Lexington County School District One 2022 Booklet 23PY

www.piercegroupbenefits.com BENEFITSEMPLOYEEPLANLEXINGTONCOUNTYSCHOOLDISTRICTONE PLAN YEAR: January 1, 2023 - December 31, 2023 ARRANGED BY: Pierce Group Benefits

Welcome to the Lexington County School District One comprehensive benefits program. This booklet highlights the benefits offered to all eligible employees for the plan year listed below. Benefits described in this booklet are voluntary, employee-paid benefits unless otherwise noted. ** for informational purposes only ENROLLMENT PERIOD: SEPTEMBER 15, 2022 - OCTOBER 31, 2022 EFFECTIVE DATES: JANUARY 1, 2023 - DECEMBER 31, 2023 EMPLOYEE BENEFITS GUIDE TABLE OF CONTENTS Rev. 09/05/2022 page 55 page 53 page 54 Authorization Form Notice Of ContinuationInformationInsurancePracticesOfCoverageforBenefitsForm page 3PEBA Insurance Benefits** page 2Qualifications & Important Info page 23 page 28 Cancer Benefits Critical Illness Benefits page 44 page 51 Medical Bridge Benefits Life Insurance page 15PEBA Perks page 18 PEBA Preventive Health Screening Voucher page 19PEBA Participating Preventive Screening Providers page 17PEBA - RALLY Overview page 40Accident Benefits page 36Disability Benefits page 20 Pre-Tax & SupplementalPost-TaxBenefits page 21 Online Enrollment Instructions for Supplemental Benefits

ENROLLMENT PERIOD: SEPTEMBER 15, 2022 - OCTOBER 31, 2022 EFFECTIVE DATES: JANUARY 1, 2023 - DECEMBER 31, 2023 Life Insurance Colonial Life •Whole Life Insurance LEXINGTON COUNTY SCHOOL DISTRICT ONE PRE-TAX & POST-TAX BENEFITS PRE-TAX POST-TAXBENEFITSBENEFITS Please note existing insurance products will remain in effect unless you speak with a representative to change them. BenefitsCancer Colonial Life BenefitsAccident Colonial Life Medical Bridge Benefits Colonial Life BenefitsDisability Colonial Life IllnessCriticalBenefits Colonial Life 2

There are certain times throughout the year when you may enroll in insurance coverage or make changes to your coverage . Review this summary to plan the 2023 health coverage and additional benefits that are best for you and your family.

Eligible employees generally are those who:

New hires

Your employer will initiate the enrollment process

Generally, an employee must work at least an average of 30 hours per week to be considered employed full time and eligible to participate in the insurance program .

You will need to provide a valid email address to your employer, then make your elections online by following the instructions in the email you receive from PEBA . For more details about the enrollment process, view the Insurance Enrollment Guide for New Hires flyer. From the date you become eligible, you have 31 days to enroll in your health insurance and other available insurance benefits.

• Are hired into an insurance-eligible position

2023 Insurance Summary

• Work full-time for and receive compensation from a state agency, a public higher education institution, a public school district, a participating public charter school or a participating optional employer, such as a participating county or municipal government; and

Follow these steps to learn about open enrollment and make changes: Step 1 Visit the open enrollment webpage, peba.sc.gov/oe, to learn about the changes you can make . Step 2 Download your open enrollment worksheet at peba.sc.gov/oe to plan your coverage for 2023 Step 3 Log in to MyBenefits (mybenefits.sc.gov) to review your coverage and make changes during open enrollment if necessary .

Open enrollment is October 1-31, 2022 . During open enrollment, eligible employees may change their coverage for the upcoming year. Review your current coverage in MyBenefits (mybenefits.sc.gov). If you are satisfied with your current elections, the only thing you need to do is re-enroll in MoneyPlus flexible spending accounts. All open enrollment changes take effect January 1, 2023.

The following summary is included in this booklet for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov). 3

WelcomeEligibility

Amount: $______________________________

Standard

The TRICARE Supplement Plan provides secondary coverage to TRICARE members of the military community who are not eligible for Medicare . For eligible employees, it provides an alternative to the State Health Plan . Learn more about the plans at peba.sc.gov/health .

Employee

4

contribute to

Tobacco-use premium

If you are a State Health Plan subscriber with single coverage and you use tobacco or e-cigarettes, you will pay an additional $40 monthly premium . If you have premiumthetobaccoorfamilyemployee/childrenemployee/spouse,orfullcoverage,andyouanyoneyoucoverusesore-cigarettes,additionalmonthlywillbe$60ThepremiumisautomaticforallStateHealthPlansubscribersunlessthe

Your health plan options

Medical Spending Account

Your insurance needs are as unique as you are . You may meet your deductible each year, or maybe you can’t remember the last time you saw a doctor . No matter your situation, the State Health Plan gives you two options to cover your expenses: the Standard Plan or the Savings Plan .

subscriber certifies no one he covers uses tobacco or e-cigarettes or covered individuals who use tobacco or e-cigarettes have completed the Quit for Life® tobacco cessation program . The tobacco-use premium does not apply to TRICARE Supplement Plan subscribers 2023 Monthly premiums If you work for an optional employer, verify your rates with your benefits office. PlanSavings PlanTRICARE Supplement $97 .68 $9 .70 $62 .50 on the worksheet on Page 13 to determine how much you should your (MSA).

Employee/spouse $253 36 $77 40 $121 50 Employee/children $143 .86 $20 .48 $121 .50 Full family $306 56 $113 00 $162 50 How much will you spend out of pocket on medical care? Include this amount

2023 Insurance Summary

The Standard Plan has higher premiums and lower deductibles The Savings Plan has lower premiums and higher deductibles Compare the two plans on Page 5

The following summary is included in this booklet for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov).

5

2Out of network, you will pay 40% coinsurance, and your coinsurance maximum is different. An out-of-network provider may bill you more than the State Health Plan’s allowed amount. Learn more about out-of-network benefits at peba.sc.gov/health

In network, you pay 20% up to $3,000 per individual or $6,000 per family In network, you pay 20% up to $3,000 per individual or $6,000 per family .

Physician’s office visit3

You pay a $115 copayment (outpatient services) or $193 copayment (emergency care) plus the remaining allowed amount until you meet your deductible . Then, you pay the copayment plus your coinsurance . You pay the full allowed amount until you meet your deductible Then, you pay your coinsurance hospitalizationInpatient6

Review

30-day supply/90-day supply at a network pharmacy Tier 1 (generic): $13/$32 Tier 2 (preferred brand): $46/$115 Tier 3 (non-preferred brand): $77/$192 You pay up to $3,000 in prescription drug copayments . Then, you pay nothing . You pay the full allowed amount until you meet your annual deductible Then, you pay your coinsurance Drug costs are applied to your coinsurance maximum When you reach the maximum, you pay nothing accountsTax-favored

7Prescription drugs are not covered at out-of-network pharmacies

6Inpatient hospitalization requires prior authorization for the State Health Plan to provide coverage Not calling for prior authorization may lead to a $515 penalty

8With Express Scripts’ Patient Assurance Program, members in the Standard and Savings plans will pay no more than $25 for a 30-day supply of preferred and participating insulin products in 2023 This program is year to year and may not be available in the following year It does not apply to Medicare members, who will continue to pay regular copays for insulin .

You pay the full allowed amount until you meet your deductible . Then, you pay your coinsurance . You pay the full allowed amount until you meet your deductible . Then, you pay your coinsurance . drugsPrescription7,8

2023 Insurance Summary Comparison of health plans

3The $15 copayment is waived for routine mammograms, adult well visits and well-child visits Standard Plan members who receive in-person care at a BlueCross-affiliated patient-centered medical home (PCMH) provider will not be charged the $15 copayment for a physician's office visit. After Standard Plan and Savings Plan members meet their deductible, they will pay 10% coinsurance, rather than 20%, for care at a PCMH .

Coinsurance2

Maximum deductiblecopaymentsexcludesand

Standard Plan Savings Plan Annual deductible

You pay a $15 copayment plus the remaining allowed amount until you meet your deductible Then, you pay the copayment plus your coinsurance You pay the full allowed amount until you meet your deductible Then, you pay your coinsurance Outpatient facility/ emergency care4,5

Medical Spending Account Health Savings Account Limited-use Medical Spending Account 1If more than one family member is covered, no family member will receive benefits, other than preventive benefits, until the $8,000 annual family deductible is met

The following summary is included in this booklet for purposes only. your current coverage in MyBenefits (mybenefits.sc.gov).

4The $115 copayment for outpatient facility services is waived for physical therapy, speech therapy, occupational therapy, dialysis services, partial hospitalizations, intensive outpatient services, electroconvulsive therapy and psychiatric medication management .

5The $193 copayment for emergency care is waived if admitted

You pay up to $515 per individual or $1,030 per family . You pay up to $4,000 per individual or $8,000 per family .1

informational

service Network

Dental PlusBasic Dental Employee $26 60 $0 00 Employee/spouse $61 .42 $7 .64 Employee/children $75 76 $13 72 Full family $101 94 $21 34 Dental Plus

is

for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov). 6

amount Basic Dental How much will you spend out of pocket on dental care? Include this amount on the worksheet on Page 13 to determine how much you should contribute to your Medical Spending Account (MSA). Amount: $______________________________

. 2023 Monthly premiums If you work for an optional employer, verify

Your dental plan options

New hires have two options for dental coverage Dental Plus pays more and has higher premiums and lower out-of-pocket costs Basic Dental pays less and has lower premiums and higher out-of-pocket costs Changes to existing dental coverage can be made only during open enrollment in odd-numbered years . Learn more about the plans at peba.sc.gov/dental your rates with your benefits office. has higher allowed amounts, which are the maximum amounts allowed by the plan for a covered providers cannot charge you for the difference in their cost and the allowed amount. Dental Plus Basic Dental has lower allowed amounts, which are the maximum amounts allowed by the plan for a covered service There is no network for Basic Dental; therefore, providers can charge you for the difference in their cost and the allowed

.

following

in this

The summary included booklet

2023 Insurance Summary

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You pay up to a $25 deductible per person 1 The Plan will pay 50% of a lower allowed amount A provider can charge you for the difference in its cost and the allowed amount

Prosthodontics Crowns, dentures,bridges,implants

Dentist’s initial charge $191 00 $191 00 $191 00 Allowed amount3 $135 00 $171 00 $67 60 Amount paid by the Plan (100%) $135 .00 $171 .00 $67 .60 Your coinsurance (0%) $0 .00 $0 .00 $0 .00 Difference between allowed amount and charge $56 00 Dentist writes this off $20 00 $123 40 You pay $0 00 $20 .00 Difference in allowed amount and charge $123 .40 Difference in allowed amount and charge

3Allowed amounts may vary by network dentist and/or the physical location of the dentist . Routine checkup example

7

Diagnostic and preventive Exams, cleanings, X-rays

1If you have basic or prosthodontics services, you pay only one deductible Deductible is limited to three per family per year 2There is a $1,000 maximum lifetime benefit for each covered child, regardless of plan or plan year.

The following summary is included in this booklet for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov).

Orthodontics2 Limited to covered children ages 18 and younger

You pay up to a $25 deductible per person 1 The Plan will pay 50% of a higher allowed amount In network, a provider cannot charge you for the difference in its cost and the allowed amount

Dental Plus Basic Dental

You do not pay a deductible . The Plan will pay 100% of a higher allowed amount . In network, a provider cannot charge you for the difference in its cost and the allowed amount .

2023 Insurance Summary Comparison of dental plans

$1,000 per person each year for diagnostic and preventive, basic and prosthodontics services .

You do not pay a deductible . There is a $1,000 lifetime benefit for each covered child. paymentMaximum $2,000 per person each year for diagnostic and preventive, basic and prosthodontics services .

You do not pay a deductible . There is a $1,000 lifetime benefit for each covered child.

You pay up to a $25 deductible per person 1 The Plan will pay 80% of a higher allowed amount . In network, a provider cannot charge you for the difference in its cost and the allowed amount .

You do not pay a deductible . The Plan will pay 100% of a lower allowed amount . A provider can charge you for the difference in its cost and the allowed amount . Basic Fillings, oral surgery, root canals

Includes exam, four bitewing X-rays and adult cleaning Dental Plus (in network) Dental Plus (out of network) Basic Dental

You pay up to a $25 deductible per person 1 The Plan will pay 80% of a lower allowed amount . A provider can charge you for the difference in its cost and the allowed amount .

Comprehensive exam with dilation as necessary A $10 copay . Up to $35 . Retinal imaging Up to $39 . No reimbursement . Frames A $0 copay and 80% of balance over $150 allowance Up to $75 .

Disposable contact lenses A $0 copay and balance over $130 allowance Up to $104 How much will you spend out of pocket on vision care?

2023 Insurance Summary

Employee/spouse $11 88 Employee/children $12 .76 Full family $18 70 State Vision

Include this amount on the worksheet on Page 13 to determine how much you should contribute to your Medical Spending Account (MSA).

Good vision is crucial for work and play. It is also a significant part of your health. An annual eye exam can help detect serious illnesses . You can have an exam once a year and get either frames/lenses or contacts . Learn more about your vision coverage at peba.sc.gov/vision . you work for an verify your rates with your benefits office. Vision Plan .94 Plan glance

State

Standard contact lenses fit & follow-up A $0 copay Up to $40 Premium contact lenses fit & follow-up A $0 copay and receive 10% off retail price less $40 allowance Up to $40

Employee $5

Conventional contact lenses A $0 copay and 85% of balance over $130 allowance . Up to $104

In network, you pay: Out of network, you receive:

coverage

optional employer,

Your vision

Amount: $______________________________

The following summary is included in this booklet for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov). 8

2023 Monthly premiums If

Standard plastic lenses A $10 copay . Up to $55 . Standard progressive lenses A $35 copay Up to $55 Premium progressive lenses $35–$80 for Tiers 1–3 . For Tier 4, you pay copay and 80% of cost less $120 allowance . Up to $55

at a

for informational

• Includes matching amount of AD&D insurance. Coverage reduces to 65% at age 70, to 42% at age 75, and to 31 7% at age 80 and beyond Life-Spouse with AD&D Elect in $10,000 increments up to a maximum of $100,000 or 50% of your Optional Life amount, whichever is less If you are not enrolled in Optional Life, spouse coverages of $10,000 or $20,000 are available

.

2023 Insurance Summary

Dependent

•

1Reduces

The summary is included in this booklet purposes current coverage in MyBenefits (mybenefits.sc.gov).

following

Your life insurance coverage

Monthly

You are automatically enrolled in Basic Life insurance at no cost if you enroll in health insurance . This policy provides $3,000 in coverage .1 You’ll also get a matching amount of Accidental Death and Dismemberment (AD&D) insurance. You may elect more coverage for yourself, spouse and/or children . Learn more about your life insurance options and valueadded services at peba.sc.gov/life-insurance .

•

only. Review your

Coverage level Coverage details Optional Life with AD&D Elect in $10,000 increments up to a maximum of $500,000 .

•

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• $20,000 of coverage guaranteed within 31 days of initial eligibility

2023 premiums

Optional Life and Dependent Life-Spouse Your premiums are determined by your or your spouse’s age as of the previous December 31 and the coverage amount . Rates shown are per $10,000 of coverage . Remember to review your premium, even if you don’t change your coverage levels . Your monthly premium will change when your age bracket changes . AgeRate AgeRate AgeRate Under 35$0 .40 50-54$1 .44 70-74$24 .22 35-39$0 .50 55-59$2 .84 75-79$37 .50 40-44$0 60 60-64$6 0080 and older$62 04 45-49$0 .82 65-69$13 .50

•

Life insurance at a glance

• Lesser of three times annual earnings or $500,000 of coverage guaranteed within 31 days of initial eligibility

• Includes matching amount of AD&D insurance. Dependent Life-Child $15,000 per child Coverage guaranteed Children are eligible from live birth to ages 19 or 25 if a full-time student Child can be covered by only one parent under this Plan Dependent Life-Child $1 .26 per month; you pay only one premium for all eligible children to $1,500 for employees ages 70 and older

2023 Insurance Summary Your long term disabilty coverage You are automatically enrolled in Basic Long Term Disability at no cost if you enroll in health insurance. The maximum benefit is $800 per month. You may elect more coverage for added protection . Learn more about long term disability coverage at peba.sc.gov/longterm-disability . 2023 Monthly premium factors Multiply the premium factor for your age and plan selection by your monthly earnings to determine your monthly premium AgeJanuarypreceding1 waiting90-dayperiod waiting180-dayperiod Under 310 000680 00053 31-40 0 .000940 .00073 41-50 0 .001850 .00141 51-60 0 003740 00287 61-65 0 .004490 .00344 66 and older0 005490 00422 SLTD at a glance Benefit Benefit waiting period 90 or 180 days Monthly SLTD benefit1 Up to 65% of your predisability earnings, reduced by your deductible income Minimum benefit $100 per month Maximum benefit $8,000 per month The Supplemental Long Term Disability (SLTD) benefit provides:•Competitive group rates; • Survivor’s benefits for eligible dependents; • Coverage for injury, physical disease, mental disorder or pregnancy; • Return-to-work incentive; • SLTD conversion insurance; • Cost-of-living adjustment; and • Lifetime security benefit. 1Basic Long Term Disability and Supplemental Long Term Disability benefits are subject to federal and state income taxes. Check with your accountant or tax advisor about your tax liability . The following summary is included in this booklet for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov). 10

Your Standard Plan works great with a Medical Spending Account (MSA). Use your MSA to pay for eligible medical expenses, including copayments and coinsurance . As you have eligible expenses, you can use a debit card for your account or submit claims for reimbursement . You can carry over into 2024 up to $570 in unused funds from your account . You forfeit funds over $570 left in your account after the reimbursement deadline . You must re-enroll each year .

Pretax Premium Feature

Limited-use Medical Spending Account

You can use a Dependent Care Spending Account (DCSA) to pay for day care costs for children and adults It cannot be used to pay for dependent medical care You submit claims for reimbursement as you have eligible expenses . The funds can be used for expenses incurred January 1, 2023, through March 15, 2024 . You forfeit funds left in your account after the reimbursement deadline . You must re-enroll each year .

The following summary is included in this booklet for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov). 11

2023 Insurance Summary

Dependent Care Spending Account

Medical Spending Account

Are you leaving money on the table? MoneyPlus is a tax-favored accounts program that allows you to save money on eligible medical and dependent care costs . You fund the accounts with money deducted pretax from your paycheck . Learn more about your MoneyPlus options at peba.sc.gov/moneyplus .1 1Contributions made before taxes lower your taxable earned income The lower your earned income, the higher the earned income tax credit . See IRS Publication 596 or talk to a tax professional for more information

Your MoneyPlus elections

This feature allows you to pay insurance premiums before taxes for health (including the tobacco-use premium), vision, dental and up to $50,000 of Optional Life coverage . You do not need to re-enroll each year .

If you have a Health Savings Account (see Page 14), you can also use a Limited-use Medical Spending Account to pay for those expenses the Savings Plan does not cover, like dental and vision care . You can carry over into 2024 up to $570 in unused funds from your account . You forfeit funds over $570 left in your account after the reimbursement deadline . You must re-enroll each year .

2023 Insurance Summary Account features Plan availableFunds expensesMedical Dental,expensesvision Child expensescare Balance carries from year to year eachRe-enrollyear MSA Standard January 1  Up to $570  Limited-use MSA Savings January 1  Up to $570  DCSA N/AAs deposited   2023 Monthly administrative fees Account Fee Medical Spending Account $2 .32 Limited-use Medical Spending Account$2 .32 Dependent Care Spending Account$2 32 2023 Contribution limits Account Limit MedicalAccountSpending2 $2,850 Limited-use Medical Spending Account2 $2,850 Dependent Care Spending Account2,3 $2,500 (married, filing separately) $5,000 (single, head of household) $5,000 (married, filing jointly 2These are 2022 limits; contribution limits for 2023 will be released by the IRS at a later date 3Contribution limit for highly compensated employees is $1,700 2023 Reimbursement deadlines AccountGrace periodDeadline MedicalAccountSpending NoneMarch 31, 2024 Limited-use Medical Spending Account NoneMarch 31, 2024 Dependent Care Spending Account March 15, 2024March 31, 2024 The following summary is included in this booklet for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov). 12

Estimate your eligible out-of-pocket medical expenses for the plan year expenses Health insurance deductible$ and coinsurance$ drugs care care $ costs for medical care$ eligible expenses contribution

Prescription

$

MoneyPlus worksheet

The following summary is included in this booklet for informational purposes only. Review your current coverage in MyBenefits (mybenefits.sc.gov).

$ Vision

13

Dependent Care Spending Account

Travel

Use the worksheet below to calculate the amount you may wish to contribute to an MSA or a DCSA . Be sure to include the amounts you listed on Pages 4, 6 and 8 in the worksheet . Be conservative in your planning . Remember that any unclaimed funds cannot be returned to you . You can, however, carry over up to $570 of unused MSA funds into the 2024 plan year . You cannot carry over DCSA funds, and you cannot transfer funds between flexible spending accounts . Refer to Page 12 for annual contribution limits .

$ Dental

2023 Insurance Summary Medical Spending Account

Other

Copayments

Estimate your eligible dependent care expenses for the plan year Child care expenses Day care services $ In-home care/au pair services$ Nursery/preschool $ After-school care $ Summer day camps $ Elder care expenses Day care center services $ In-home care services $ Annual contribution $

Medical

$ Annual

• You cannot be covered by any other health plan that is not a high deductible health plan, including Medicare or TRICARE .

Limited-use Medical Spending Account

The following summary is included in this booklet for purposes your current coverage in MyBenefits (mybenefits.sc.gov).

• Carry over all funds from one year to the next. You don’t have to spend the funds in the year you deposit them

14

State Health Plan Savings Plan members can contribute to a Health Savings Account, or HSA

• Keep your account. The money in your account belongs to you . If you leave your job or retire, you can take the account with you and continue to use it for qualified expenses .

Your Health Savings Account

• You cannot use your HSA funds to pay premiums .

• Make payments online. Use the Online Bill Pay feature to pay your medical bills or reimburse yourself

Benefits of an HSA An HSA is essential to help you prepare for your health expenses

If you have an HSA, you can enroll in a Limited-use Medical Spending Account to pay for dental and vision care expenses Doing so allows you to save your HSA funds for future medical expenses Learn more on Page 11 2023 Monthly fees from HSA Central TypeFee Administrative fee$0 50 Paper statements$3 .00 2023 Contribution limits Your health coverage level determines your contribution limit . Coverage level Limit Self only $3,850 Family $7,750 Catch-up for members ages 55 and older$1,000

• Invest your savings. You can invest your funds once your account balance reaches $1,000 to earn investment income tax-free .

2023 Insurance Summary

To contribute money pretax through payroll deduction, you must enroll in an HSA through MyBenefits HSA Central will automatically set up the bank account based on enrollment information from PEBA You will receive a welcome email from HSA Central with instructions on how to fully open the account once it is set up How to enroll

HSA limitations

An HSA helps you get the most out of your health plan by reducing your taxes while you save for future medical expenses Learn more about HSAs at peba.sc.gov/hsa

• No one else can claim you as a dependent on their income tax return

• There’s no limit to how much you can save While there is an annual contribution limit, there’s no limit to how much you can accumulate in your account

informational

• Pay for eligible healthcare items with your debit card. Use your HSA debit card for transactions in-store, online or at your doctor .

• You have not received Veterans Administration (VA) benefits within the past three months

only. Review

It’s always better to address a health issue before it becomes a health crisis

Identifying health issues early can prevent serious illness and help save you money. This benefit, worth more than $300, allows you to receive a biometric screening at no cost Flu vaccine The flu affects 5-20% of the U.S. population each year. An annual flu vaccine is the best way to reduce your risk of getting sick and spreading it to others

Adult vaccinations

Cervical cancer screening

Colorectal cancer screening

Colorectal cancer is the second-most common cause of cancer deaths in the U S The State Health Plan covers the cost for both diagnostic and routine screenings based on age ranges recommended by the United States Preventive Services Task Force (USPSTF). Any facility charges or associated lab work as a result of the screening may be subject to copayments, deductibles and coinsurance .

2023 Insurance Summary

•

. Visit a network provider or pharmacy to take advantage of these value-based benefits at no cost to you. These benefits can help make it easier for you and your family to stay healthy. For more details about PEBA Perks, including eligibility, visit www.PEBAperks.com

Value-based benefits at no cost to you

. • Diabetes 15

Vaccines are one of the safest ways to protect your health and the health of those around you The State Health Plan covers adult vaccinations, including the Shingrix vaccine, based on age, interval and medical history recommendations from the Centers for Disease Control and Prevention (CDC). Well child benefits (exams and immunizations)

•

Cervical cancer deaths have decreased since the implementation of widespread cervical cancer screenings .

Preventive screening

The State Health Plan allows women ages 18-65 to receive a Pap test each calendar year at no cost . For women ages 3065, the Plan covers the HPV test in combination with a Pap test once every five years at no cost.

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No-Pay Copay No-Pay Copay encourages members to be more engaged in their health — and saves them money . By completing activities in Strive each year, members can receive certain generic drugs the next quarter at no cost Covered conditions include: High blood pressure and high cholesterol Cardiovascular disease, congestive heart failure and coronary artery disease

This benefit aims to promote good health and prevention of illness in children Covered children through age 18 are eligible for this benefit. The State Health Plan covers doctor visits based on recommendations from the American Academy of Pediatrics and immunizations based on recommendations from the CDC at network providers

2023 Insurance Summary

A mammogram is an important step in taking care of yourself. This benefit provides one baseline routine mammogram (four views) for women ages 35-39. Women ages 40 and older can receive one routine mammogram (four views) each calendar year. The State Health Plan also covers diagnostic mammograms, which are subject to copayments, deductibles and coinsurance Diabetes education Managing your diabetes can help you feel better It can also reduce your chance of developing complications

Mammography

This benefit provides enrollment in the Quit For Life program at no cost It also includes a $0 copay for some tobacco cessation drugs to eligible participants

This benefit allows members to video chat with a lactation consultant at no cost . Get help for many of the common issues associated with breastfeeding from the comfort and privacy of your own home . And it doesn’t have to stop after the first visit. You can schedule follow-up appointments at a time and frequency that are right for you Appointments are available seven days a week

This benefit provides diabetes education through certified diabetes educators Tobacco cessation

Lactation consultations through Blue CareOnDemand

Text messages are a great way to keep up with kids, friends and appointments They can help you stay on top of your health, too Sign up for secure State Health Plan mobile messages. You’ll get benefits information, health and wellness reminders, and cost-saving tips . Learn how to avoid catching a cold. Find out about benefits available at no cost. Get information about healthy lifestyle programs, health coaching and value-based benefits. Mobile messaging is completely optional, but we encourage you to sign up! It’s a simple and secure way to get information you can use Sign up for mobile messaging. 1 . Call 844 .284 .5417 from your mobile phone; or 2 Text PERKS to 735-29. Data rates may apply. 16

Health help in the palm of your hand

This provides members with certain electric or manual breast pumps at no cost . Members can learn how to get a breast pump by enrolling in the maternity management program, Coming Attractions .

Breast pump

Create your Rally profile On the Rally website, click the green Sign Up button.

• If you have an existing account, enter your username and password, then click the green Login button. • If you do not have an account, select the orange Register Now! button and follow the instructions. You will need to provide your State Health Plan member ID, so have your insurance card handy.

6. Check the box to confirm you are over age 16, then click Next 7. Pick a username and an avatar image. This is how you will appear to other Rally users. Then click Next 8. Your health survey will launch automatically.

Rally is a product of Rally Health Inc., an independent company that offers a digital health platform on behalf of BlueCross BlueShield of South Carolina. 17

3. Once logged in to your My Health Toolkit account, select the Wellness tab at the top.

Log in to My Health Toolkit®

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

4. Select the Rally link, then click Sign up for Rally now! This will take you to the Rally portal.

5. Enter your email address and choose a password. Your password must be at least 8 characters, including at least one letter and one number.

After you register and complete your health survey, download the Rally app to easily keep track of your health changes, check into Missions, see your progress in Challenges, use your Rally Coins and more - from the palm of your hand. Available for iOS and AndroidTM

Rally will walk you through each step in the health survey, rewarding you with coins along the way! At the end, you’ll receive your Rally Age and personalized recommendations based on your responses.

How to log in and complete your Rally® Health Survey

2. Log in to your My Health Toolkit member account.

1. Go to www.StateSC.SouthCarolinaBlues.com

59165-02-2017

For a list of screening providers, visit www.PEBAperks.com

BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.

. 213278-01-2021

Preventive health screening voucher

Employees, retirees, COBRA subscribers and their covered spouses whose primary coverage is the State Health Plan are eligible for one preventive health screening at no cost. If you are unable to attend a worksite or regional screening event, take this voucher and your State Health Plan ID card to a participating screening provider. Present this voucher along with your State Health Plan insurance card to one of the participating screening providers and ask for the preventive health screening. In addition to measuring your height, weight and blood pressure, the screening will include a lipid panel (total cholesterol, HDL, LDL and triglycerides); chemistry profile (BUN and creatinine, glucose and electrolytes); and hemogram (red and white blood cells, hemoglobin and hematocrit). There will be no cost to you. Note to provider This screening is covered in full without member cost share for employees, retirees, COBRA subscribers and their covered spouses whose primary insurance is the State Health Plan. Please bill code 96160. If you have any questions, please contact BlueCross BlueShield of South Carolina at 800.444.4311. 18

Visit doctorscare.com/locate to find the location closest to you. By appointment only

Walk-in All Doctor’s Care locations

Mackey Family Practice 1025 W. Meeting St., Suite 200, Lancaster, SC 29720

Carolina Occupational Health Screening Group/North Greenville Fitness 907 N. Main St., Travelers Rest, SC 29690

MUSC Health Primary Care- Lancaster 201 W. Meeting Street, Lancaster, SC 29720 803.286.4666

1333 Taylor Street, Suite 3D, Columbia, SC 29220

https://prismahealth.org/hospitals/prisma803.296.5914-health-baptist hospital

https://www.northgreenvillefitness.com/cohsg864.915.2015

https://mackeyfamilypractice.com/803.286.5223

Participating preventive screening providers SCPEBA 112020 Participating preventive screening providers

Prisma Health Business Health Solutions

19

•Elections made during this enrollment period CANNOT BE CHANGED AFTER THE ENROLLMENT PERIOD unless there is a family status change as deﬁned by the Internal Revenue Code. Examples of a family status change are: marriage, divorce, death of a spouse or child, birth or adoption of a child, termination or commencement of a spouse's employment, or the transition of spouse's employment from full-time to part-time, or vice-versa.

IMPORTANT

IMPORTANT FACTS:

QUALIFICATIONS & IMPORTANT INFO THINGS YOU NEED TO KNOW

•You must work 20 hours or more per week.

•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, •Additionally,2023.

•If signing up for PEBA coverage, please have your marriage license, or page one of your most recent joint federal tax return to add spouse to coverage, and a copy of the long birth certiﬁcate to add children to coverage. If signing up for any Colonial coverage on your spouse and/or children, please have their dates of birth and social security numbers available when speaking with the Beneﬁts Representative.

•The plan year for Colonial Insurance products lasts from January 1, 2023 through December 31, 2023.

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

•Pleasedetails.beaware there are certain coverages that may be subject to federal and state tax when premium is paid by pretax deduction or employee contribution.

•Deductions for Colonial Insurance products will begin January 2023.

QUALIFICATIONS:

•Once a family status change has occurred, an employee has 31 days to notify the HR Generalist for status changes for PEBA, or the Pierce Group Beneﬁts Service Center for status changes for Colonial products.

some policies may include a pre-existing condition clause. Please read your policy carefully for full

NOTE & DISCLAIMER 20

HARMONY ONLINE ENROLLMENT:

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

The screen shows ‘My Beneﬁts’. Review your current beneﬁts and make changes/selections for the upcoming plan year. 8.6.5.4.3.2.1.7.

ONLINE

During your open enrollment period, a Pierce Group Beneﬁts representative will be available by appointment to answer any questions you may have and to assist you in the enrollment process. You may enroll or make changes online to your beneﬁts plan. To enroll online, please see the information below and on the following page.

Your password must have: 1 lowercase letter, 1 uppercase letter, 1 number and 8 characters minimum Your password cannot include: ﬁrst name, last name, spaces, special characters (such as ! $ % &) or User ID

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

PERIOD: SEPTEMBER 15, 2022 - OCTOBER 31, 2022

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

ENROLLMENT

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

•If you are a new employee and unable to log into the online system, please speak with the Beneﬁts Representative assigned to your location, or contact Human Resources.

•Enterhttps://harmonyenroll.coloniallife.comyourUserName:LEXSD1 and then Last Name and then Last 4 of Social Security Number (LEXSD1SMITH6789)

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

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

Choose a security question and enter answer [______________________________________].

IN PERSON

COLONIAL INSURANCE PRODUCTS 21

HELPFUL TIPS:

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

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

•

12.10.9.11. HARMONY ONLINE ENROLLMENT CONT.: 22

• CANCER ASSIST

You may enroll online in Cancer Assist coverage. - EDUCATOR DISABILITY ADVANTAGE (EDA1100)

You may enroll online in EDA1100 coverage.

• DISABILITY

• ACCIDENT 1.0

You may enroll online in Accident 1.0; however, persons over age 64 applying for coverage and employees wishing to purchase an individual policy for their spouse should speak with the Beneﬁts Representative. BRIDGE

• MEDICAL

You may enroll online in Medical Bridge coverage. CRITICAL ILLNESS 6000

You may enroll online in Critical Illness 6000 coverage. WHOLE LIFE 5000 Plus

•

You may enroll online in Whole Life 5000 Plus; however, employees wishing to purchase an individual policy for their spouse should speak with the Beneﬁts Representative. Click ‘Finish’. Click ‘I Agree’ to electronically sign the authorization for your beneﬁt elections. Click ‘Print a copy of your Elections’ to print a copy of your elections, or download and save the document. Please do not forget this important step! Click ‘Log out & close your browser window’ and click ‘Log Out’.

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.

Initial diagnosis of cancer progressive payment rider provides 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.

Specified disease hospital confinement rider provides $300 per day for confinement to a hospital for treatment of one of 34 specified diseases covered under the rider.

Attractive features Available for businesses with 3+ eligible employees

Cancer Insurance

Cancer Assist helps protect employees and their loved ones through diagnosis, treatment and recovery.

This individual voluntary policy provides benefits that can be used for both medical and out-of-pocket, non-medical expenses traditional health insurance may not cover. Cancer Assist can enhance any competitive benefits package without adding costs to a company’s bottom line.

CANCER ASSIST23

Competitive advantages

The plan’s family care benefit provides a daily benefit when a covered dependent child receives inpatient or outpatient cancer treatment.

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

Employer-optional cancer wellness/health screening benefits are available: 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.

Composite rates are available.

Flexible family coverage Individual, individual/spouse, one-parent and two-parent family policies

Family coverage that includes eligible dependent children (to age 26) for the same rate, regardless of the number of children covered

There are 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).

Full schedule of 30+ benefits and three optional riders (benefit amounts may vary based on plan level selected) with each plan level

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

Broad range of policy issue ages, 17-75

HSA-compliant Guaranteed renewable Portable 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 Form 1099s may not be issued in most states because all benefits require that a charge is incurred.

Optional riders (available at an additional cost/payable once per covered person)

Initial diagnosis of cancer rider provides a one-time benefit for the initial diagnosis of cancer.

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

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

Radiation/chemotherapy

Topical chemotherapy: $150-$400 once per calendar month Chemotherapy by pump: $150-$400 once per calendar month

THIS POLICY PROVIDES LIMITED BENEFITS. 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. Applicable to policy form CanAssist (and state abbreviations where applicable, for example: CanAssist-TX).

See your Colonial Life benefits representative for complete details.

Radiation delivered by medical personnel: $250-$1,000 once per calendar week

Anesthesia

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

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

Local: $25-$50 per procedure Hospital confinement

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

$150-$300 once per lifetime Home health care services

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

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. 24

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

Cancer Assist benefits overview This overview shows benefits available for all four plan levels and the range of benefit amounts payable for most common cancer treatments. Each benefit is payable for each covered person under the policy. Actual benefits vary based on the plan level selected. 6-19 | 101478-2

General: 25% of surgical procedures benefit

Transportation and lodging

Self-injected chemotherapy: $150-$400 once per calendar month

Anti-nausea medication

Oral non-hormonal chemotherapy: $150-$400 once per calendar month

Oral hormonal chemotherapy (25+ months): $75-$200 once per calendar month

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

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

ColonialLife.com

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

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

Second medical opinion on surgery or treatment

Skin cancer initial diagnosis $300-$600 payable once per lifetime Surgical procedures

Talk with your benefits representative to learn more.

Injected chemotherapy by medical personnel: $250-$1,000 once per calendar week

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

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

Oral hormonal chemotherapy (1-24 months): $150-$400 once per calendar month

Benefits also included in each plan

For more information, talk with your benefits counselor. To encourage early detection, our cancer insurance offers benefits for wellness and health screening tests.

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. 25

Part two: Cancer wellness — additional invasive diagnostic test or surgical procedure

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 which may affect any benefits payable. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to policy form CanAssist (and state abbreviations where applicable, for example: CanAssist-TX).

CANCER ASSIST WELLNESS | 6-19 | 101486-2

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. Health screening tests ■ Blood test for triglycerides ■ Carotid Doppler ■ Echocardiogram (ECHO) ■ Electrocardiogram (EKG, ECG) ■ Fasting blood glucose test ■ Serum cholesterol test for HDL and LDL levels ■ Stress test on a bicycle or treadmill

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.

Part one: Cancer wellness/health screening

Cancer wellness tests ■ 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) ■ Chest X-ray ■ Colonoscopy ■ Flexible sigmoidoscopy ■ 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

Cancer Insurance Wellness Benefits

Maximum per lifetime $10,000$12,500$15,000$15,000 $30$40$50$60 per year $1,500$2,000$2,500$3,000 $200$200$350$500$50$75$100$150 per year $1,000$1,000$1,000$1,000$50$50$50$50

Maximum combined Initial and Daily per lifetime$15,000$15,000$15,000$15,000 $100$150$250$350$200$300$500$700$50$50$75$80

Level 1Level 2Level 3Level 4 $2,000$2,000$2,000$2,000 Maximum trips per confinement 2 2 2 2 $250$250$250$250 Maximum trips per confinement 2 2 2 2 $25$30$40$50$25$40$50$60 Maximum per month$100$160$200$240 $150$150$175$250 Maximum per year $10,000$10,000$10,000$10,000 $3,500$4,000$7,000$10,000$500$500$750$1,000 Maximum transplants per lifetime 2 2 2 2 $0.50$0.50$0.50$0.50 Maximum per round trip $1,000$1,000$1,200$1,500 $500$700$1,000$1,500$175$200$350$500$200$250$300$300

Maximum days per year 70707070 $75$125$175$225 Maximum per year $150$250$350$450 $100$200$300$400 Maximum per year $300$600$900$1,200 $1,000$1,500$2,000$3,000$50$75$125$150

Maximum per lifetime $2,000$3,000$4,000$6,000

The policy and its riders may have additional 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. Coverage is dependent on answers to health questions. Applicable to policy forms CanAssist-IL and CanAssist-SC, and rider forms R-CanAssistIndx-IL, R-CanAssistProg-IL, R-CanAssistSpDis-IL, R-CanAssistIndxSC, R-CanAssistProg-SC and R-CanAssistSpDis-SC. Hospital Confinement, 30 days or less, per day Hospital Confinement, 31 days or more, per day Lodging, per day Medical Imaging Studies, per study Outpatient Surgical Center, per day Private Full-time Nursing Services, per day Prosthetic Device/Artificial Limb, per device or limb Family Care, per day Hair/External Breast/Voice Box Prosthesis, per year Home Health Care Services, per day Hospice, Initial, per lifetime Hospice, Daily 25% of Surgical Procedures Benefit 30 days or twice the days confined of Egg(s) Extraction or Harvesting or Sperm Collection, per lifetime Egg(s) or Sperm Storage, per lifetime Experimental Treatment, per day Cancer Insurance Benefits Anesthesia, General Air Ambulance, per trip Ambulance, per trip Anesthesia, Local, per procedure Anti-Nausea Medication, per Blood/Plasma/Platelets/Immunoglobulins,day per day

Maximum

Benefits

Bone Marrow or Peripheral Stem Cell Donation, per lifetime Bone Marrow or Peripheral Stem Cell Transplant, per transplant Companion Transportation, per mile 26

Maximum

Individual Cancer Insurance Description

Individual Cancer Insurance Description of Benefits

only to losses

benefits for cancer or skin cancer: Supportive/Protective Care Drugs/Colony Stimulating Factors, per The policy and

The policy and its riders may have additional 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. Coverage is dependent on answers to health questions. Applicable to policy forms CanAssist-IL and CanAssist-SC, and rider forms R-CanAssistIndx-IL, R-CanAssistProg-IL, R-CanAssistSpDis-IL, R-CanAssistIndxSC, R-CanAssistProg-SC and R-CanAssistSpDis-SC.

Cancer Insurance Benefits

Self-Injected Chemotherapy, per month $150$200$300$400 Pump Chemotherapy, per month $150$200$300$400

Injected chemotherapy by medical personnel, per week$250$500$750$1,000

Maximum

Oral Hormonal Chemotherapy (1-24 months), per month$150$200$300$400

Maximum per procedure, including 25% for general $2,500$2,500$3,000$3,000 $150$200$300$300$75$100$100$150$300$300$400$600$50$100$150$200

Topical Chemotherapy, per month $150$200$300$400

Radiation delivered by medical personnel, per week $250$500$750$1,000

riders may have a

Level 1Level 2Level 3Level 4

Oral Non-Hormonal Chemotherapy, per month $150$200$300$400$40$40$60$60

Oral Hormonal Chemotherapy (25+ months), per month$75$100$150$200

coverage

Maximum

Maximum per year $400$800$1,200$1,600 $40$50$60$70 per procedure $2,500$3,000$5,000$6,000 $0.50$0.50$0.50$0.50 per round trip $1,000$1,000$1,200$1,500

the

payable.

for

YesYesYesYes$50$50$50$50$50$50$50$50

WeEXCLUSIONSwillnotpay its waiting period. Waiting period means the first 30 days following the policy’s effective date during which no benefits are If your cancer has a date of diagnosis before the end of waiting period, coverage that cancer will apply commencing after the policy has been in force for two years, unless it is excluded by name or specific description in the policy.

Surgical Procedures, per surgical unit ReconstructiveRadiation/ChemotherapySurgery,per surgical unit Second Medical Opinion, per lifetime Skilled Nursing Care Facility, per day, up to days confined Skin Cancer Initial Diagnosis, per lifetime ©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. Transportation, per mile Waiver of Premium Bone Marrow Donor Screening, per lifetime Cancer Vaccine, per lifetime Part 1: Cancer Wellness/Health Screening, per year Part 2: Cancer Wellness/Health Screening, per year One amount per account: $0, $25, $50, $75 or Same$100 as Part 1 WAITING PERIOD Additional Riders may be available at an additional cost Policy-Wellness Benefits possessions; or cancer. 27

Group Critical Illness Insurance Plan 1 GCI6000 – PLAN 1 – CRITICAL ILLNESS

When life takes an unexpected turn due to a critical illness diagnosis, your focus should be on recovery — not finances. Colonial Life’s group critical illness provide financial support by providing a lump-sum benefit payable directly to you for your greatest needs.

insurance helps

Coverage amount: ____________________________ Household expenses while he was unable to Co-paymentswork and hospital bills not covered by his medical insurance Physical therapy to get back to doing what he loves For illustrative purposes only. An unexpected moment changes life forever 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’S COVERAGE HELPED The lump-sum payment from his critical illness insurance helped pay for: COVERED CONDITION¹ PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Benign brain tumor 100% Coma 100% End stage renal (kidney) failure 100% Heart attack (myocardial infarction) 100% Loss of hearing 100% Loss of sight 100% Loss of speech 100% Major organ failure requiring transplant 100% Occupational infectious HIV or occupational infectious hepatitis B, C, or D 100% Permanent paralysis due to a covered accident 100% Stroke 100% Sudden cardiac arrest 100% Coronary artery disease 25% Critical illness benefit 28

If you receive a benefit for a critical illness, and are later diagnosed with the same critical illness,3 25% of the coverage amount may be payable for that critical illness.

EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS

Available coverage for spouse and eligible dependent children at 50%

Additional covered conditions for dependent children

If you receive a benefit for a critical illness, and are later diagnosed with a different critical illness, 100% of the coverage amount may be payable for that particular critical illness.

1. Refer to the certificate for complete definitions of covered conditions.

2. Dates of diagnoses of a covered critical illness must be separated by more than 180 days.

Preparing for the unexpected is simpler than you think. With Colonial Life, youʼll have the support you need to face lifeʼs toughest challenges. 29

Subsequent diagnosis of the same critical illness2

PRE-EXISTING CONDITION LIMITATION

3. Critical illnesses that do not qualify include: coronary artery disease, loss of hearing, loss of sight, loss of speech, and occupational infectious HIV or occupational infectious hepatitis B,C,or D.

For more information, talk with

Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.

PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Cerebral

We will not pay the Critical Illness Benefit, Benefits Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.

100% Cleft

100% Cystic

100%

100% Spina

ColonialLife.com 5-20 | 385403

Subsequent diagnosis of a different critical illness2

THIS INSURANCE PROVIDES LIMITED BENEFITS Insureds in MA must be covered by comprehensive health insurance before applying for this coverage.

We will not pay a benefit for a pre-existing condition that occurs during the 12-month period after the coverage effective date. Pre-existing condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.

your coverage amount Cover your eligible dependent children at no additional cost Receive specifiedhistory,regardlesscoverageofmedicalwithinlimits Works alongside your health savings account (HSA) Benefits insuranceregardlesspayableofother KEY BENEFITS COVERED

100% Down

©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. your benefits counselor. of CONDITION¹ palsy lip or palate fibrosis syndrome bifida

Group Critical Illness Insurance Plan 2 GCI6000 – PLAN 2 – CRITICAL ILLNESS AND CANCER When life takes an unexpected turn, your focus should be on recovery — not finances. Colonial Life’s group critical illness insurance helps relieve financial worries by providing a lump-sum benefit payable directly to you to use as needed. Coverage amount: ____________________________ COVERED CRITICAL ILLNESS CONDITION¹ PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Benign brain tumor 100% Coma 100% End stage renal (kidney) failure 100% Heart attack (myocardial infarction) 100% Loss of hearing 100% Loss of sight 100% Loss of speech 100% Major organ failure requiring transplant 100% Occupational infectious HIV or occupational infectious hepatitis B, C, or D 100% Permanent paralysis due to a covered accident 100% Stroke 100% Sudden cardiac arrest 100% Coronary artery disease 25% COVERED CANCER CONDITION¹ PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Invasive cancer (including all breast cancer) 100% Non-invasive cancer 25% Skin cancer initial diagnosis $400 per lifetime Critical illness and cancer benefits Special strengthtoPhysicalheartforandAdaycareneedshospitalstaytreatmentcorrectivesurgerytherapybuildmuscle For illustrative purposes only. Preparing for a lifelong journey Rebecca was born with Down syndrome. Her parents’ critical illness coverage provided a benefit that can help cover expenses related to Rebecca’s care and her changing needs. HOW THEIR COVERAGE HELPED The lump-sum amount from the family coverage benefit helped pay for: 30

EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS

We will not pay the Critical Illness Benefit, Benefits Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.

If you receive a benefit for invasive cancer and are later diagnosed with a reoccurrence of invasive cancer, 25% of the coverage amount is payable if treatment-free for at least 12 months and in complete remission prior to the date of reoccurrence; excludes non-invasive or skin cancer. For more information, talk with your benefits counselor.

3. Critical illnesses that do not qualify include: coronary artery disease, loss of hearing, loss of sight, loss of speech, and occupational infectious HIV or occupational infectious hepatitis B,C,or D.

Subsequent diagnosis of a different critical illness2

Available coverage for spouse and eligible dependent children at 50% of your coverage amount Cover your eligible dependent children at no additional cost Receive specifiedhistory,regardlesscoverageofmedicalwithinlimits Works alongside your health savings account (HSA) Benefits insuranceregardlesspayableofother 31

2. Dates of diagnoses of a covered critical illness must be separated by more than 180 days.

Reoccurrence of invasive cancer (including all breast cancer)

Preparing for the unexpected is simpler than you think. With Colonial Life, youʼll have the support you need to face lifeʼs toughest challenges.

ColonialLife.com 5-20 | 387100

We will not pay a benefit for a pre-existing condition that occurs during the 12-month period after the coverage effective date. Pre-existing condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

COVERED CONDITION¹ PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

THIS INSURANCE PROVIDES LIMITED BENEFITS Insureds in MA must be covered by comprehensive health insurance before applying for this coverage.

Cerebral palsy 100% Cleft lip or palate 100% Cystic fibrosis 100% Down syndrome 100% Spina bifida 100%

If you receive a benefit for a critical illness, and are later diagnosed with a different critical illness, 100% of the coverage amount may be payable for that particular critical illness.

Subsequent diagnosis of the same critical illness2

We will not pay the Invasive Cancer (including all Breast Cancer) Benefit, Non-Invasive Cancer Benefit, Benefit Payable Upon Reoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benefit for a covered person’s invasive cancer or non-invasive cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having invasive or non-invasive cancer. No pre-existing condition limitation will be applied for dependent children who are born or adopted while the named insured is covered under the certificate, and who are continuously covered from the date of birth or adoption.

1. Refer to the certificate for complete definitions of covered conditions.

EXCLUSIONS AND LIMITATIONS FOR CANCER

PRE-EXISTING CONDITION LIMITATION

KEY BENEFITS

Additional covered conditions for dependent children

If you receive a benefit for a critical illness, and are later diagnosed with the same critical illness,3 25% of the coverage amount is payable for that critical illness.

The first diagnosis building benefit rider provides a lump-sum payment in addition to the coverage amount when you are diagnosed with a covered critical illness or invasive cancer (including all breast cancer). This benefit is for you and all your covered family members.

For more information, talk with your benefits

Group Critical Illness Insurance First Diagnosis Building Benefit Rider

GCI6000 – FIRST DIAGNOSIS BUILDING BENEFIT RIDER | 5-20 | 387381

¾

ColonialLife.comcounselor.

First diagnosis building benefit Payable once per covered person per lifetime Named insured Accumulates $1,000 each year Covered spouse/dependent children Accumulates $500 each year

Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

THIS INSURANCE PROVIDES LIMITED BENEFITS. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX) and rider form R-GCI6000-BB. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.

¾

The benefit amount accumulates each rider year the rider is in force before a diagnosis is made, up to a maximum of 10 years. If diagnosed with a covered critical illness or invasive cancer (including all breast cancer) before the end of the first rider year, the rider will provide one-half of the annual building benefit amount. Coronary artery disease is not a covered critical illness. Non-invasive and skin cancer are not covered cancer conditions. 32

Group 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 which can be used toward health care expenses or meeting day-today needs. These benefits are for you as well as your covered family members. Payable for each covered infectious disease once per covered person per lifetime For more information, talk with your benefits ColonialLife.comcounselor. GCI6000 – INFECTIOUS DISEASES RIDER COVERED INFECTIOUS DISEASE¹ PERCENTAGE OF APPLICABLE COVERAGE AMOUNT Hospital confinement for seven or more consecutive days for treatment of the disease 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% Hospital confinement for 14 or more consecutive days for treatment of the disease Coronavirus disease 2019 (COVID-19) 25% 33

We will not pay benefits for a covered infectious disease that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a covered infectious disease.

EXCLUSIONS AND LIMITATIONS FOR INFECTIOUS DISEASES RIDER

1. Refer to the certificate for complete definitions of covered diseases. THIS INSURANCE PROVIDES LIMITED BENEFITS.

ColonialLife.com

PRE-EXISTING CONDITION LIMITATION

5-20 | 387523

We will not pay a benefit for a pre-existing condition that occurs during the 12-month period after the coverage effective date. Pre-existing condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX) and rider form R-GCI6000-INF. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. 34

Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

1. Refer to the certificate for complete definitions of covered diseases.

EXCLUSIONS AND LIMITATIONS FOR PROGRESSIVE DISEASES RIDER

GCI6000 – PROGRESSIVE DISEASES RIDER | 5-20 | 387594

We will not pay a benefit for a pre-existing condition that occurs during the 12-month period after the coverage effective date. Pre-existing condition means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX) and rider form R-GCI6000-PD. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.

ColonialLife.com 35

2. Activities of daily living include bathing, continence, dressing, eating, toileting and transferring. THIS INSURANCE PROVIDES LIMITED BENEFITS.

COVERED PROGRESSIVE DISEASE¹ PERCENTAGE OF APPLICABLE COVERAGE AMOUNT

This benefit is payable if the covered person is unable to perform two or more activities of daily living2 and the 90-day elimination period has been met.

Amyotrophic Lateral Sclerosis (ALS) 25% Dementia (including Alzheimer’s disease) 25% Huntington’s disease 25% Lupus 25% Multiple sclerosis (MS) 25% Muscular dystrophy 25% Myasthenia gravis (MG) 25% Parkinson’s disease 25% Systemic sclerosis (scleroderma) 25% Payable for each covered progressive disease once per covered person per lifetime

For more information, talk with your benefits counselor.

Group Critical Illness Insurance Progressive Diseases Rider

Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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. These benefits are for you as well as your covered family members.

We will not pay benefits for a covered progressive disease that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the preexisting condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a covered progressive disease.

PRE-EXISTING CONDITION LIMITATION

for disability coverage and accidental injury

Educator

and/or

(PEBA)

Educator Disability Advantage Short Term Disability

if you become

Educator Disability Advantage insurance1 from Colonial Life is designed to provide financial protection for all education workers with plans that can help supplement complement the South Carolina Public Employee Benefit Authority plan. Disability Advantage insurance provides flexible options benefits help maintain lifestyle needs disabled

protect your income and

to

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 Off-job accident/sickness First 3 months $_____________/month $_____________/month Next 9 months $_____________/month $_____________/month • Partial disability Up to 3 months $____________/month $_____________/month When will my benefits start? • After an accident: ___________ days After a sickness: ___________ days What additional features or benefits are included? • 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. How long could you afford to go without a paycheck? Monthly expenses: Mortgage/rent $_____________ Groceries $_____________ Car $_____________ Medical bills $_____________ Utilities $_____________ Other $_____________ Total $ EDUCATOR DISABILITY ADVANTAGE (EDA1100) — MENTAL & NERVOUS 36

•

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. Anita’s coverage helped* With her coverage, she received benefits for: Accident treatmentemergency $400 X-ray $150 Collarbone fracture requiring surgery $1,200 Elbow dislocation (nonsurgical) $400 Hospital stay of 3 nights $150 Short-term disability benefits $1,400 Total amount: ..... $3,700 *For illustrative purposes only. Coverage amounts may vary based on injury, treatment, income and more.

•

..........

Additional employee coverage

$25,000 • Loss

•

.....................................

•

an eye Single dismemberment .................................................. $7,500 Double dismemberment $15,000 • Common carrier death

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 6 benefits per accident per person, up to 12/year per person)

•

How

•

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS death of a finger or of a hand, arm, foot or sight of (includes school bus for school activities)

•

.......

Pays in addition to disability benefit. Benefits begin on the first day of confinement in a hospital. Up to 3 months $1,500/month ($50/day)

HOSPITAL CONFINEMENT BENEFIT FOR ACCIDENT OR SICKNESS

$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 • Skull (simple) $525 $1,050 • Upper arm, upper jaw $525 $1,050 • Facial bones $450 $900 • Vertebral processes ................................... $300 ........... $600 • Rib $300 $600 • Finger, toe ............................................. $175 ........... $350 • Coccyx $125 $250 37

toe Single dismemberment $750 Double dismemberment $1,500 • Loss

..............................

• Accidental

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 2 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 6 benefits per accident per person, up to 12/year per person) HOSPITAL CONFINEMENT BENEFIT FOR ACCIDENT OR SICKNESS Up to 3 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500/month ($50/day) ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS • Accidental death, spouse/dependent $10,000 / $5,000 • Loss of a finger or toe Single dismemberment $75 Double dismemberment $150 • Loss of a hand, arm, foot or sight of an eye Single dismemberment $750 Double dismemberment $1,500 • Common carrier death, spouse/dependent Includes school bus for school activities. . . . . . . . . . . . . . . . . . . . . . . . . $20,000 / $10,000 More than 1 in 4 of 20-year-olds become disabled retirementbeforeage.2 38

• Your employer will allow you to return to your job or place of employment for less than half of your normally scheduled hours per week; and

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).

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

If you change jobs or retire, you can take your coverage with you until age 70, as long as you pay your premiums when they are due or within the grace period.

1. Educator Disability Advantage is the marketing name of the insurance product filed as “Disability Income Insurance Policy (SCE1100).”

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

How do I file a claim?

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

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.

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

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 12 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. If you become disabled due to a pre-existing condition, we will not pay for any disability period if it begins during the first 12 months the policy is in force.

Can I keep my coverage if I change jobs?

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

Totally disabled means you are:

What is the mental or nervous disorder benefit?

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 may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. Applicable to policy form SCE1100. 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. © 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 | 1172391-SCColonialLife com 39

When am I considered totally disabled?

• You are able to work at your job or your place of employment for less than half of your normally scheduled hours per week;

What is a pre-existing condition?

The total disability benefit must have been paid for at least 14 days immediately prior to your being partially disabled.

• Unable to perform the material and substantial duties of your occupation; • Not, in fact, working at any occupation; and • Under the regular and appropriate care of a doctor.

When do disability benefits end?

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.

• You are unable to perform the material and substantial duties of your job for more than half of your normally scheduled hours per week;

Insurance 40

What if I change employers?

BenefitScreeningHealthwith-Preferred1.0Accident Accidents happen in places where you and your family spend the most time – at work, in the home and on the playground – and they’re unexpected. How you care for them shouldn’t be. In your lifetime, which of these accidental injuries have happened to you or someone you know? l Sports-related accidental injury l Broken bone l Burn l Concussion l Laceration l Back or knee injuries Colonial Life’s Accident Insurance is designed to help you fill some of the gaps caused by increasing deductibles, co-payments and out-of-pocket costs related to an accidental injury. The benefit to you is that you may not need to use your savings or secure a loan to pay expenses. Plus you’ll feel better knowing you can have greater financial security. l Car accidents l Falls & spills l Dislocation l Accidental injuries that send you to the Emergency Room, Urgent Care or doctor’s office What additional features are included? l Worldwide coverage l Portable l Compliant with Healthcare Spending Account (HSA) guidelines Will my accident claim payment be reduced if I have other insurance? You’re paid regardless of any other insurance you may have with other insurance companies, and the benefits are paid directly to you (unless you specify otherwise).

Colonial Life can change your premium only if we change it on all policies of this kind in the state where your policy was issued. How do I file a claim? Visit coloniallife.com or call our Customer Service Department at 1.800.325.4368 for additional information.

If you change jobs or leave your employer, you can take your coverage with you at no additional cost. Your coverage is guaranteed renewable as long as you pay your premiums when they are due or within the grace period. Can my premium change?

Accident

Your Colonial Life policy also provides benefits for the following injuries received as a result of a covered accident. l Burn (based on size and degree) .................................................................................... $1,000 to $12,000 l Coma ............................................................................................................................................................. $10,000 l Concussion ......................................................................................................................................................... $60 l Emergency Dental Work ....................................... $75 Extraction, $300 Crown, Implant, or Denture l Lacerations (based on size) ........................................................................................................... $30 to $500 Requires Surgery l Eye Injury $300 l Tendon/Ligament/Rotator Cuff $500 - one, $1,000 - two or more l Ruptured Disc $500 l Torn Knee Cartilage $500 Surgical Care l Surgery (cranial, open abdominal or thoracic) ................................................................................ $1,500 l Surgery (hernia) ..............................................................................................................................................$150 l Surgery (arthroscopic or exploratory) ....................................................................................................$200 l Blood/Plasma/Platelets ................................................................................................................................$300 Benefits listed are for each covered person per covered accident unless otherwise specified. Initial Care l Accident Emergency Treatment...........$125 l Ambulance ....................................... $200 l X-ray Benefit ................................................... $30 l Air Ambulance ............................. $2,000 Common Accidental Injuries Dislocations (Separated Joint) Non-Surgical Surgical Hip $2,200 $4,400 Knee (except patella) $1,100 $2,200 Ankle – Bone or Bones of the Foot (other than Toes) $880 $1,760 Collarbone (Sternoclavicular) $550 $1,100 Lower Jaw, Shoulder, Elbow, Wrist $330 $660 Bone or Bones of the Hand $330 $660 Collarbone (Acromioclavicular and Separation) $110 $220 One Toe or Finger $110 $220 Fractures Non-Surgical Surgical Depressed Skull $2,750 $5,500 Non-Depressed Skull $1,100 $2,200 Hip, Thigh $1,650 $3,300 Body of Vertebrae, Pelvis, Leg $825 $1,650 Bones of Face or Nose (except mandible or maxilla) $385 $770 Upper Jaw, Maxilla $385 $770 Upper Arm between Elbow and Shoulder $385 $770 Lower Jaw, Mandible, Kneecap, Ankle, Foot $330 $660 Shoulder Blade, Collarbone, Vertebral Process $330 $660 Forearm, Wrist, Hand $330 $660 Rib $275 $550 Coccyx $220 $440 Finger, Toe $110 $220 41

Care l

Named Insured ................ $25,000 Spouse .............. $25,000 Child(ren) ......... $12,500 365-day

l

$25,000

l

...................................................

Care l

.................................................................................

l Loss

l

.....................................................

l Loss

or l

l

l Prosthetic

l Rehabilitation

Accidental Dismemberment l

l Loss

l Spouse

l Child(ren) $5,000

.........................................................

Payable

Accident

Transportation/Lodging Assistance

l Occupational

.................................................$100

Accidental Death Accidental Death Common Carrier l Named

feet l

If injured, covered person must travel more than 50 miles from residence to receive special treatment and confinement in a hospital. Transportation $500 per round trip up to 3 round trips Lodging (family member or companion) $125 per night up to 30 days for a hotel/motel lodging costs

..................... $7,500

42

l Appliances ..........................................................................................

l Loss

....................................................

l Loss

......................................................................................................

l Loss

l

*

Accident Hospital Hospital Admission* $1,000 per accident Hospital ICU Admission* $2,000 per accident We will pay either the Hospital Admission or Hospital Intensive Care Unit (ICU) Admission, but not both. Hospital Confinement $225 per day up to 365 days per accident Hospital ICU Confinement $450 per day up to 15 days per accident Follow-Up Accident Follow-Up Doctor Visit $50 (up to 3 visits per accident) Medical Imaging Study $150 per accident (limit 1 per covered accident and 1 per calendar year) or Physical Therapy $25 per treatment up to 10 days $100 (such as wheelchair, crutches) Devices/Artificial Limb $500 - one, $1,000 - more than 1 Unit per day up to 15 days per covered accident, and 30 days per calendar year. Maximum of 30 days per calendar year Loss of Finger/Toe $750 – one, $1,500 – two or more or Loss of Use of Hand/Foot/Sight of Eye – one, $15,000 – two or more severe injuries that result in the total and irrecoverable: of one hand and one foot of the sight of both eyes of both hands or both Loss of the hearing of both ears or loss of use of one arm and one leg Loss of the ability to speak or loss of use of both arms or both legs elimination period. Amounts reduced for covered persons age 65 and over. once per lifetime for each covered person. Insured $100,000 $25,000 $100,000 $20,000

Catastrophic Accident For

(blood test for myeloma) l Stress test on a bicycle or treadmill l Skin cancer biopsy l Thermography l ThinPrep pap test l Virtual colonoscopy Colonial Life 1200 Colonial Life Boulevard Columbia, South Carolina 29210 coloniallife.com ©2011 Colonial Life & Accident Insurance Company. Colonial Life

Health Screening Benefit l $50 per covered person per calendar year Provides a benefit if the covered person has one of the health screening tests performed. This benefit is payable once per calendar year per person and is subject to a 30-day waiting period.

EXCLUSIONS

71740-2-SC

We will not pay benefits for losses that are caused by or are the result of: felonies or illegal occupations; sickness; suicide or self-inflicted injuries; war or armed conflict; in addition to the exclusions listed above, we also will not pay the Catastrophic Accident benefit for injuries that are caused by or are the result of: birth; intoxication.

For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form Accident 1.0-HS-SC. This is not an insurance contract and only the actual policy provisions will control.

are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. Colonial Life and Making benefits count are registered service marks of Colonial Life & Accident Insurance Company. 10/11 BenefitScreeningHealthwith-Preferred1.0Accident My Coverage Worksheet (For use with your Colonial Life benefits counselor) Who will be covered? (check one) Employee Only Spouse Only One Child Only Employee & Spouse One-Parent Family, with Employee One-Parent Family, with Spouse Two-Parent Family When are covered accident benefits available? (check one) On and Off -Job Benefits Off -Job Only Benefits 43

Tests include: l Blood test for triglycerides l Bone marrow testing l Breast ultrasound l CA 15-3 (blood test for breast cancer) l CA125 (blood test for ovarian cancer) l Carotid doppler l CEA (blood test for colon cancer) l Chest x-ray l Colonoscopy l Echocardiogram (ECHO) l Electrocardiogram (EKG, ECG) l Fasting blood glucose test l Flexible sigmoidoscopy l Hemoccult stool analysis l Mammography l Pap smear l PSA (blood test for prostate cancer) l Serum cholesterol test to determine level of HDL and LDL l Serum protein electrophoresis products

ColonialLife.com

Maximum of 15 days per confinement with a 30-day maximum per covered person per calendar year

..................................................................................

Hospital Confinement Indemnity Insurance Plan 1

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

Colonial Life & Accident Insurance Company’s Individual Medical Bridge offers an HSA compatible plan in most states. 44

Waiver of premium Available after 30 continuous days of a covered hospital confinement of the named insured Health savings account (HSA) compatible This plan is compatible with HSA guidelines. This plan may also be offered to employees who do not have HSAs.

For more information, talk with your benefits counselor.

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, mental or emotional disorders, pregnancy of a dependent child, suicide or injuries which any covered person intentionally does to himself or herself, war, or giving birth within the first nine months after the effective date of the policy. We will not pay benefits for hospital confinement of a newborn who is neither injured nor sick. We will not pay benefits for loss during the first 12 months after the effective date due to a pre-existing condition. A preexisiting condition is a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the effective date of the policy.

For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number IMB7000-SC. This is not an insurance contract and only the actual policy provisions will control.

THIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONS

©2016 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. IMB7000 – PLAN 1 | 1-16 | 101576-SC

Observation room $100 per visit Maximum of two visits per covered person per calendar year Rehabilitation unit confinement $100 per day

For more information, talk with your benefits counselor. Hospital Confinement Indemnity Insurance Plan 3 IMB7000 – 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 $ 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 – Amniocentesis – Cervical biopsy – Cone biopsy – Endometrial biopsy Tier 2 diagnostic procedures Cardiac – Angiogram – Arteriogram – Thallium stress test – Transesophageal echocardiogram (TEE) 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 Diagnostic radiology – Computerized tomography scan (CT scan) – Electroencephalogram (EEG) – Magnetic resonance imaging (MRI) – Myelogram – Positron emission tomography scan (PET scan) – Hysteroscopy – Loop (LEEP)excisionalelectrosurgicalprocedure 45

Tier 1 outpatient surgical procedures Breast – Axillary node dissection – Breast capsulotomy – Lumpectomy Cardiac – Pacemaker insertion Digestive – Colonoscopy – Fistulotomy – Hemorrhoidectomy – Lysis of adhesions Skin – Laparoscopic hernia repair – Skin grafting Liver – Paracentesis Ear, nose, throat, mouth – Adenoidectomy – Removal of oral lesions – Myringotomy – Tonsillectomy – Tracheostomy – Tympanotomy Gynecological – Dilation and curettage (D&C) – Endometrial ablation – Lysis of adhesions Musculoskeletal system – Carpal/cubital repair or release – Foot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair) – Removal of orthopedic hardware – Removal of tendon lesion 1-21 | 562942

THIS POLICY PROVIDES LIMITED BENEFITS.

(m)Apre-existingconditionisasicknessorphysicalconditionforwhichacoveredpersonwastreated,hadmedicaltesting, receivedmedicaladviceorhadtakenmedicationwithinthe12monthsbeforetheeffectivedateofthepolicy.(n)This limitationappliestothefollowingbenefits,ifapplicable:HospitalConfinement,DailyHospitalConfinement,Enhanced IntensiveCareUnitConfinementandRehabilitationUnitConfinement. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. Applicable to policy form IMB7000 (including state abbreviations where used, for example: IMB7000TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. This form is not complete without form #562973. 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. 46

Gynecological – Hysterectomy – Myomectomy Musculoskeletal system – Arthroscopic knee surgery with meniscectomy (knee cartilage repair) – Arthroscopic shoulder surgery – Clavicle resection – Dislocations (open reduction with internal fixation) – Fracture (open reduction with internal fixation) – Removal or implantation of cartilage – Tendon/ligament repair Thyroid – Excision of a mass Urologic – Lithotripsy

ColonialLife.com Breast – Breast reconstruction – Breast reduction Cardiac – Angioplasty – Cardiac catheterization Digestive – Exploratory laparoscopy – Laparoscopic appendectomy – Laparoscopic cholecystectomy Ear, nose, throat, mouth – Ethmoidectomy – Mastoidectomy – Septoplasty – Stapedectomy – Tympanoplasty Eye – Cataract surgery – Corneal surgery (penetrating keratoplasty) – Glaucoma surgery (trabeculectomy) – Vitrectomy

EXCLUSIONS

PRE-EXISTING CONDITION LIMITATION (l)Wewillnotpaybenefitsforlossduringthefirst12monthsaftertheeffectivedateduetoapre-existingcondition.

Tier 2 outpatient surgical procedures

Wewillnotpaybenefitsforinjuriesreceivedinaccidentsorforsicknesseswhicharecausedby:(a)alcoholismordrug addiction,(b)dentalprocedures,(c)electiveproceduresandcosmeticsurgery,(d)feloniesorillegaloccupations,(e) pregnancy ofadependentchild,(f)psychiatricorpsychologicalconditions,(g)suicideorinjurieswhichanycoveredperson intentionally doestohimselforherself,or(h)war.Wewillnotpaybenefitsforhospitalconfinement(i)duetogivingbirth withinthefirst ninemonthsaftertheeffectivedateofthepolicyor(j)foranewbornwhoisneitherinjurednorsick.(k)The policymayhave additionalexclusionsandlimitationswhichmayaffectanybenefitspayable.

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.

OR: Pre-existing Condition means having a sickness or physical condition for which any covered person was diagnosed, received treatment, care or medical advice within the 6-month period immediately preceding the effective date of this policy.

The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form IMB7000 (including state abbreviations where used, for example: IMB7000-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. This form is not complete without base form 562880, 562911, or 562942.

FL: (m) Pre-existing Condition means any covered person having a sickness or physical condition that during the 12 months immediately preceding the effective date of this policy had manifested itself in such a manner as would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment or for which medical advice, diagnosis, care, or treatment was recommended or received.

Routine follow-up care during the 12 months immediately preceding the effective date of this policy to determine whether a breast cancer has recurred in a covered person who has been previously determined to be free of breast cancer does not constitute medical advice, diagnosis, care, or treatment for purposes of determining pre-existing conditions, unless evidence of breast cancer is found during or as a result of the follow-up care.

CT: (m) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, received medical advice or had taken medication within 12 months before the effective date of this policy.

NV, WY: (m) applies within the six months before the policy effective date.

NC: (m) Pre-existing Condition means having those conditions whether diagnosed or not, for which any covered person received medical advice, diagnosis, care or treatment was received or recommended within one-year period immediately preceding the effective date of this policy. If you are 65 or older when this policy is issued, pre-existing conditions will include only conditions specifically eliminated by rider.

STATE-SPECIFIC EXCLUSIONS

IL: (m) Pre-existing Condition means having a sickness or physical condition for which any covered person was diagnosed, treated, had medical testing by a legally qualified physician, or received medical advice or had taken medication within 12 months prior to the effective date of this policy.

ME: (m) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, or received medical advice within 12 months before the effective date of this policy.

This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states.

IMB7000 – EXCLUSIONS AND LIMITATIONS | 1-21 | 56297347

AK: (a) Replaced by intoxicants and narcotics CA: (a) Replaced by intoxicants or controlled substances; (c) Replaced by cosmetic surgery CT: (a) Replaced by intoxication or drug addiction; (d) Replaced by felonies; (e) Exclusion does not apply DE: (a) Exclusion does not apply IL: (a) Replaced by alcoholism, intoxication, or drug addiction; (e) Exclusion does not apply; (g) Exclusion does not apply KS: (a) Replaced by intoxicants and narcotics; (f) Exclusion does not apply; (h) Replaced by war or armed conflict; (i) Exclusion does not apply; (j) or requires necessary care and treatment of medically diagnosed congenital defects, birth abnormalities or routine and necessary immunizations KY: (a) Replaced by intoxicants, narcotics and hallucinogenics LA: (a) Replaced by intoxicants and narcotics MN: (a) Replaced by narcotic addiction; (e) Exclusion does not apply; (g) Exclusion does not apply MO: (a) Replaced by drug addiction NC: (i) Exclusion does not apply OR: (a) Exclusion does not apply; (d) Replaced by felony; (i) Replace “nine months” with “six months” SC: (f) Replaced by mental or emotional disorders SD: (a) Exclusion does not apply TN: (a) Replaced by intoxicants and narcotics; (e) Exclusion does not apply TX: (a) Replaced by intoxicants and narcotics WA: (a) Only sicknesses caused by alcoholism or drug addiction are excluded, not accidents

Hospital Confinement Indemnity Insurance Exclusions and Limitations

GA: (m) Pre-existing Condition means having a sickness or physical condition for which any covered person was treated, had medical testing, received medical advice or had taken prescription medication within 12 months before the effective date of this policy.

Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

STATE-SPECIFIC PRE-EXISTING CONDITION LIMITATIONS

This

and limitations which may affect any benefits payable. Applicable to policy form IMB7000 (including state abbreviations where used, for example: IMB7000-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. IMB7000 – HEALTH SCREENING BENEFIT | 1-21 | 101579-4 ColonialLife.com Health screening $_____________ Payable once 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 Chest X-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopy Individual Medical BridgeSM insurance’s health screening benefit can help pay for health and wellness tests you have each year. 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. 48

MO & ND: Waiting period does not apply POLICY PROVIDES LIMITED BENEFITS. information is not intended to be a complete description of provisions unavailable exclusions

THIS

may vary or be

the insurance coverage available. The insurance or its

For more information, talk with your benefits counselor. Hospital Confinement Indemnity Insurance Health Screening

in some states. The policy has

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

Hospital Confinement Indemnity Insurance Medical Treatment Package

For more information, talk with your benefits counselor.

...................................................................................

EXCLUSIONS

|

IMB7000-MEDICAL TREATMENT PACKAGE SOUTH CAROLINA EDUCATORS 3-21 | NS-15014-SC

Maximum of two benefits per covered person per calendar year

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, mental or emotional disorders, suicide or injuries which any covered person intentionally does to himself or herself, or war. 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-SC. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.

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

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

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.

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

THIS POLICY PROVIDES LIMITED BENEFITS. 49

For more information, talk with your benefits counselor.

THIS POLICY PROVIDES LIMITED BENEFITS.

ColonialLife.com

Hospital Confinement Indemnity Insurance Optional Riders

EXCLUSIONS

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.

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, war, or giving birth within the first nine months after the effective date of the rider. 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. A pre-existing condition is a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the effective date of the rider. This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. Applicable to policy form IMB7000 and rider forms R-DHC7000 and R-EIC7000 (including state abbreviations where used, for example: IMB7000-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. This form is not complete without a base form (101576, 101578, 101581, 562880, 562911 or 562942).

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

IMB7000 – DAILY HOSPITAL CONFINEMENT AND ENHANCED INTENSIVE CARE UNIT CONFINEMENT RIDERS | 1-21 | 101582-5

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. 50

ADVANTAGES OF WHOLE LIFE PLUS INSURANCE Permanent coverage that stays the same through the life of the policy Premiums will not increase due to changes in health or age • Accumulates cash value based on a non-forfeiture interest rate of 3.75%1 Policy loans available, which can be used for emergencies Benefit for the beneficiary that is typically tax-free

ADDITIONAL COVERAGE

•

OPTIONS

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

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.

BENEFITS AND FEATURES

Stand-alone spouse policy available even without buying a policy for Abilityyourselftokeep the policy if you change jobs or retire

•

Whole Life Plus Insurance

Give your family peace of mind and coverage for final expenses with Whole Life Plus insurance from Colonial Life.

Immediate $3,000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses Provides cash surrender value at age 100 (when the policy endows) 51

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

Choose the age when your premium payments end — Paid-Up at Age 70 or Paid-Up at Age 100

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 illness2

WHOLE LIFE PLUS (IWL5000)

Chronic care 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.2 A subsequent diagnosis benefit is included.

Critical illness accelerated death benefit rider

| NS-875250 52

To learn more, talk with your benefits counselor. ColonialLife.com

EXCLUSIONS AND LIMITATIONS: If the insured dies by suicide, whether sane or insane, within two years 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 ICC19IWL5000-70/IWL5000-70, ICC19-IWL5000-100/IWL5000-100, ICC19-IWL5000J/IWL5000J and rider forms 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. For cost and complete details of the coverage, call or write your Colonial Life benefits counselor or the company.

Benefits worksheet

1. 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.

FOR LEXINGTON SCHOOL DISTRICT ONE EMPLOYEES

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. Once you are no longer disabled, premium payments will resume.

How much coverage do you need? n YOU $ Select the option: n Paid-Up at Age 70 n Paid-Up at Age 100 n SPOUSE $ Select the option: n Paid-Up at Age 70 n Paid-Up at Age 100 n

For use with your benefits counselor

Accidental death benefit rider

2. 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.

ADDITIONAL COVERAGE OPTIONS (CONTINUED)

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.

Guaranteed purchase option 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.2 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 (bathing, continence, dressing, eating, toileting and transferring). Premiums are waived during the benefit period.

DEPENDENT STUDENT $ Select the option: n Paid-Up at Age 70 n Paid-Up at Age 100 Select any optional riders: n Accidental death benefit rider n Chronic care accelerated death benefit rider n Critical illness accelerated death benefit rider n Guaranteed purchase option rider n Waiver of premium benefit rider

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. 9-21

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.

___________________

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.

Authorization for Colonial Life & Accident Insurance Company

Any information Colonial obtains pursuant to this authorization will be used for the purpose of evaluating my application(s) for insurance or eligibility for benefits. Some information obtained may not be protected by certain federal regulations governing the privacy of health information, but the information is protected by state privacy laws and other applicable laws. Colonial will not disclose the information unless permitted or required by thoseThislaws.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 or Attorney Designee, or Conservator. (Printed name of legal representative) (Signature of legal representative) (Date Signed) 53

54

YES! I want to keep my Colonial Life Coverage. My premiums are no longer being payroll-deducted. Complete this form and mail it today — along with a check for your premium payment. Name: ____________________________________ Daytime Telephone Number: (______) ________________________ Mailing Address: Social Security Number or Date of Birth:_____________________ City: ______________________________________ State:_______________________ Zip: _____________________ Policy number(s) to be ______________________,continued:______________________, ______________________, ______________________, Which Colonial Life & Accident Insurance do you want to continue? (check one or more) Accident Disability Hospital Income Cancer or Critical Illness Life Please choose one of the following payment options: M 1. Deduct premiums monthly from my bank account. M 1st-5th M 6th-10th M 11th-15th M 16th-20th M 21st-26th Your draft will occur on one of the dates within the range you have selected. Please include a voided check or Routing #____________________________ and Account #________________________________ Signature of bank account owner M 2. Bill me directly. (choose one of the following) M Quarterly (Submit a payment 3 times your monthly premium) M Semi-annually (Submit a payment 6 times your monthly premium) M Annually (Submit a payment 12 times your monthly premium) Date: ____________________ Policy Owner ’s Signature:______________________________________________ Return ColonialTo:Life & Accident Insurance Company P.O. Box Columbia,1365South Carolina 29202 1.800.325.4368 (phone) 1.800.561.3082 (fax) Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 10-16 18514-16 55

COLONIAL LIFE • Website: www.coloniallife.com • Claims Fax: 1-800-880-9325 Customer Service & Wellness Screenings: 1-800-325-4368 TDD for hearing impaired customers call: 1-800-798-4040

CONTACT INFORMATION:

VISIT COLONIALLIFE.COM TO SET UP YOUR PERSONAL ACCOUNT

For additional information concerning plans offered to employees of Lexington County School District One, please contact our Pierce Group Benefits Service Center at 1-833-556-0006

• FILE BY PHONE! Call 1-800-325-4368 and provide the information requested by Colonial’s Automated Voice Response System, 24 hours per day, 7 days a week, or SUBMIT ON THE INTERNET using the Wellness Claim Form at www.coloniallife.com, or

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

PEBA - SC STATE HEALTH PLAN Customer Service: 1-803-737-6800 or 1-888-260-9430 Website: www.peba.sc.gov

RETIREMENT SYSTEMS AND

•

Please Note: If your cancer policy includes a second part to the screening benefit, bills for tests covered and a copy of the diagnostic report (reflecting the abnormal reading of your first test) must be mailed or faxed to us for benefits to be provided.

•

If your Wellness/Cancer Screening test was more than 18 months ago, you must fax or mail Colonial a copy of the bill or statement from your doctor indicating the type of procedure performed, the charge incurred and the date of service. Please write your full name, social security number, and current address on the bill.

PIERCE GROUP BENEFITS CUSTOMER SERVICE

If you wish to file a Wellness/Cancer Screening claim for a test performed within the past 18 months, you need the name and date of the test performed as well as your doctor’s name and phone number. Colonial also needs to know if this is for you or another covered individual and their name and social security number. You may:

• Write your name, address, social security number and/or policy/certificate number on your bill and indicate “Wellness Test.” Fax this to Colonial at 1-800-880-9325 or MAIL to PO Box 100195, Columbia, SC 29202

•

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