Hospital Confinement Indemnity Insurance Can you afford the out-of-pocket costs not covered by your health insurance?

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1 Hospital Confinement Indemnity Insurance Can you afford the out-of-pocket costs not covered by your health insurance? coloniallife.com

2 How will you cover all of your medical expenses? As major medical plans move toward larger deductibles and higher co-payments, you may be left with more gaps to fill. Colonial Life & Accident Insurance Company s Hospital Confinement Indemnity insurance plan can help you fill those gaps and help protect against those out-of-pocket expenses that occur when it comes to you or your family members health care. Benefits of this plan include: = Wellness Benefit Pays $50 for one of the wellness tests listed below. Pays one test per calendar year for employee-only coverage; or two tests per calendar year combined for family coverage. This benefit helps reimburse you for part of the expense of tests you may normally have each year. Blood test for triglycerides Colonoscopy or virtual colonoscopy PSA (blood test for prostate cancer) Breast ultrasound Fasting blood glucose Serum protein electrophoresis CA 15-3 (blood test for breast cancer) Flexible sigmoidoscopy (blood test for myeloma) CA 125 (blood test for ovarian cancer) Hemoccult stool analysis Serum cholesterol test for HDL and LDL CEA (blood test for colon cancer) Mammography Stress test on a bicycle or treadmill Chest x-ray Pap smear or thin prep pap Thermography To file your wellness claim, it is not necessary to complete a claim form. Call our toll-free Customer Service number at The following benefits are payable due to a covered accident or covered sickness: = Outpatient Surgical Procedure Benefit Pays a lump-sum benefit when a covered person requires a surgical procedure and is not confined to the hospital at the time of the surgery. The procedure must be performed in a hospital or an ambulatory surgical center. Refer to the outline of coverage for the calendar year maximum and the list of covered procedures. = Hospital Confinement Benefit Pays a lump-sum benefit if any covered person is confined. This benefit can help you pay for the deductibles associated with a hospital confinement. = Rehabilitation Unit Benefit Pays $100 per day up to 15 days per confinement with no more than 30 days per calendar year if any covered person is transferred to a rehabilitation unit immediately after a period of hospital confinement. = Waiver of Premium Benefit Waives the premium for the policy and any attached riders once the named insured has been confined to a hospital for 30 continuous days. The premium is then waived as long as the confinement in a hospital or rehabilitation unit continues.

3 Based on a typical 2006 PPO plan design, the typical American family of four would pay $2,210 out of their own pocket through member cost-sharing. Medical Index 2006, June 30, 2006 Consider the following: The United States spent nearly $2 trillion on health care in Spread over the population, this amounts to about $6,697 per person. Health Care Costs, Kaiser Family Foundation, 2007 Wouldn t you feel better knowing that you or your family have the added protection that Colonial Life can provide to help fill those unexpected gaps? The average length of hospital confinement for adults under age 65 is almost five days. Advance Data from Vital and Health Statistics, National Center for Health Statistics, 2004 National Hospital Discharge Survey, May 4, 2006 With this plan: = Benefits are paid directly to you, unless you specify otherwise. = Your benefits are paid regardless of any other coverage you may have with other insurance companies. = There is no lifetime maximum to any of the benefits under this policy. = If you change jobs or leave your employer, you can take your coverage with you at no increase in premium.

4 Benefit Worksheet For use by Colonial Life Benefits Representative Coverage: (check one) For you (employee only) For you and your dependent children For you and your spouse Flexible Benefit For you, your spouse and your dependent children Premium per Pay Period $ Monthly Premium $ Learn more about these and all of the benefits Colonial Life has to offer at coloniallife.com. This coverage has exclusions and limitations that may affect benefits payable. Coverage type and benefits vary by state and may not be available in all states. See the outline of coverage within for complete details. Applicable to policy form MB3000. This brochure is not complete without the corresponding outline of coverage form MB3000-O, including state variations where applicable, for example, MB3000-O-TX. Colonial Life 1200 Colonial Life Boulevard Columbia, South Carolina coloniallife.com 7/10 Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand

5 Medical BridgeBSMB 3000 Colonial s Medical BridgeBSMB 3000 insurance provides benefits to your employees to help pay for deductible and coinsurance costs, as well as everyday living expenses. And we pay benefits directly to insureds, unless otherwise specified. As the employer, there are several plan options available to you so you may tailor the best plan offering for your employees. You will choose whether to offer the same benefits to all employees or have two classes of employees segmented by the benefits offered to them. You will select plan design(s) to be offered. You may choose one plan per employee class with no more than two plans for your account. Finally, you will select two levels of hospital confinement. These levels cannot be separated by more than $1,000. Employees can choose a level of hospital confinement. Employee; employee and spouse; employee and dependent children; and employee, spouse and dependent plans are available. Features Coverage is guaranteed renewable for life as long as premiums are paid when due or during the grace period. Coverage is portable. An employee can take his coverage with him if he changes jobs or leaves your company. Benefits are paid in addition to other insurance your employees may have with other insurance companies. Benefits are paid directly to the employee unless they specify otherwise or we receive an assignment of benefits. Benefits are paid as a lump sum. There is no elimination period. There is no waiting period. There are no deductibles or lifetime maximums to any of the benefits. Eligibility Requirements Issue ages for both the employee and spouse The Proposed (Named) Insured is the employee or the spouse if the employee is not eligible. The employee must be actively at work at the time of application. The employee must be actively working 20 hours per week. Children younger than the age of 26 are eligible dependents. Participation Requirements For Standard Underwriting, we require only three eligible employees apply. Additional underwriting options include participation requirements. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina PS01171

6 Premium Information Premiums are not based on occupational risk. Premiums are age banded: 17-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, Premiums do not increase as the employee reaches a new age band. Premium levels are available for employee; employee and spouse; employee and dependents; employee, spouse and dependents. Definitions Pre-Existing Condition- is 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. Other Important Provisions Time Limits on Certain Defenses- After this policy has been in force for 12 months from the effective date of this policy, we will pay benefits for any loss as a result of a pre-existing condition not excluded by name or specific description if the covered loss began 12 months after the effective date of the policy, unless credit for previous coverage is applicable. Credit will be given for the time the covered person was covered under previous coverage if the previous coverage was similar to or exceeded the coverage provided under this policy and the previous coverage was continuous to a date not more than 62 days before the effective date of this policy. What is Not Covered General Exclusions and Limitations: Benefits will not be paid for injuries received in accidents or for sicknesses which are caused by: Alcoholism or drug addiction Pregnancy of a dependent child Birth in the first nine months after the Psychiatric or psychological conditions effective date of the policy (only applies to Suicide or injuries which any covered the Hospital Confinement Benefit) person intentionally does to himself Dental procedures War Elective procedures and cosmetic surgery Well Baby Care Illegal activities Pre-existing conditions Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina PS01171

7 The above list does not include a complete description of each limitation and exclusion. To obtain a complete description, please refer to an outline of coverage, sample policy, or see your Colonial representative. Underwriting-- Medical BridgeBSMB 3000 As the employer, you may choose one of the following underwriting options: Post Enrollment Guaranteed Issue (PEGI) Standard Underwriting Post Enrollment Guaranteed Issue (PEGI) Available for hospital confinement levels 1-3 ($500-$1,500); Levels 1-2 ($500-$1,000) for Health Care, Education and Government accounts. Minimum account size is 15+ eligible employees. Requires the greater of 15 lives or 20% participation. Available only at the initial product enrollment and to new hires at subsequent enrollments (if participation was met at the initial enrollment). Pre-existing conditions will apply. Spouse policies will not count toward participation. Dependent children are not eligible for PEGI. Underwriting questions are always asked. If participation requirements are met, Colonial will issue coverage to all employees and their spouses regardless of health questions (provided spouse coverage is applied for). If participation is not met, eligibility and health question information will be evaluated based on underwriting guidelines. Standard Underwriting Available for hospital confinement Levels 1-3 ($500-$1,500); Levels 1-2 ($500, $1,000) for Health Care, Education and Government accounts. Requires the completion of three to five underwriting questions depending on the level of hospital confinement. Pre-existing conditions will apply. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina PS01171

8 Medical BridgeBSMB 3000 Benefits - Plan 2 Base Plan + Outpatient Surgical Procedure Wellness Outpatient Surgical Procedure Hospital Confinement Rehabilitation Unit Waiver of Premium X X X X X Wellness Benefit: $50; one per calendar year for employee only coverage; two per calendar year combined for family coverage. Outpatient Surgical Procedure Benefit*: The employer chooses one option to be offered. Outpatient Surgery Option 1 Option 2 Option 3 Tier 1 $500 $750 $1,000 Tier 2 $1,000 $1,500 $2,000 Calendar Year Maximum per covered person per year $1,500 $2,500 $3,000 Hospital Confinement Benefit*: Six levels from $500-$3000 in $500 increments. You will choose two levels of hospital confinement. The levels cannot be separated by more than $1,000. (For example, $1,000 and $2,000 are acceptable; $1,000 and $2,500 are not.) Level 1: $500 Level 2: $1,000 Level 3: $1,500 Level 4: $2,000 Level 5: $2,500 Level 6: $3,000 Rehabilitation Unit Benefit*: $100 per day up to 15 days per confinement as an inpatient in a rehabilitation unit. 30-day maximum per covered person per calendar year. Must occur immediately after the hospital confinement. Waiver of Premium Benefit: after 30 continuous days of the employee s hospital confinement. Waives premium for the entire policy. *The pre-existing condition limitation is applicable to these benefits. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina PS01154

9 Medical BridgeBSMB 3000 Plan 2 Benefit Amount Options & Monthly Premiums Hospital Confinement Outpatient Outpatient Surgery Tier 1 Surgery Tier 2 BA $500 $500 $1,000 BB $1,000 $500 $1,000 BC **$1,500 $500 $1,000 BD *$2,000 $500 $1,000 BE *$2,500 $500 $1,000 BF *$3,000 $500 $1,000 CA $500 $750 $1,500 CB $1,000 $750 $1,500 CC **$1,500 $750 $1,500 CD *$2,000 $750 $1,500 CE *$2,500 $750 $1,500 CF *$3,000 $750 $1,500 DA $500 $1,000 $2,000 DB $1,000 $1,000 $2,000 DC **$1,500 $1,000 $2,000 DD *$2,000 $1,000 $2,000 DE *$2,500 $1,000 $2,000 DF *$3,000 $1,000 $2,000 *Requires prior underwriting approval based on Major Medical deductible information. ** Requires prior underwriting approval for Health Care, Governmental, and Educator groups based on Major Medical deductible information. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina PS01154

10 Medical Bridge 3000 Plan 2 Monthly Premiums Base Plan + Outpatient Surgical Procedures Employee Issue Age DA DB DC DD DE DF $13.45 $19.25 $25.05 $30.85 $36.65 $ $15.65 $21.95 $28.25 $34.55 $40.85 $ $16.30 $21.95 $27.60 $33.25 $38.90 $ $16.65 $21.85 $27.05 $32.25 $37.45 $ $17.45 $22.95 $28.45 $33.95 $39.45 $ $19.75 $25.90 $32.05 $38.20 $44.35 $ $22.20 $29.10 $36.00 $42.90 $49.80 $ $24.80 $32.90 $41.00 $49.10 $57.20 $ $29.05 $39.10 $49.15 $59.20 $69.25 $ $34.15 $47.30 $60.45 $73.60 $86.75 $ $36.75 $51.70 $66.65 $81.60 $96.55 $ Employee & Spouse Issue Age DA DB DC DD DE DF $25.70 $36.60 $47.50 $58.40 $69.30 $ $29.15 $40.50 $51.85 $63.20 $74.55 $ $30.85 $41.30 $51.75 $62.20 $72.65 $ $31.95 $41.85 $51.75 $61.65 $71.55 $ $34.00 $44.65 $55.30 $65.95 $76.60 $ $38.60 $50.75 $62.90 $75.05 $87.20 $ $44.00 $57.85 $71.70 $85.55 $99.40 $ $50.50 $66.90 $83.30 $99.70 $ $ $59.50 $79.90 $ $ $ $ $67.40 $91.85 $ $ $ $ $74.90 $ $ $ $ $ Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina PS01154

11 Employee & Dependent Children Issue Age DA DB DC DD DE DF $23.00 $32.65 $42.30 $51.95 $61.60 $ $25.50 $35.45 $45.40 $55.35 $65.30 $ $25.95 $35.05 $44.15 $53.25 $62.35 $ $25.80 $34.15 $42.50 $50.85 $59.20 $ $26.60 $35.05 $43.50 $51.95 $60.40 $ $28.35 $37.35 $46.35 $55.35 $64.35 $ $30.85 $40.55 $50.25 $59.95 $69.65 $ $33.80 $44.75 $55.70 $66.65 $77.60 $ $38.20 $51.10 $64.00 $76.90 $89.80 $ $42.20 $57.10 $72.00 $86.90 $ $ $45.95 $63.80 $81.65 $99.50 $ $ Employee, Spouse & Dependent Children Issue Age DA DB DC DD DE DF $32.30 $45.80 $59.30 $72.80 $86.30 $ $35.85 $49.90 $63.95 $78.00 $92.05 $ $37.60 $50.80 $64.00 $77.20 $90.40 $ $38.65 $51.30 $63.95 $76.60 $89.25 $ $40.75 $54.15 $67.55 $80.95 $94.35 $ $45.60 $60.55 $75.50 $90.45 $ $ $50.95 $67.55 $84.15 $ $ $ $57.25 $76.45 $95.65 $ $ $ $63.45 $86.60 $ $ $ $ $74.25 $ $ $ $ $ $81.80 $ $ $ $ $ Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina PS01154