

$0.45

$0.31

$0.47

40-44

24-Pay Premium

$0.40

$0.60

$0.42

$0.63

45-49

24-Pay Premium

$0.55

$0.83

$0.58

$0.88

50-54

24-Pay Premium

$0.71

$1.06

$0.75

$1.12

55-59

24-Pay Premium

$0.91

$1.40

$0.95

$1.47

60-64

24-Pay Premium

$1.16

$1.80

$1.22

$1.89

65-69

24-Pay Premium

$1.23

$2.02

$1.29

$2.12

70-74

24-Pay Premium

$1.33

$2.15

One-Parent Family $3.33

Two Parent Family $5.11

Welbeing Amount $100

$1.27 $2.05 Wellbeing Assistance Benefit Rates by wellbeing amount = 1 unit Named Employee & Insured Spouse $2.08 $3.20 24-Pay Premium

Sample rates only. Multiple choices and options available and rates may vary.

68


CRITICAL ILLNESS BENEFIT PREMIUMS Plan 2- Critical Illness & Cancer Benefits Rates illustrated per unit. Named Insured unit value = $1000

Issue Age

Deduction

Named Insured

Employee & Spouse

One-Parent Family

Two Parent Family

Non-Tobacco 17-24

24-Pay Premium

$0.13

$0.20

$0.14

$0.22

25-29

24-Pay Premium

$0.19

$0.29

$0.20

$0.30

30-34

24-Pay Premium

$0.30

$0.47

$0.32

$0.49

35-39

24-Pay Premium

$0.51

$0.78

$0.54

$0.82

40-44

24-Pay Premium

$0.70

$1.07

$0.73

$1.12

45-49

24-Pay Premium

$0.88

$1.34

$0.92

$1.41

50-54

24-Pay Premium

$1.07

$1.62

$1.13

$1.70

55-59

24-Pay Premium

$1.30

$2.00

$1.37

$2.10

60-64

24-Pay Premium

$1.82

$2.81

$1.93

$2.95

65-69

24-Pay Premium

$1.94

$3.11

$2.05

$3.26

70-74

24-Pay Premium

$2.09

$3.30

One-Parent Family $3.33

Two Parent Family $5.11

Welbeing Amount $100

$1.98 $3.14 Wellbeing Assistance Benefit Rates by wellbeing amount = 1 unit Named Employee & Insured Spouse $2.08 $3.20 24-Pay Premium

Sample rates only. Multiple choices and options available and rates may vary.

69


To be eligible for Short-Term Disability benefits you must have at least one year of contributing membership service in the Retirement System earned within the 36 calendar months preceding your disability. To be eligible for Long-Term Disability benefits you must have at least five years of contributing membership service in the Retirement System earned within the 96 calendar months prior to becoming disabled or upon cessation of continuous salary continuation payments, whichever is later.

THE STATE OF NORTH CAROLINA

PROVIDES A DISABILITY INCOME PLAN FOR ITS PERMANENT, FULL-TIME TEACHERS AND STATE EMPLOYEES – AT NO COST TO THE INDIVIDUAL. The State Plan is designed to provide for the continuation of a portion of your salary should you suffer the misfortune of an accident or sickness which disables you for longer than 60 days. HERE’S HOW IT WORKS… 1.

WHEN YOU ARE DISABLED: Percentage of Your Total Monthly Salary the State Pays You* Maximum Total Benefit Reduced By Not Reduced By

First 12 Months of Disability

Thereafter**

50%

65%

$3,000

$3,900

Workers’ Compensation

Workers’ Compensation Social Security

Social Security

----------------------

* 1/12 of your total pay during the 12 months prior to your disability. ** you must have at least five years of contributing membership service in the Retirement System earned within the 96 calendar months prior to the end of the short-term disability period. 2.

Benefits under the State Plan are payable, for “Disability,” which means that you are mentally or physically incapable of performing the duties of your usual occupation.

3.

You become a member of the plan when you become a full-time, permanent employee of the State, and you are eligible to receive benefits from the Plan if you become disabled after you have completed one year’s service. Your coverage under the Plan ends when your employment with the State terminates.

4.

Benefits of the Plan are payable beginning 60 DAYS AFTER THE DATE OF YOUR DISABILITY (60day waiting period).

5.

The Plan coordinates with other benefits related to your employment, so that after the amounts you are eligible to receive from Social Security (for the first six months only), Workers’ Compensation, or State retirement plans, etc., the State pays you enough, in addition, to total a) 50% the first twelve months and b) 65% thereafter of your total salary, as explained in the chart above. HOWEVER, ANY BENEFIT FROM A PLAN FOR WHICH YOU PAY THE ENTIRE COST YOURSELF DOES NOT AFFECT THE STATE PLAN IN ANY WAY. BENEFITS ARE SUBJECT TO NC STATE LAW

This information provided by Colonial Life Columbia, South Carolina 29202 www.coloniallife.com

70


Click on the video below to learn more about Disability Benefits!

DISABILITY BENEFITS


Educator Disability Advantage Short-Term Disability Educator Disability Advantage insurance1 from Colonial Life is designed to provide financial protection for all education workers with plans that can help supplement and/or complement the Disability Income Plan of North Carolina. Educator Disability Advantage insurance provides flexible options for disability coverage and accidental injury benefits to help protect your income and maintain lifestyle needs if you become disabled due to a covered accident or sickness.

My Disability Coverage Worksheet (For use with your Colonial Life benefits counselor)

Employee Coverage (includes both on- and off-job benefits) How much coverage do I need? • Total Disability On-Job Accident/Sickness First three months $_____________/month Next nine months $_____________/month

Off-Job Accident/Sickness $_____________/month $_____________/month

• Partial Disability Up to three months $____________/month

$_____________/month

When will my benefits start? After an accident: ___________ days

After a sickness: ___________ days

What additional features or benefits are included?

How long could you afford to go without a paycheck? Monthly Expenses: Mortgage/rent

$_____________

Groceries

$_____________

Car

$_____________

Medical bills

$_____________

Utilities

$_____________

Other

$_____________

TOTAL

$_____________

• Normal pregnancy is covered the same as any other covered sickness. • Waiver of Premium: We will waive your premium payments after 90 consecutive days of a covered disability. • Goodwill Child Benefit: $1,000, up to two benefits per year for adoption or ward of a guardian • Mental or Nervous Disorders Benefit How much will it cost? Your cost will vary based on the level of coverage you select. 72

EDUCATOR DISABILITY ADVANTAGE (EDA1100) – MENTAL & NERVOUS


Additional Employee Coverage In addition to disability coverage, this plan also provides employees with benefits related to accidental injuries, their treatment and more. Even if you’re not disabled, the following benefits are payable for covered accidental injuries or sickness: ACCIDENTAL INJURIES BENEFITS • Accident emergency treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $400 • X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150 • Accident follow-up treatment (including transportation)/Telemedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$75 (up to six benefits per accident per person, up to twelve a year per person)

Disability benefits and more Anita teaches at a local community college and enjoys spending time on active hobbies and volunteering with nonprofits. When she was injured in a mountain biking accident, she worried that she might not be able to make ends meet for a while. How Anita’s coverage helped* With her coverage, she received benefits for: • Accident emergency treatment . . . . . . . . .$400 • X-ray . . . . . . . . . . . . . . $150 • Collarbone fracture requiring surgery . . $1,200 • Elbow dislocation (nonsurgical) . . . . . . .$400 • Hospital stay of three nights . . . . . $150

HOSPITAL CONFINEMENT BENEFIT FOR ACCIDENT OR SICKNESS Pays in addition to disability benefit. Benefits begin on the first day of confinement in a hospital. Up to three months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500/month ($50/day) The Hospital Confinement benefit increases to $7,500/month when the Total Disability benefit ends at age 70. ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS • Accidental death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$25,000 • Loss of a finger or toe Single dismemberment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$750 Double dismemberment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 • Loss of a hand, foot or sight of an eye Single dismemberment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$5,000 Dismemberment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $10,000 • Common carrier death (includes school bus for school activities) . . . . . . . . .$50,000 COMPLETE FRACTURES

Nonsurgical

Surgical

• Hip, thigh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 . . . . . . . . . .$3,000 • Vertebrae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,350 . . . . . . . . . . $2,700 • Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,200 . . . . . . . . . .$2,400 • Skull (depressed) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 . . . . . . . . . .$3,000 • Leg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $900 . . . . . . . . . . $1,800 • Foot, ankle, kneecap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$750 . . . . . . . . . . $1,500 • Forearm, hand, wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$750 . . . . . . . . . . $1,500 • Lower jaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $600 . . . . . . . . . . $1,200 • Shoulder blade, collarbone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $600 . . . . . . . . . . $1,200

• Short-term disability benefits . . . . . . . . . . $1,400

• Skull (simple) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$525 . . . . . . . . . . $1,050

Total amount: . . . . . $3,700

• Facial bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $450 . . . . . . . . . . . $900

*For illustrative purposes only. Coverage amounts may vary based on injury, treatment, income and more.

• Upper arm, upper jaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $525 . . . . . . . . . . $1,050

• Vertebral processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 . . . . . . . . . . . $600 • Rib . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 . . . . . . . . . . . $600 • Finger, toe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $175 . . . . . . . . . . . $350 • Coccyx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $125 . . . . . . . . . . . $250

73


COMPLETE DISLOCATIONS

Nonsurgical

Surgical

• Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 . . . . . . . . . .$3,000 • Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$975 . . . . . . . . . . $1,950 • Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$750 . . . . . . . . . . $1,500 • Collarbone (sternoclavicular) . . . . . . . . . . . . . . . . . . . . . . . . . . . .$750 . . . . . . . . . . $1,500 • Ankle, foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$750 . . . . . . . . . . $1,500 • Collarbone (acromioclavicular and separation) . . . . . . . . . . . .$675 . . . . . . . . . . $1,350 • Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$525 . . . . . . . . . . $1,050 • Lower jaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $450 . . . . . . . . . . . $900 • Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $400 . . . . . . . . . . . $800 • Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $400 . . . . . . . . . . . $800 • One finger, toe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $125 . . . . . . . . . . . $250 • For a chip fracture, your benefit would be 25% of the amount shown. Chip fractures are those in which a fragment of bone is broken off near a joint at a point where a ligament is attached. • For multiple fractures or dislocations, we will pay for both, up to two times the highest amount. • For your first dislocation, you would receive the amount shown; however, recurrent dislocations of the same joint are not covered.

Optional Spouse and Dependent Child(ren) Coverage You may cover one or all of the eligible dependent members of your family for an additional premium. Eligible dependents include your spouse and ALL dependent children who are younger than age 26. ACCIDENTAL INJURIES BENEFITS • Accident emergency treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $400 • X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150 • Accident follow-up treatment (including transportation)/Telemedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$75 (up to six benefits per accident per person, up to twelve a year per person) HOSPITAL CONFINEMENT BENEFIT FOR ACCIDENT OR SICKNESS Up to three months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500/month ($50/day) ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS • Accidental death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$5,000 • Loss of a finger or toe Single dismemberment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$75 Double dismemberment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150 • Loss of a hand, foot or sight of an eye Single dismemberment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500 Double dismemberment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,000 • Common carrier death (includes school bus for school activities) . . . . . . . . . $10,000

74

More than 1 in 4 of 20-year-olds become disabled before retirement age.2


Frequently Asked Questions When do disability benefits end?

Will my disability income payment be reduced if I have other insurance?

The Total Disability Benefit will end on the policy anniversary date on or next following your 70th birthday, or when you are no longer considered disabled as defined in the policy, whichever comes first.

Benefits are payable regardless of workers’ compensation or any other insurance you may have with other insurance companies. Benefits are payable directly to you (unless you specify otherwise). When am I considered totally disabled?

The Hospital Confinement benefit increases when the Total Disability Benefit ends.

Totally disabled means you are:

Can I keep my coverage if I change jobs?

• Unable to perform the material and substantial duties of your occupation;

If you change jobs or retire, you can take your coverage with you at no additional cost. Your coverage is guaranteed renewable for life as long as you pay your premiums when they are due or within the grace period.

• Not, in fact, working at any occupation; and • Under the regular and appropriate care of a doctor.

How do I file a claim?

What if I want to return to work part time after I am totally disabled?

Visit ColonialLife.com or call our Policyholder Service Center at 1-800-325-4368 for additional information.

You may be able to return to work part time and still receive benefits. We call this “Partial Disability.” This means you may be eligible for coverage if:

What is a pre-existing condition? A pre-existing condition means a sickness or physical condition for which any covered person was treated, received medical advice, or had taken medication within twelve months before the effective date of the policy. If you are age 65 or older when the policy is issued, pre-existing conditions include only conditions specifically excluded from coverage by the rider.

• You are unable to perform the material and substantial duties of your job for more than half of your normally weekly scheduled hours; • You are able to work at your job or your place of employment for less than half of your normally weekly scheduled hours; • Your employer will allow you to return to your job or place of employment for less than half of your normally weekly scheduled hours; and

If you become disabled due to a pre-existing condition, we will not pay for any disability period if it begins during the first twelve months the policy is in force.

• You are under the regular and appropriate care of a doctor.

What is the Mental or Nervous Disorder benefit? This benefit provides coverage for a disability due to a mental or nervous condition. Coverage provides a benefit up to three months per occurrence, with a cumulative lifetime maximum benefit of 24 months.

The total disability benefit must have been paid for at least fourteen days immediately prior to your being partially disabled.

For more information, talk with your Colonial Life benefits counselor.

1. Educator Disability Advantage is the marketing name of the insurance product filed as “Disability Income Insurance Policy.” 2. U.S. Social Security Administration, The Faces and Facts of Disability. https://www.ssa.gov/disabilityfacts/facts.html. Accessed April 2021. EXCLUSIONS AND LIMITATIONS We will not pay benefits for losses that are caused by or are the result of: Cosmetic Surgery, Felonies and Illegal Occupations, Flying, Hazardous Avocations, Intoxicants and Narcotics, Racing, Semiprofessional or Professional Sports, Substance Abuse, Suicide or Self-Inflicted Injuries, and War or Armed Conflict. 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. Applicable to policy form NCK1100. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ColonialLife.com

© 2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 8-22 | 1006400-1

75


Æ$! ÿ Çÿ #& ÿ ÿ È&" &+&% ÿÉ ")$ !

ÿ ÿ !"ÿ!#!$ % & ÿ'ÿ!#! ÿ ()$ÿ*& & +ÿ"&%) %&( ,ÿ

-6 9 66 ÿ67 297 5ÿ 97ÿ 5.ÿ 1 ÿ.9 ÿ812ÿ5/52 09 ÿ6/671ÿ52.57 5 ÿ970ÿ55.ÿ 1 ÿ 81 50ÿ17ÿ9671ÿ 925ÿ18ÿ 5ÿ75 ÿ9006617ÿ1ÿ 1 2ÿ8946

345ÿ789:;8<8=>ÿ8?9@A:?BCÿB:?ÿDC<E

012ÿ4125ÿ6781249617ÿÿ 9 ÿ 6 ÿ 1 2ÿÿ 57586 ÿ 1 7 512

11769 685 14

Fÿ ÿÿG 5ÿ 9ÿ25 1/52 ÿ.52610ÿ6 ÿ 62ÿ 55 ÿH717I 5 92597ÿ056/52 Jÿ12ÿ561 ÿ 55 ÿH 5 92597ÿ056/52 J ÿ K8ÿ 1 2ÿ 964ÿ6 ÿ9..21/50ÿ 1 2ÿ 57586 ÿ 6ÿ 92ÿ9L52ÿ 1 ÿ 96 8 ÿ 1 2ÿ 564679617ÿ.52610ÿH 96671ÿ.52610J Fÿ ÿM57586 ÿ925ÿ.960ÿ0625 ÿ1ÿ 1 ÿ1ÿ 5ÿ9 ÿ 1 ÿ 55ÿ86 Fÿ ÿN1 2ÿ06 9 66 ÿ 57586 ÿ925ÿ71ÿ9O5 50ÿ ÿ 1 2ÿ54.1 52P ÿ59/5ÿ18ÿ9 57 5ÿ.211294ÿ 5ÿ 0946 ÿQ506 9ÿ 59/5ÿR ÿH0Q RJÿ 1 2ÿ 6 ÿ59/5ÿ12ÿ.960ÿ645ÿ1OS/9 9617ÿ645 Fÿ ÿK8ÿ 1 ÿ 525ÿ71ÿ.251797ÿ 58125ÿ 1 2ÿ 1/52915ÿ5O5 6/5ÿ095ÿ.251797 ÿ 14.6 9617 ÿ ÿ 9 ÿ.25I524ÿ9 12ÿ15 96179ÿ069 55 ÿ970ÿ.25I5 94. 69ÿ925ÿ25950ÿT ÿ65ÿ97 ÿ1 52ÿ 1/5250ÿ 6 75 N1 2ÿ06 9 66 ÿ.16 ÿ49 ÿ 9/5ÿ9ÿ16/671ÿ 62 ÿ6469617 ÿK8ÿ 1ÿ 6 ÿ4597 ÿ 11769ÿ 685ÿ 6ÿ71ÿ.9 ÿ 06 9 66 ÿ 57586 ÿ68ÿ 1 ÿ16/5ÿ 62 ÿ 6 67ÿ 5ÿ862 ÿ7675ÿ417 ÿ9L52ÿ 1 2ÿ 1/52915ÿ5O5 6/5ÿ095 ÿK8ÿ 5ÿ.251797 ÿ6 ÿ 17 605250ÿ9ÿ.25I526 671ÿ 1706617ÿ97 ÿ095 ÿ46 50ÿ8214ÿ 12ÿ0 5ÿ1ÿ.251797 ÿ 056/52 ÿ12ÿ9 1 6950ÿ 14.6 9617 ÿ49 ÿ71ÿ 5ÿ 1/5250 ÿU59 5ÿ25852ÿ1ÿ 1 2ÿ06 9 6 ÿ 95 ÿ 21 25

V?7CA9=:?78?Wÿ>4@AÿC<8X8?:=84?ÿECA847ÿY5:8=8?WÿECA847Z

K8ÿ 1 2ÿ 964ÿ6 ÿ9..21/50ÿ 1 2ÿ 57586 ÿ 6ÿ 92ÿ9L52ÿ 1 ÿ 9/5ÿ 96 8650ÿ 5ÿ564679617ÿ.52610ÿ 6 ÿ6 ÿ 5ÿ.52610ÿ18ÿ645ÿ 9ÿ71ÿ 57586 ÿ925ÿ.9 9 5 ÿN1 2ÿ564679617ÿ.52610ÿ49 ÿ/92 ÿ 9 50ÿ17ÿ 5ÿ.97ÿ 1 ÿ 55 ÿ ²·³³´¯°¯± ¸µ¹º¶³³¶µ»¯

¼³³½ ¿

¼³³½ ¾

¼³³½ À

¼³³½ Á

¼³³½ Â

¼³³½ Ã

²·³³´¸µ¹º¶³³¶µ»¯

¼³³½ ¿

¼³³½ ¾

¼³³½ À

¼³³½ Á

¼³³½ Â

¼³³½ Ã

¼³³½ Ä

¼³³½ Å

Fÿ l]d]`ef]b`ÿkgc]bhÿÿÿÿFÿ g`ga]f^ÿkeseilg

ÿ ÿ ÿ ÿ¡ ¢ ÿ£ ¤ÿ ÿ ÿ ¥¤ ÿ ¢ ÿ ¤ ¦ § ¨§ÿ § ÿ £ ÿ ¡ ¢ ÿ § © ÿ£ ª ÿ £ ÿª ÿª ÿ ÿ ÿ© « ÿ ¬ ÿ § ÿ ¢ ÿ ¤­ÿ § ÿ ® ÿ ¤ ÿ ÿ¢ § ÿ£ ª ÿ ¦¬ ÿ¤ ¤ ® ¨ÿ § ÿ ¢ ÿ ¤ÿ ¤ÿ ¨ÿ ÿª ÿ¢ § ÿ ªÿ¤ £ ­ÿ § ÿ ¢ ¨ÿ¤ ÿ© ÿ£ ÿ ¤ÿ ¨ÿ § ÿ¤ ÿ ÿ

Ê8<8?Wÿ>4@Aÿ789:;8<8=>ÿB<:8X

K8ÿ 525ÿ925ÿ71ÿ 14.6 9617 ÿ 1 ÿ 1 0ÿ865ÿ 1 2ÿ 964ÿ9L52ÿ056/52 ÿ012ÿ 14.6 9617 ÿ 58125ÿ 056/52 ÿ 1 ÿ 1 0ÿ865ÿ 1 2ÿ 964ÿ9 ÿ 117ÿ9 ÿ 5ÿ01 12ÿ6706 95 ÿ 1 ÿ925ÿ 79 5ÿ1ÿ 1767 5ÿ 12671

[\]^ÿ]`abcdef]b`ÿ]^ÿ̀bfÿ]`fg`hghÿfbÿigÿeÿjbdklgfgÿhg^jc]kf]b`ÿbaÿf\gÿ]`^mce`jgÿjbngceogÿene]leilgpÿ[\gÿ]`^mce`jgÿ\e^ÿ gqjlm^]b`^ÿe`hÿl]d]fef]b`^ÿr\]j\ÿdesÿetgjfÿe`sÿig`ga]f^ÿkeseilgpÿubngceogÿfskgÿe`hÿig`ga]f^ÿdesÿnecsÿisÿ^fefgÿe`hÿ desÿ̀bfÿigÿene]leilgÿ]`ÿellÿ^fefg^pÿvbcÿjb^fÿe`hÿjbdklgfgÿhgfe]l^ÿbaÿjbngceogwÿjellÿbcÿrc]fgÿsbmcÿublb`]elÿx]ag ig`ga]f^ÿjbm`^glbcÿbcÿf\gÿjbdke`sp

ykkl]jeilgÿfbÿkbl]jsÿabcd^ÿz{[|}~~~ÿe`hÿc]hgcÿabcdÿz{[|}~~~ y|z ÿ ]`jlmh]`oÿ^fefgÿeiicgn]ef]b`^ÿr\gcgÿm^ghwÿabcÿgqedklg ÿz{[|}~~~ [ ÿ e`hÿz{[|}~~~ y|z [ ÿ pÿykkl]jeilgÿfbÿkbl]jsÿabcdÿ|z{~~~ÿ]`jlmh]`oÿ^fefgÿeiicgn]ef]b`^ÿr\gcgÿm^ghpÿykkl]jeilgÿfbÿ |ÿ|z{p~ÿ]`jlmh]`oÿ ^fefgÿeiicgn]ef]b`^ÿr\gcgÿm^ghpÿykkl]jeilgÿfbÿkbl]jsÿabcdÿzuu |z }~~~ÿe`hÿzuu |z }~~~ |z{pÿykkl]jeilgÿfbÿkbl]jsÿabcd^ÿ |z{ ÿe`hÿ jgcf]a]jefgÿabcdÿ |z{ uÿ ]`jlmh]`oÿ^fefgÿeiicgn]ef]b`^ÿr\gcgÿm^ghwÿabcÿgqedklg ÿ |z{ [ ÿe`hÿ |z{ u [ pÿykkl]jeilgÿfbÿkbl]jsÿabcdÿ {[| ÿe`hÿjgcf]a]jefgÿabcdÿ {[|uÿ]`jlmh]`oÿ^fefgÿeiicgn]ef]b`^ÿr\gcgÿm^ghpÿvbcÿjb^fÿe`hÿjbdklgfgÿhgfe]l^ÿbaÿjbngceogwÿjellÿbcÿrc]fgÿsbmcÿ ublb`]elÿx]agÿig`ga]f^ÿcgkcg^g`fef]ngÿbcÿf\gÿjbdke`sp Ë`hgcrc]ffg`ÿisÿublb`]elÿx]agÿÌÿyjj]hg`fÿz̀^mce`jgÿubdke`swÿublmdi]ewÿ{u Í ~ ÿublb`]elÿx]agÿÌÿyjj]hg`fÿz̀^mce76 `jgÿubdke`spÿyllÿc]o\f^ÿcg^gcnghpÿublb`]elÿx]agÿ]^ÿeÿ cgo]^fgcghÿfcehgdecÎÿe`hÿdecÎgf]`oÿice`hÿbaÿublb`]elÿx]agÿÌÿyjj]hg`fÿz̀^mce`jgÿubdke`sp ÿ ÿ~~~}


SHORT-TERM DISABILITY PREMIUMS On/Off-Job Accident and On/Off-Job Sickness with Mental or Nervous Benefit Monthly Benefit Amount

Elimination Period

Pay Premium

First 3 Months

Next 9 Months

Units

$400.00 $600.00 $800.00 $1,000.00 $1,500.00 $2,000.00 $2,500.00 $3,000.00 $3,500.00 $3,900.00

$200.00 $300.00 $400.00 $500.00 $750.00 $1,000.00 $1,250.00 $1,500.00 $1,750.00 $1,950.00

4 6 8 10 15 20 25 30 35 39

24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium

0/7

0/14

14/14

$11.35 $14.55 $17.75 $20.95 $28.95 $36.95 $44.95 $52.95 $60.95 $67.35

$9.75 $12.15 $14.55 $16.95 $22.95 $28.95 $34.95 $40.95 $46.95 $51.75

$9.35 $11.55 $13.75 $15.95 $21.45 $26.95 $32.45 $37.95 $43.45 $47.85

Monthly Disability Benefit To Provide 60% Monthly Disability Benefit $400.00 $600.00 $800.00 $1,000.00 $1,200.00 $1,500.00 $2,000.00 $2,500.00 $3,000.00 $3,500.00 $4,000.00 $4,500.00 $5,000.00

Percent of Income Coverage

$8,000 - $9,999.99 $12,000 - $13,999.99 $16,000 - $17,999.99 $20,000 - $21,999.99 $24,000 - $25,999.99 $30,000 - $31,999.99 $40,000 - $41,999.99 $50,000 - $51,999.99 $60,000 - $61,999.99 $78,000 - $82,799.99 $102,000 - $106,799.99 $126,000 - $130,799.99 $150,000 and above

Sample rates only. Multiple choices and options available and rates may vary.

77

60% 60% 60% 60% 60% 60% 60% 60% 60% 53.85% 47.06% 42.86% 40%


Click on the video below to learn more about Accident Benefits!

ACCIDENT BENEFITS


Accident Insurance Preferred Plan

Our coverage includes:

If you are in an accident, your focus should be on recovery, not how you’re going to pay your bills. Colonial Life Accident Insurance can pay benefits directly to you to use however you like — from medical costs to everyday expenses — offering financial support when you need it.

• Benefits payable directly to you • No medical questions to qualify for coverage • Coverage for simple and complex injuries • Benefits payable regardless of other insurance • Worldwide coverage • Works alongside your Health Savings Account (HSA)

BENEFITS STORY

Jacob was running on the playground when he tripped and injured his hand. With Colonial Life accident benefits, Jacob’s parents were able to pay the annual deductible and co-payments.

JACOB’S ACCIDENT BENEFITS Jacob went to an urgent care facility and received immediate care.

Accident emergency treatment

$125

The doctor ordered an X-ray and discovered Jacob had fractured his hand.

• X-ray • Fracture (hand)

$30 $375

The doctor also found that Jacob had a cut on his hand.

Laceration (no stitches)

$30

Jacob was discharged with a splint.

Medical equipment (splint)

$30

Over the next several weeks, Jacob had three follow-up appointments with his doctor.

Accident follow-up treatment (3 visits)

$165

Total

$755

For illustrative purposes only for covered accidents. Benefit amounts may vary and may not cover all expenses.

79

IAC4000 – PREFERRED PLAN


BENEFITS STORY

Olivia was driving to the store when she got into a car accident. Olivia’s accident benefits helped cover her annual deductible and co-payments. OLIVIA’S ACCIDENT BENEFITS Olivia arrived by ambulance at the nearest emergency room and received immediate care.

• Ambulance — ground or water • Accident emergency treatment • Injury due to auto accident

$200 $125 $250

The doctor ordered an X-ray and discovered Olivia had fractured her thigh (femur). He also ordered a CT scan of her head to check for a brain injury.

• X-ray • Medical imaging (CT) • Thigh fracture — femur (surgical)

$30 $200 $4,400

Olivia was admitted to the hospital for surgery on her leg. She was confined for three days.

• Hospital admission • Surgery (exploratory/arthroscopic) • Hospital confinement (3 days)

$1,000 $300 $750

Olivia had eight sessions of physical therapy to help regain the strength in her leg.

• Physical therapy (8 days) • Medical equipment (crutches)

$280 $100

Over the next several weeks, she had six follow-up appointments with her doctor.

Accident follow-up treatment (6 visits)

$330

Total

$7,965

For illustrative purposes only for covered accidents. Benefit amounts may vary and may not cover all expenses.

Summary of Benefits Benefits are per covered person per covered accident unless stated otherwise.

Initial care

Dislocation — separated joint • Non-surgical — repair . . . . . . . . . . . . . . . . . . . . . . . $100–$2,250 Examples: elbow: $500 | ankle: $1,000 | hip: $2,250

Accident emergency treatment. . . . . . . . . . . . . . . . . . . . . . . . . $125 Hospital emergency room, urgent care facility or physician’s office

• Incomplete dislocation — or dislocation without anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25% (payable as a % of the applicable dislocation benefit)

Accidental injury due to an automobile accident1 . . . . . . . . $250 Air ambulance2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$2,000 Ambulance — ground or water2 . . . . . . . . . . . . . . . . . . . . . . . . $200

• Surgical — repair . . . . . . . . . . . . . . . . . . . . . . . . . . . .$200–$4,500 Examples: elbow: $1,000 | ankle: $2,000 | hip: $4,500

Observation room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150 per day (up to two days per calendar year)

Emergency dental work . . . . . . . . . . . . . . . . . . . . . . . . . . $100–$300 Dental extraction or dental crown, denture or implant

X-ray. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30

Common accidental injuries

Eye injury — with surgical repair or removal of a foreign object . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200

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

Fracture — complete

Burn — skin graft . . . . . . . . . . . . . .50% of applicable burn benefit

• Non-surgical — repair . . . . . . . . . . . . . . . . . . . . . . . $250–$3,000 Examples: hand/foot: $375 | collarbone: $625 | leg: $1,000

Coma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $12,500 (lasting for seven or more consecutive days)

• Chip fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25% (payable as a % of the applicable fracture benefit )

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

• Surgical — repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . $450–$5,000 Examples: hand/foot: $750 | collarbone: $1,250 | leg: $2,000

80


Follow-up care Accident follow-up treatment, including transportation/telemedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . .$55 (up to six benefits per covered person per covered accident and up to 12 benefits per covered person per calendar year) Medical equipment • Tier 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30 Arm sling, cane, medical ring cushion, neck brace or wrist/ankle splint • Tier 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$100 Bedside commode, cold therapy system (cryotherapy), crutches, leg brace, shower chair, walker or walking boot • Tier 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200 Back brace, body jacket, continuous passive movement (CPM), halo, electric scooter, hospital bed (including rental), knee scooter, stair lift chair or wheelchair Medical imaging study — CT, CAT scan, EEG, EMG, MR or MRI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200 (one per calendar year) Pain management for epidural anesthesia — non-surgical . .$100 Post-traumatic stress disorder (PTSD) . . . . . . . . . . . . . . . . . $200 Prosthetic device/artificial limb Hearing-loss injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$120

• One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $750

Knee cartilage — torn — with surgical repair . . . . . . . . . . . . . $650

• More than one . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500

Laceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30–$600 (based on repair and length)

• Repair/replacement4 . . . . . . . . . . . . . . . . . . . . . . . . . . $375/$750

3

Rehabilitation unit confinement . . . . . . . . . . . . . . . . $150 per day (up to 15 days, not to exceed 30 days per calendar year)

Ruptured disc — with surgical repair . . . . . . . . . . . . . . . . . . . $750 Tendon/ligament/rotator cuff — with surgical repair

Therapy — occupational, physical or speech . . . . . . $35 per day (up to 10 days)

• One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $650 • Two or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,300

Accidental dismemberment

Hospital care

Accidental dismemberment . . . . . . . . . . . . . . . . . . $4505–$20,000 • Loss, loss of use or paralysis – hand, arm, foot, leg, sight of eye • Loss, loss of use – finger, toe, partial dismemberment of finger or toe

Hospital admission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,000 Hospital confinement . . . . . . . . . . . . . . . . . . . . . . . . . $250 per day (up to 365 days)

Accidental dismemberment due to a catastrophic accident

Hospital sub-acute intensive care unit confinement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $325 per day (up to 30 days)

• Named insured, spouse or child . . . . . . . . . . . . . . . . . .$25,0006 • Total and irrecoverable loss, loss of use or paralysis – 180-day elimination period • Loss of both hands, arms, feet, legs or the sight of both eyes; or any combination; or • Loss of hearing in both ears, or loss of ability to speak

Intensive care unit admission . . . . . . . . . . . . . . . . . . . . . . . .$2,000 Intensive care unit confinement . . . . . . . . . . . . . . . . $450 per day (up to 15 days)

Surgical care

Accidental death

Blood/plasma/platelets — transfusion . . . . . . . . . . . . . . . . . $300

Accidental death

Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200–$1,500 (based on type of repair and surgery)

• Named insured, spouse . . . . . . . . . . . . . . . . . . . . . . . . . . $40,000 • Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$10,000

Transportation and lodging

Accidental death common carrier Examples of common carriers are mass transit trains, buses and planes

Transportation for hospital confinement . . $600 per round trip (up to three round trips, 50+ miles from home)

• Named insured, spouse . . . . . . . . . . . . . . . . . . . . . . . . . .$160,000

Lodging–companion . . . . . . . . . . . . . . . . . . . . . . . . . . $125 per day (up to 30 days)

• Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30,000

81


For more information, contact your Colonial Life benefits counselor.

professional sports, sickness, suicide or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we will not pay Accidental Dismemberment Due to Catastrophic Accident benefits for injuries a child sustains during birth, or for injuries that are the result of intoxication or use of narcotics.

1 Requires transportation by a licensed professional air ambulance or ambulance (ground or water). 2 In Nevada, air ambulance or ambulance: We will pay this benefit directly to the provider unless the air ambulance or ambulance bill shows that all charges have been paid in full.

STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONS

3 One benefit for each injured ear per covered person per lifetime.

IL: Also includes “aviation.” Not applicable to “hazardous avocations, racing, semi-professional or professional sports.”

4 One repair or replacement per prosthetic device/artificial limb per covered person per lifetime.

MT: Not applicable to “suicide or injuries which you intentionally do to yourself” and “injuries a child sustains during birth.”

5 In Maine, the minimum benefit for full dismemberment of finger or toe is $1,000.

NV: Not applicable to “intoxicants and narcotics.”

6 Payable once per lifetime per covered person.

OK: Not applicable to “hazardous avocations, racing and semiprofessional or professional sports.” For Accidental Dismemberment Due to Catastrophic Accidents, replace “injuries a child sustains during birth, or for injuries that are the result of intoxication” with “alcoholism or drug addiction, or narcotics.”

HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLE This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs.

UT: Also includes “aviation.” Not applicable to “hazardous avocations, racing, semi-professional or professional sports.”

THIS POLICY PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this 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. Applicable to policy form IAC4000 (including state abbreviations where used, for example: IAC4000-TX). For cost and complete details of the coverage, call or write your Colonial Life benefits counselor or the company.

EXCLUSIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of a covered personʼs felonies or illegal occupations, hazardous avocations, racing, semi-professional or

Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. ColonialLife.com

82

FOR EMPLOYEES

8-24 | 101776-6


Accident Insurance Active Lifestyles Benefit

This benefit increases the amount you receive by 20% for your covered eligible benefits, giving you more financial protection for the unexpected. The active lifestyles benefit is available to you with accident coverage, as well as all your covered family members.

Example of a benefits calculation

Eligible benefits1

$2,500

Eligible benefits

$2,500

Eligible benefit amount

x 20%

Active lifestyles benefit

$500

Active lifestyles benefit calculation

$2,500

Eligible benefit amount

+ $500

Active lifestyles benefit

• Concussion • Dislocation • Emergency dental work • Eye injuries • Fractures • Knee cartilage (torn) • Laceration • Medical imaging study • Ruptured disc with surgical repair • Surgery ‐ cranial, open abdominal, thoracic/hernia

$3,000

‐ exploratory and arthroscopic

Total

• Tendon/ligament/rotator cuff with surgical repair • X-ray

For illustrative purposes only

To learn more, talk with your Colonial Life benefits counselor.

83

IAC4000 – ACTIVE LIFESTYLES BENEFIT


1 Active lifestyles benefit applies to any combination of these injuries or services due to a covered accident. HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLE This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs. THIS POLICY PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this coverage. ADDITIONAL DISCLOSURES FOR KENTUCKY Eligibility for benefits: We will pay benefits for a covered accident if any covered person sustains an injury as a result of a covered accident if: • the covered accident occurs while the policy is in force; • the covered accident occurs on or after the policy coverage effective date; • the covered accident is an accident type listed on the policy schedule; and • the covered accident is not excluded by name or specific description in the policy. Noncancellable: This policy is noncancellable. We have no right to change the premiums we charge on this policy. Any riders attached to this policy may be subject to a change in premium. The premium can be changed following the approval of the Commissioner of Insurance only if we change it on all riders of the same kind in force in the state where the policy was issued. What is not covered by this policy: We will not pay benefits for losses that are caused by, contributed to by or occur as a result of the covered person’s felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we also will not pay the Accidental Dismemberment due to Catastrophic Accident benefit for injuries that are caused by or are the result of birth or intoxicants, narcotics and hallucinogencis. 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. Applicable to policy form IAC4000 (including state abbreviations where used, for example: IAC4000-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. An insurance producer may contact you. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. ColonialLife.com

84

FOR EMPLOYEES

3-24 | 101778-3


Accident Insurance Sickness Hospital Confinement Rider

These benefits can help with medical costs related to a hospital stay for a covered sickness, including costs that your health insurance may not cover, such as co-pays and deductibles. The sickness hospital confinement rider is optional coverage available to you and all your covered family members. Daily sickness hospital confinement . . . . . . . . . . . . . . . . . . . . . . . $100 per day

To learn more, talk with your Colonial Life benefits counselor.

Up to 30 days per covered person per confinement for a covered sickness Re-confinement for the same or related condition within 90 days of discharge is considered a continuation of a previous confinement.

85

IAC4000 – SICKNESS HOSPITAL CONFINEMENT RIDER


HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLE This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs. THIS POLICY PROVIDES LIMITED BENEFITS. This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this coverage. EXCLUSIONS AND LIMITATIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of accidental injuries, alcoholism or drug addiction, dental procedures, elective procedures and cosmetic surgery, felonies or illegal occupations, psychiatric or psychological conditions, intoxicants and narcotics, psychiatric or psychological conditions, suicide or injuries which you intentionally do to yourself, war or armed conflict and well baby care. PRE-EXISTING CONDITION LIMITATION Pre-existing condition means a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, received medical advice, or had taken medication within 12 months before the rider coverage effective date shown on the rider schedule. After this rider has been in force for 12 months from the rider coverage effective date shown on the rider schedule, we will pay benefits as stated in the rider for any loss as the result of a pre-existing condition not excluded by name or specific description if the covered loss began at least 12 months after the rider coverage effective date. STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONS AK: Replace “alcoholism or drug addiction” with “intoxicants or narcotics.” DE: Replace “alcoholism or drug addiction” with “substance abuse.” FL: Replace “psychiatric or psychological conditions” with “mental or nervous disorders.” IL: Pre-existing Condition Limitation definition also includes “produced symptoms.” LA: Replace “alcoholism or drug addiction” with “intoxicants and narcotics.” ME: Pre-existing Condition Limitation definition does not include “had taken medication.” MO: Replace “alcoholism or drug addiction” with “substance abuse.” MT: Pre-existing Condition Limitation definition does not include “whether diagnosed or not” or “had medical testing.” NC: Pre-existing Conditions Limitation definition also includes “If a covered person is 65 or older when this policy is issued, pre-existing conditions for that covered person will include only conditions specifically eliminated by rider.” OK: Replace “psychiatric or psychological conditions” with “mental or emotional conditions.” SC: Replace “psychiatric or psychological conditions” with “mental or emotional disorders.” SD: Not applicable to “alcoholism or drug addiction.” UT: Replace “psychiatric or psychological conditions” with “mental or nervous disorders.” VT: Not applicable to “alcoholism or drug abuse, psychiatric or psychological conditions, well baby care,” or the limitation for giving birth within the first nine months after the rider coverage effective date. ADDITIONAL DISCLOSURES FOR THE STATE OF KENTUCKY Eligibility for Benefits: We will pay the benefits for a covered accident if any covered person sustains an injury as a result of a covered accident if: • The covered accident occurs while the policy is in force; • The covered accident occurs on or after the policy coverage effective date; • The covered accident is on an accident type listed on the policy schedule; and • The covered accident is not excluded by name or specific description in the policy. What is not covered by this policy: We will not pay benefits for losses that are caused by, contributed to by or occurs as a result of the covered person’s felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we also will not pay the Accidental Dismemberment due to Catastrophic Accident benefit for injuries that are caused by or are the result of birth or intoxicants, narcotics, and hallucinogenics. Termination of this Rider: This rider will terminate on the earliest of: the date the policy to which this rider is attached terminates; the date premium for this rider is not paid by the end of the grace period; or the date we receive your written request to terminate this rider. Noncancellable: This policy is noncancellable. We have no right to change the premiums we charge on this policy. Any riders attached to this policy may be subject to a change in premium. The premium can be changed following the approval of the Commissioner of Insurance only if we change it on all riders of the same kind in force in the state where the policy was issued. 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. Applicable to policy form IAC4000 and rider form R-SHC4000 (including state abbreviations where used, for example: IAC4000-AL). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.

ColonialLife.com

© 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. FOR EMPLOYEES 3-24 | 101785-5

86


Accident Insurance Wellbeing Assistance Standard Benefit

This benefit can help reduce the risk of serious illness through early detection of disease or other risk factors, giving you more protection from the unexpected. Wellbeing assistance standard . . . . . . . . . . . . . . . . . . . . . .$____________________ Payable once per covered person per calendar year; subject to a 30-day waiting period1 • Blood test for triglycerides

• Hemoccult stool analysis

• Bone marrow testing

• Mammography

• Breast ultrasound

• Pap smear2

• CA 15-3 (blood test for breast cancer)

• PSA (blood test for prostate cancer)

• CA 125 (blood test for ovarian cancer)

• Serum cholesterol test for HDL and LDL levels

• Carotid Doppler • CEA (blood test for colon cancer)

• Serum protein electrophoresis (blood test for myeloma)

• Chest X-ray

• Skin cancer biopsy

• Colonoscopy

• Stress test on a bicycle or treadmill

• Echocardiogram (ECHO) • Electrocardiogram (EKG, ECG) • Fasting blood glucose test • Flexible sigmoidoscopy

To learn more, talk with your Colonial Life benefits counselor .

• Thermography • ThinPrep pap test2 • Virtual colonoscopy

87

IAC4000 – WELLBEING ASSISTANCE STANDARD BENEFIT


1 No waiting period in ID, MD, MO, VA and VT. 2 In WV only, benefit is also payable for human papillomavirus screening test. THIS POLICY PROVIDES LIMITED BENEFITS . This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this coverage. EXCLUSIONS FOR ARIZONA We will not pay benefits for losses that are caused by, contributed to by or occur as the result of a covered personʼs felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness, suicide or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we will not pay Accidental Dismemberment Due to Catastrophic Accident benefit for injuries a child sustains during birth, or for injuries that are the result of intoxication or use of narcotics. ADDITIONAL DISCLOSURES FOR KENTUCKY Waiting Period: Waiting period means the first 30 days following each covered person’s coverage effective date during which no benefits are payable. Eligibility for Benefits: We will pay the benefits for a covered accident if any covered person sustains an injury as a result of a covered accident if: • The covered accident occurs while the policy is in force; • The covered accident occurs on or after the policy coverage effective date; • The covered accident is on an accident type listed on the policy schedule; and • The covered accident is not excluded by name or specific description in the policy. What is not covered by this policy: We will not pay benefits for losses that are caused by, contributed to by or occurs as a result of the covered person’s felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we also will not pay the Accidental Dismemberment due to Catastrophic Accident benefit for injuries that are caused by or are the result of birth or intoxicants, narcotics, and hallucinogencis. Noncancellable: This policy is noncancellable. We have no right to change the premiums we charge on this policy. Any riders attached to this policy may be subject to a change in premium. The premium can be changed following the approval of the Commissioner of Insurance only if we change it on all riders of the same kind in force in the state where the policy was issued. 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. Applicable to policy form IAC4000 (including state abbreviations where used, for example: IAC4000-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. An insurance producer may contact you. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2024 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. ColonialLife .com

88

FOR EMPLOYEES

6-24 | 101781-5


ACCIDENT BENEFIT PREMIUMS Preferred with Active Lifestyles - On/Off-Job Accident Coverage and Standard $100 Wellbeing Assistance

24-Pay Premium Named Insured

$13.56

Employee & Spouse

$20.76

Spouse Only

$13.56

Dependent Only

$13.56

Sample rates only. Multiple choices and options available and rates may vary.

89


2027 STATE HEALTH PLAN COMPARISON ACTIVE and NON-MEDICARE Subscribers STANDARD PPO Plan Non Preferred

Out of Network

Preferred

Access

$5,000 Ind $15,000 Ind $15,000 Fam $45,000 Fam

$1,000 Ind $3,000 Fam

$1,500 Ind $4,500 Fam

$12,000 Ind $4,000 Ind $6,500 Ind ACA LIMIT $36,000 Ind $12,000 Fam $16,300 Fam $24,000 Fam $72,000 Fam

$3,000 Ind $9,000 Fam

$5,000 Ind $10,000 Ind $30,000 Ind $15,000 Fam $20,000 Fam $60,000 Fam

Preferred

Access

Annual Deductible

$1,500 Ind $4,500 Fam

$3,000 Ind $9,000 Fam

Out-of-Pocket Maximum

(combined medical & pharmacy)

PLUS PPO Plan Non Preferred

Out of Network

$4,000 Ind $12,000 Ind $12,000 Fam $36,000 Fam

ACA LIMIT

In-Network (deducitble & OOP max cross-accumulates)

In-Network (deducitble & OOP max cross-accumulates)

MEDICAL BENEFITS $0 Preventive Services

Preventive

$0 Preventive Services

Primary Care Provider (PCP)

$15 Preferred PCP listed on ID card $40 other PCP listed on ID card $50 other PCP

50% after deductible

$10 PCP Preferred PCP listed on ID card $30 other PCP listed on ID card $40 other PCP

40% after deductible

Walk-In Clinic

$40 other PCP on ID card $50 other PCP

50% after deductible

$30 other PCP on ID card $40 other PCP

40% after deductible

Specialist

$40

30% after deductible

$65

50% after deductible

$25

20% after deductible

$50

40% after deductible

Behavioral Health

$15

50% after deductible

$10

40% after deductible

Speech, Occupational, Chiropractic, Physical Therapy

$62

50% after deductible

$42

40% after deductible

High-Cost Imaging

$400

30% after deductible

$1,000, then 30% after ded

50% after deductible

$250

20% after deductible

$500, then 20% after ded

Urgent Care

$100

$70

Emergency Room

$600, then 30% after deductible (copay waived with admission)

$500, then 20% after deductible (copay waived with admission)

40% after deductible

Inpatient Hospital

$750

$600, then $1,500, then 30% after ded 30% after ded

50% after deductible

$500

$500, then $1,000, then 20% after ded 20% after ded

40% after deductible

Outpatient Surgery

$600

$350, then $1,000, then 30% after ded 30% after ded

50% after deductible

$300

$300, then $500, then 20% after ded 20% after ded

40% after deductible

Ambulatory Surgical Center

$400

50% after deductible

$250

Lantern

30% after deductible

$1,000, then 30% after ded

Lantern Surgical Benefit $0 Member Cost 90

20% after deductible

$500, then 20% after ded

40% after deductible

Lantern Surgical Benefit $0 Member Cost


2027 STATE HEALTH PLAN COMPARISON ACTIVE and NON-MEDICARE Subscribers STANDARD PPO Plan

PLUS PPO Plan

PHARMACY BENEFITS Rx Tier 1

$25

$15

Rx Tier 2

$75

$55

Rx Tier 3

Deductible / Coinsurance

Deductible / Coinsurance

Rx Tier 4

$200

$100

Rx Tier 5

$600

$500

Rx Tier 6

Deductible / Coinsurance

Deductible / Coinsurance

Preferred Blood Glucose Meters and Supplies*

$10*

$5*

Preferred & Non-Preferred Insulin

$0

$0

Preventive Medications

$0

$0

Rx copays for 30-day supply.

*This does not include Continuous Glucose Monitoring Systems or associated supplies. These are considered a Tier 2 member copay.

91


Click on the video below to learn more about Medical Bridge Benefits!

MEDICAL BRIDGE BENEFITS


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

93

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.

94

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)

95

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


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

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

– 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

– 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.

96

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.

97

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

Doctor’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 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.

ColonialLife.com

This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form IMB7000-NC. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2021 Colonial Life & Accident Insurance Company. All rights reserved Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. IMB7000-MEDICAL TREATMENT PACKAGE NORTH CAROLINA EDUCATORS | 3-21 | NS-15014-1-NC

98


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

99


MEDICAL BRIDGE BENEFIT PREMIUMS INDIVIDUAL MEDICAL BRIDGE Plan 2 Named Insured

Hospital Confinement Medical Treatment Pkg $100 Health Screening Outpatient Surgical Procedure

Ages 17-49 Ages 50-59 Ages 60-64 Ages 65-75

24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium

Level 3

Level 4

$1,500.00

$2,000.00

Option 2 Tier 1 $750 Tier 2 $1,500 CY Max $2,500 $19.18 $25.13 $31.95 $45.20

Option 2 Tier 1 $750 Tier 2 $1,500 CY Max $2,500 $23.23 $30.65 $39.45 $56.23

Sample rates only. Multiple choices and options available and rates may vary.

100


Click on the video below to learn more about Term Life Insurance!

TERM LIFE INSURANCE


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

102


How much coverage do you need? £ YOU $ ___________________ Select the term period: £ 10-year £ 15-year £ 20-year £ 30-year £ SPOUSE $ ___________________ Select the term period: £ 10-year £ 15-year £ 20-year £ 30-year

Select any optional riders: £ Spouse term life rider $ _____________ face amount for ________-year term period £ Children’s term life rider $ _____________ face amount £ Accidental death benefit rider £ Chronic care accelerated death benefit rider

Optional riders At an additional cost, you can purchase the following riders for even more financial protection.

Spouse term life rider Your spouse may receive a maximum death benefit of $50,000; 10-year and 20-year spouse term riders are available.

Children’s term life rider You can purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy – not both.

Accidental death benefit rider The beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70. The benefit doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.

Chronic care accelerated death benefit rider If a licensed health care practitioner certifies that you have a chronic illness, you may receive an advance on all or a portion of the death benefit, available in a one-time lump sum or monthly payments.1 A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living.2 Premiums are waived during the benefit period.

Critical illness accelerated death benefit rider

£ Critical illness accelerated death benefit rider

If you suffer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benefit is payable.1 A subsequent diagnosis benefit is included.

£ Waiver of premium benefit rider

Waiver of premium benefit rider Premiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period.3

To learn more, talk with your Colonial Life benefits counselor.

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. 2 Activities of daily living are bathing, continence, dressing, eating, toileting and transferring. 3 You must resume premium payments once you are no longer disabled.

EXCLUSIONS AND LIMITATIONS If the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage effective date or the date of reinstatement, we will not pay the death benefit. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you.

ColonialLife.com

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. Applicable to policy forms ICC18-ITL5000/ITL5000 and rider forms ICC18-R-ITL5000-STR/RITL5000- STR, ICC18-R-ITL5000-CTR/R-ITL5000-CTR, ICC18-R-ITL5000-WP/R-ITL5000-WP, ICC18-R-ITL5000-ACCD/RITL5000- ACCD, ICC18-R-ITL5000-CI/R-ITL5000-CI, ICC18-R-ITL5000-CC/R-ITL5000-CC. For cost and complete details of the coverage, call or write your Colonial Life benefits counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

103

9-21 | 101895-2


TERM LIFE INSURANCE PREMIUMS 10-Year Term Base Plan Monthly Non-Tobacco Rates Issue Age 25 30 35 40 45 50 55 60

Pay Premium

$10,000.00

$25,000.00

$50,000.00

$100,000.00

24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium

$3.32 $3.53 $3.79 $3.99 $4.59 $5.86 $8.09 $11.68

$5.30 $5.83 $6.47 $6.98 $8.46 $11.65 $17.22 $26.20

$5.11 $5.11 $5.63 $7.02 $9.31 $12.79 $18.19 $26.98

$8.21 $8.21 $9.25 $12.04 $16.63 $23.58 $34.38 $51.96

20-Year Term Base Plan Monthly Non-Tobacco Rates Issue Age 25 30 35 40 45 50 55 60

Pay Premium

$10,000.00

$25,000.00

$50,000.00

$100,000.00

24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium

$3.36 $3.56 $3.85 $4.12 $4.84 $6.34 $9.03 $13.42

$5.39 $5.91 $6.62 $7.29 $9.11 $12.85 $19.57 $30.55

$5.27 $5.27 $5.79 $7.71 $10.90 $15.79 $23.17 $36.00

$8.54 $8.54 $9.59 $13.42 $19.79 $29.58 $44.33 $70.00

Sample rates only. Multiple choices and options available and rates may vary.

104


Click on the video below to learn more about Whole Life Insurance!

WHOLE LIFE INSURANCE


Whole Life Plus Insurance*

You can’t predict your family’s future, but you can prepare for it.

Advantages of Whole Life Plus insurance

Help give your family more peace of mind and coverage for final expenses with Colonial Life Individual Whole Life Plus insurance.

• Permanent life insurance coverage that stays the same through the life of the policy

Benefits and features Choose the age when your premium payments end — Paid-Up at Age 70 or Paid-Up at Age 100 Stand-alone spouse policy available even without buying a policy for yourself

• Premiums will not increase due to changes in health or age.

Ability to keep the policy if you change jobs or retire

• Accumulates cash value based on a nonforfeiture interest rate of 3.75%2

Built-in terminal illness accelerated death benefit that provides up to 75% of the policy’s death benefit (up to $150,000) if you’re diagnosed with a terminal illness1

• Policy loans available, which can be used for emergencies

Immediate $3,000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses

• Benefit for the beneficiary that is typically tax-free

Provides cash surrender value at age 100 (when the policy endows)

Additional coverage options Spouse term rider Cover your spouse with a death benefit up to $50,000, for 10 or 20 years.

Juvenile Whole Life Plus policy Purchase a policy (Paid-Up at Age 70) while children are young and premiums are low — whether or not you buy a policy for yourself. You may also increase the coverage when the child is 18, 21 and 24 without proof of good health.

Children’s term rider

Your cost will vary based on the amount of coverage you select.

You may purchase up to $20,000 in term life insurance coverage for all of your eligible dependent children and pay one premium. The children’s term rider may be added to either your policy or your spouse’s policy — not both. 106

WHOLE LIFE PLUS (IWL5000)


Benefits worksheet

Additional coverage options (Continued)

For use with your benefits counselor

Accelerated death benefit for long term care services rider3

How much coverage do you need?

Talk with your benefits counselor for more details.

 YOU $_______________________

Accidental death benefit rider

Select the option:

 Paid-Up at Age 70  Paid-Up at Age 100  SPOUSE $ __________________ Select the option:

 Paid-Up at Age 70  Paid-Up at Age 100  DEPENDENT STUDENT

$ ____________________________ Select the option:

 Paid-Up at Age 70  Paid-Up at Age 100 Select any optional riders:

 Spouse term rider

$ _____________face amount for _________-year term period

 Children’s term rider

$ ______________ face amount

 Accelerated death benefit for long term care services rider

 Accidental death benefit rider  Chronic care accelerated death benefit rider

 Critical illness accelerated death benefit rider

 Guaranteed purchase option rider

 Waiver of premium benefit rider

To learn more, talk with your benefits counselor.

An additional benefit may be payable if the covered person dies as a result of an accident before age 70, and doubles if the injury occurs while riding as a fare-paying passenger using public transportation. An additional 25% is payable if the injury occurs while driving or riding in a private passenger vehicle and wearing a seatbelt.

Chronic care accelerated death benefit rider If a licensed health care practitioner certifies that you have a chronic illness, you may receive an advance on all or a portion of the death benefit, available in a one-time lump sum or monthly payments.1 Talk with your benefits counselor for more details.

Critical illness accelerated death benefit rider If you suffer a heart attack, stroke or end-stage renal (kidney) failure, a $5,000 benefit is payable.1 A subsequent diagnosis benefit is included.

Guaranteed purchase option rider This rider allows you to purchase additional whole life coverage — without having to answer health questions — at three different points in the future. The rider may only be added if you are age 50 or younger when you purchase the policy. You may purchase up to your initial face amount, not to exceed a total combined maximum of $100,000 for all options.

Waiver of premium benefit rider Policy and rider premiums are waived if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period. Once you are no longer disabled, premiums will resume.

* Whole Life Plus is a marketing name of the insurance policy filed as “Whole Life Insurance” in most states. 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. 2 Accessing the accumulated cash value reduces the death benefit by the amount accessed, unless the loan is repaid. Cash value will be reduced by any outstanding loans against the policy. 3 The rider is not available in all states. This life insurance does not specifically cover funeral goods or services and may not cover the entire cost of your funeral at the time of your death. The beneficiary of this life insurance may use the proceeds for any purpose, unless otherwise directed. EXCLUSIONS AND LIMITATIONS: If the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage effective date or the date of reinstatement, we will not pay the death benefit. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. Applicable to policy forms ICC19-IWL5000-70/ IWL5000-70, ICC19-IWL5000-100/IWL5000-100, ICC19-IWL5000J/IWL5000J and rider forms ICC23IWL5000-LTC/IWL5000-LTC, ICC19-R-IWL5000-STR/R-IWL5000-STR, ICC19-R-IWL5000-CTR/RIWL5000-CTR, ICC19-R-IWL5000-WP/R-IWL5000-WP, ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD, ICC19-R-IWL5000-CI/R-IWL5000-CI, ICC19-R-IWL5000-CC/R-IWL5000-CC, ICC19-R-IWL5000GPO/R-IWL5000-GPO (including state abbreviations where applicable). For cost and complete details of the coverage, call or write your Colonial Life benefits counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. © 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

ColonialLife.com

107

FOR EMPLOYEES

8-23 | 642298-2


WHOLE LIFE INSURANCE PREMIUMS Adult Base Plan Paid-up to Age 70 Non-Tobacco Rates Issue Age 25 30 35 40 45 50

Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium

$10,000.00 $4.67 $5.50 $6.76 $8.48 $11.21 $15.59

$25,000.00 $11.68 $13.76 $16.90 $21.19 $28.01 $38.98

$50,000.00 $23.36 $27.52 $33.79 $42.38 $56.02 $77.96

$100,000.00 $46.71 $55.04 $67.59 $84.75 $112.04 $155.92

$150,000.00 $70.07 $82.57 $101.38 $127.13 $168.07 $233.88

$100,000.00 $43.00 $49.50 $58.59 $70.75 $89.13 $114.75 $153.67 $205.92

$150,000.00 $64.50 $74.25 $87.88 $106.13 $133.69 $172.13 $230.50 $308.88

Adult Base Plan Paid-up to Age 100 Non-Tobacco Rates Issue Age 25 30 35 40 45 50 55 60

Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium 24-Pay Premium

$10,000.00 $4.30 $4.95 $5.86 $7.08 $8.92 $11.48 $15.37 $20.59

$25,000.00 $10.75 $12.38 $14.65 $17.69 $22.28 $28.69 $38.42 $51.48

$50,000.00 $21.50 $24.75 $29.29 $35.38 $44.57 $57.38 $76.84 $102.96

Sample rates only. Multiple choices and options available and rates may vary.

108


Click on the video below to learn more about Legal and ID Theft Benefits!

LEGAL & ID THEFT BENEFITS


Legal Plans

Legal help made easy MetLife Legal Plans provides you, your spouse/domestic partner and dependents with access to a network of experienced attorneys. Having an attorney on your side can help reduce worry, stress, and financial burden when legal matters arise.

to find an 1 Easy attorney

to make 2 Easy an appointment

from start 3 Easy to finish

Visit members.legalplans.com to learn more about your plan. Search for an attorney based on your ZIP code and filters such as attorney experience, specialty, or minority, veteran, or LGBTQ-owned. Or call the Client Service Center to speak with an experienced representative that can match you with the right attorney.

Call the attorney directly after searching on our website. Meet with an attorney in person or over the phone. Or call the Client Service Center at 800-821-6400 and we will schedule your appointment directly with the attorney.

That's it! There are no limits on the number of times you can use the benefit. And no copays, deductibles or claim forms when you use a network attorney for a covered matter.

Experience and convenience you can count on. You’ll have all the help you’re looking for from our dedicated service team, network of attorneys and variety of online resources. Award-winning service • Regularly recognized for excellence in customer service1 • Experienced, Ohio-based service team available from 8:00 a.m. to 8:00 p.m., ET Top-quality attorney network • Nationwide network of attorneys with a range of specialties • Average of 25 years of experience and vetted regularly 24/7 access at your fingertips • Create an account on our website to access coverage information and our attorney locator • Access to over 1,700 self-help documents and resources online • Access to digital estate planning to create wills, living wills, and powers of attorney all online Ease of use2 • All billing is handled between MetLife and the attorney • No claim forms, hidden fees or deductibles

1. Two-time winner of the Silver Stevie in the American Business Awards, 2016 and 2017; Bronze winner in 2018, 2019 and 2020. 2. When using a network attorney for a covered legal matter.

Group legal plans are administered by MetLife Legal Plans, Inc., Cleveland, Ohio. In California, this entity operates under the name MetLife Legal Insurance Services. In certain states, group legal plans are provided through insurance coverage underwritten by Metropolitan General Insurance Company, Warwick, RI. For costs and complete details of the coverage, call or write the company. Some services not available in all states.

MetLife Legal Plans, Inc. | 1111 Superior Avenue, Suite 800 | Cleveland, OH 44114

110

L0523031475[exp0525][All States][DC,GU,PR] © 2023 MetLife Services and Solutions, LLC


Smart, simple identity and fraud protection all in one place. Proactive protection that helps stop threats before they strike.

Why Identity & Fraud Protection matters We’re doing more online than ever before – making us more vulnerable to fraud and online threats. MetLife and Aura Identity & Fraud Protection helps safeguard the things that matter to you most: your identity, money and assets, family, reputation, and privacy. The average consumer’s digital activity

The Aura app keeps all your digital security solutions in one place.

Why you need MetLife and Aura Identity & Fraud Protection Online interactions are at an all-time high. 89% of employees say that having access to an identity theft product provides peace of mind.4

100 to 200

On average, it takes about hours 5 and over six months to undo identity theft.

111


Protection Plan Features Financial Fraud Protection Credit Monitoring & Alerts (1 bureau) Annual Credit Report (1 bureau) Monthly Credit Score Tracker1 In-Platform Credit Dispute Credit, Bank & Utility Account Freeze Assistance Home & Vehicle Title Monitoring Financial Accounts and Transactions Monitoring Investment & Loan Account Monitoring High-Risk Transaction Alerts Identity Theft Protection Privacy Assistant & Spam Reduction Dark Web Monitoring Digital Vault SSN & Identity Authentication Alerts Criminal, Court & Public Records Monitoring USPS Address Monitoring Privacy & Device Protection Password Manager Email Alias Safe Web Browsing IP Address Monitoring 2 Wi-Fi Security/VPN (2 devices per adult member) 2

Antivirus (2 devices per adult member) Family Safety included (with family coverage only) Parental Controls Child Cyberbullying Protection 3-Bureau Child Credit Freeze Wizard Child SSN Monitoring & Alerts Sex Offender Geo Alerts Family Sharing Child Safety Checklist Services and Support $5M Insurance Policy per Enrolled Adult

6

Lost Wallet Protection with $500 Emergency Cash 24/7/365 100% US-based Customer Care White Glove Fraud Resolution Services Restoration Services for Pre-Existing Fraud Events Mobile App (iOS & Android) Online Resolution Tracker

112


Frequently Asked Questions Why is having identity & fraud protection so important? A. Everything you do is online, which makes your personal info more vulnerable. Get peace of mind knowing that you’ve taken a big step in protecting yourself from online threats, identity theft, and fraud.

What are some of the benefits of this protection? A. Aura offers robust protection by monitoring your personal info, credit, finances, and

devices and alerting you of suspicious activity. It's proactive protection to help stop threats before they strike. If you are a victim of fraud, an experienced Resolution Specialist will help you navigate credit bureaus, help initiate credit freezes or a credit lock, and work with you to resolve your fraud incident.

Who can I protect with a Family plan? A. Account owners can add up to 10 adults to their plan. There are no restrictions on adult family members – no matter where they live, their age, relationship, or whether they are financially dependent on the employee. Each adult member gets their own private, full-feature Aura account.

Account owners may also add unlimited minors (under 18) to their plan if they have parental guardianship rights over the minor. The minor’s alerts will be available for only the account owner to review.

How do I pay for my identity and fraud protection? A. Fees will be paid through payroll deduction, so you don’t have to worry about writing a check or missing a payment. For Employer-paid plans and buy-up, payment is made via credit card directly to Aura.

Questions? Aura’s customer service team is available 24/7/365. Call 1-844-931-2872.

Enroll in Identity & Fraud Protection during annual enrollment.

1. Connectivity and Mobile Trends Survey, Deloitte US (https://www2.deloitte.com/us/en/pages/about-deloitte/articles/press-releases/connectivity-and-mobile-trends.html), Accessed June 2023 2. How Many Passwords Does The Average Person Have in 2023?, IncrediTools (https://increditools.com/how-many-passwords-does-the-average-person-have/), Accessed June 2023 3. Average time spent per day with digital media in the United States from 2011 to 2024 (https://www.statista.com/statistics/262340/daily-time-spent-with-digital-media-according-to-us-consumsers/), Accessed June 2023 4. Q&A: Identity Theft Benefits More Relevant Than Ever, HR Daily Advisor (https://hrdailyadvisor.blr.com/2020/04/02/qa-identity-theft-benefits-more-relevant-thanever/), Accessed June 2023 5. How Long Does it Take to Correct Identity Theft?, Allstate (https://www.allstateidentityprotection.com/content-hub/how-long-does-it-take-to-correct-identity-theft), Accessed June 2023 6. As a component of becoming an Aura Plan member, Consumers receive identity theft insurance through a group policy issued to Aura which is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company, which is not an affiliate or subsidiary of MetLife. Checking & Savings Cash Recovery and 401(K) & HSA Cash Recovery are part of and not in addition to the Expense Reimbursement limit of liability. The description herein is a summary and intended for informational purposes only and does not include all terms‚ conditions and exclusions of the policies described. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. 7. The score you receive with Aura is provided for educational purposes to help you understand your credit. It is calculated using the information contained in your TransUnion or Experian credit file. Lenders use many different credit scoring systems, and the score you receive with Aura is not the same score used by lenders to evaluate your credit. 8. Coming in 2023 No one can prevent all identity theft or monitor all transactions effectively. Aura is a product of Aura Sub, LLC. Aura Sub, LLC. is not affiliated with MetLife, and the services and benefits they provide are separate and apart from any MetLife product.

MetLife Consumer Services, Inc.| 200 Park Avenue | New York, NY 10166

L0723033774[exp0725][All States][DC,GU,MP,PR,VI] © 2023 MetLife Services and Solutions, LLC.

113


Colonial Life for Policyholders Portal A faster, simpler way to manage your benefits

THE PORTAL OFFERS YOU: Faster service than calling/emailing Confirmation when a claim has been submitted

Colonial Life for Policyholders is an online portal created with you in mind. It’s the most convenient and efficient way to file a claim and manage your benefits.

Here’s what you can do on Colonial Life for Policyholders:

Simplified bill payment and management Answers to frequently asked questions and live chat assistance if you don’t see what you are looking for.

LEARN MORE Find out how simple your claims and benefits experience can be by learning more about the Colonial Life for Policyholders portal. Just visit ColonialLife.com to see what this online account administration platform can do for you.

File claims with a simple, guided form

Set up direct deposit for approved payments

View claim status or policy details anytime

Opt for instant alerts by email or text

Update your personal info & preferences

BECOME A MEMBER TODAY: 1

Go to ColonialLife .com/access to register.

2

Click “create an account”, fill out the required information and click Submit.

3

Enjoy faster service and improved benefits awareness.

NEED TO FILE A CLAIM? Filing online means never waiting for mail or dealing with fax machines and complex paper forms . Our guided question wizard walks you through the process and checks for missing information that could cause delays. Opting for direct deposit can also get approved payments to you up to a week faster than paper check.

AFTER YOU FILE: Check your claim status by logging into your account at ColonialLife .com/access. You can also sign up for text or email alerts so you know instantly if status changes or more information is needed. For your convenience, you can login anytime with a mobile device to photograph and upload documents with your camera.

Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

114

43233-41


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 re- disclose the information unless permitted or required by those laws. Re-disclosed information may no longer be protected by federal privacy 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 person's legal Guardian, Power of Attorney Designee, or Conservator. _________________________ ___________________ _______________ ___________ (Printed name of individual (Social Security (Signature) (Date Signed) subject to this disclosure) Number) If applicable, I signed on behalf of the proposed insured as ____________________(indicate relationship). If legal Guardian, Power of Attorney Designee, or Conservator. ______________________________ (Printed name of legal representative)

____________________________ (Signature of legal representative)

UW Authorization

____________ (Date Signed) 62891-1

115


COBRA CONTINUATION OF COVERAGE INTRODUCTION: You’re getting this notice because you recently gained coverage under a group 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.

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.”

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.

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 Lincoln Charter School 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.

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 [choose and enter appropriate information: must pay or aren’t required to pay] for COBRA continuation coverage.

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:

When is COBRA continuation coverage available?

• The end of employment or reduction of hours of employment; • Death of the employee; • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

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:

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: Lincoln Charter School. Applicable documentation will be required i.e. court order, certificate of coverage etc.

• Your hours of employment are reduced, or

How is COBRA continuation coverage provided?

• Your employment ends for any reason other than your gross misconduct.

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.

• 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

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

116


COBRA CONTINUATION OF COVERAGE coverage.

of Medicare after the date of the election of COBRA coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.

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, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), 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. Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends?: In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of • The month after your employment ends; or • The month after group health plan coverage based on current employment ends. If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part

For more information visit https://www.medicare.gov/medicare-and-you. 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 Lincoln Charter School Attn: Stephanie Regdos 133 Eagle Nest Rd. Lincolnton, NC 28092 stephanie.regdos@lincolncharter.org FSA COBRA Administrator: Ameriflex 2508 Highlander Way, Suite 200 Carrollton, TX 75006 Fax: 609-257-0136 Dental COBRA Administrator: Delta Dental of North Carolina Attn: COBRA Administrator 240 Venture Circle Nashville, TN 37228 Vision COBRA Administrator: Forest T. Jones & Company P.O. Box 418131 Kansas City, MO 64141-8131 Darlene Wilkinson Admin Specialty Benefits Tel: 800-821-7303 x 1419 Fax: 816-751-6095 E-mail: dwilkinson@ftj.com

117


PRIVACY NOTICES Non Public Information (NPI) We collect Non Public Information (NPI) about our customers to provide them with insurance products and services. This may include telephone number, address, date of birth, occupation, income and health history. We may receive NPI from your applications and forms. medical providers, other insurers, employers, insurance support organizations, and service providers. We share the types of NPI described above primarily with people who perform insurance, business, and professional services for us, such as helping us pay claims and detect fraud. We may share NPI with medical providers for insurance and treatment purposes. We may share NPI with an insurance support organization. The organization may retain the NPI and disclose it to others for whom it performs services. In certain cases, we may share NPI with group policy holders for reporting and auditing purposes. We may share NPI with parties to a proposed or final sale of insurance business or for study purposes. We may also share NPI when otherwise required or permitted by law, such as sharing with governmental or other legal authorities. When legal necessary, we ask your permission before sharing NPI about you our practices apply to our former, current and future customers. Please be assured we do not share your health NPI to market any product or service. We also do not share any NPI to market non financial products and services. For example, we do not sell your name to catalog companies. The law allows us to share NPI as described above (except health information) will affiliates to market financial products and services. The law does not allow you to restrict these disclosures. We may also share with companies that help us market our insurance products and services, such as vendors that provide mailing services to us. We may share with other financial institution to jointly market financial products and services. When required by law, we ask your permission before we share NPI for marketing purposes. When other companies help us conduct business, we expect them to follow applicable privacy laws. We do not authorize them to use or share NPI except when necessary to conduct the work they are performing for us or to meet regulatory or other governmental requirements.

Our affiliated companies, including insurers and insurance service providers, may share NPI about you with each other. The NPI might not be directly related to our transaction or experience with you. It may include financial or other personal information such as employment history. Consistent with the Fair Credit Reporting Act, we ask your permission before sharing NPI that is not directly related to our transaction or experience with you. We have physical, electronic and procedural safeguards that protect the confidentiality and security of NPI. We give access only to employees who need to know the NPI to provide insurance products or services to you. You may request access to certain NPI we collect to provide you with insurance products and services, You must make your request in writing and send it to the address, telephone number and policy number if we have issued a policy. If you request, we will send copies of the NPI to you. If the NPI includes health information, we may provide the health information to you through a health care provider you designate. We will also send you information related to disclosures. We may charge a reasonable fee to cover our copying costs. This section applies to NPI we collect tor provide you with coverage. It does not apply to NPI we collect in anticipation of a claim or civil or criminal proceeding. If you believe NPI we have about you is incorrect, please write us. Your letter should include your full name, address, telephone number and policy number if we have issued a policy. Your letter should also explain why you believe the NPI is inaccurate. If we agree with you, we will correct the NPI and notify you of the correction. We will also notify any person who may have received the incorrect NPI from us in the past two years if you ask us to contact that person. If we disagree with you, we will tell you we are not going to make the correction, We will give the reason(s) for our refusal. We will also tell you that you may submit a statement to us. Your statement should include the NPI you believe is correct. It should also include the reasons(s) why you disagree with our decision not to correct the NPI 118

in our files. We will file your statement with the disputed NPI. We will include your statement any time we disclose the disputed NPI. We will also give the statement to any person designated by your if we may have disclosed the disputed NPI to that person int he past two years.

Disclosure Notice Concerning The Medical Information Bureau Information regarding your insurability will be treated as confidential. Colonial or its reinsure(s) may, however, make a brief report thereon to the Medical Information Bureau, a nonprofit membership organization of life insurance companies which operates an information exchange on behalf of its members. If you apply to another Bureau member company for life or health insurance coverage, or a claim for benefits is submitted to such company, the Bureau, upon request, will supply such company with the information in its file. Upon receipt of a request from you, the Bureau will arrange disclosure of any information it may have in your file. If you question the accuracy of information in the Bureau’s file, you may contact the Bureau and seek a correction in accordance with the procedure set forth in the federal Fair Credit Reporting Act. The address of the Bureau’s information office is: 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734, telephone (617) 4263660. Colonial or its reinsure may also release information in its file to other life insurance companies to whom you may apply for life or health insurance or to whom a claim for benefits may be submitted.


CONTINUATION OF COVERAGE We are committed to being there for you and your family at every stage of life. Pierce Group Benefits makes it easy to stay protected! The following benefits can be self-enrolled online or by contacting PGB Employee Services, with Individual and Family coverage options available for most plans. You are eligible to sign up the first day after the end date of your employer-sponsored plan.

DENTAL BENEFITS

VISION BENEFITS

TELEMEDICINE BENEFITS

SUPPLEMENTAL/VOLUNTARY POLICIES Your individual supplemental/voluntary policies through Colonial Life are portable! To transfer your benefits from payroll deduction to direct billing or automatic bank draft, please call Employee Services at 888-662-7500 within 30 days of becoming unemployed, switching careers, or retiring.

TRANSFERRING EMPLOYERS? If you are transferring from a current PGB client to another, some benefits may be eligible for transfer. Please call Employee Services at 888-662-7500 for assistance.

Please visit www.piercegroupbenefits.com/individualcoverage or call 888-662-7500 for more information on these policies, as well as to enroll/continue your benefits.

NORTH CAROLINA STATE HEALTH PLAN 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 North Carolina State Health Plan at 1-877-679-6272.

If you are retiring, you must either log into www.myncretirement.com or call 1-877-679-6272.

119


ABOUT PIERCE GROUP BENEFITS Pierce Group Benefits is a leading full-service employee benefits administration and consulting agency serving employer groups across the Southeast. By leveraging market strength, exclusive partnerships, and industry expertise, we deliver trusted advice, products, and solutions that benefit employers and employees alike; delivered by one team and driven by one purpose — together we can do more.

SCAN TO VIEW YOUR CUSTOM BENEFITS MICROSITE


Turn static files into dynamic content formats.

Create a flipbook
Lincoln Charter School Benefits Guide 27PY by Pierce Group Benefits - Issuu