Page 16 - Colonial Life Benefits Booklet-CA-California Dairies_Neat

Deductions per year: 12 These rates were prepared on 4/2/2021 and are valid for 90 days.

Group Critical Care for CA Applicable to policy forms GCC1.0-P & GCC1.0-C

l Full CI Benefit, with Subsequent Diagnosis, Diagnosis of Cancer Benefit, $500/12 Cancer Treatment and Care Benefit, $100
Health Screening Benefit, First Diagnosis Building Benefit
Non-Tobacco Rates
ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY
$10,000 16-29 $17.69 $28.81 $18.59 $29.71
30-39 $23.55 $37.51 $24.47 $38.43
40-49 $35.68 $55.81 $36.73 $56.86
50-59 $54.06 $84.50 $55.11 $85.55
60-64 $75.29 $116.78 $76.32 $117.81
$20,000 16-29 $21.29 $34.21 $22.69 $35.61
30-39 $30.65 $48.11 $32.07 $49.53
40-49 $50.38 $77.81 $52.03 $79.46
50-59 $80.96 $125.50 $82.61 $127.15
60-64 $118.59 $182.78 $120.22 $184.41
$50,000 16-29 $32.09 $50.41 $34.99 $53.31
30-39 $51.95 $79.91 $54.87 $82.83
40-49 $94.48 $143.81 $97.93 $147.26
50-59 $161.66 $248.50 $165.11 $251.95
60-64 $248.49 $380.78 $251.92 $384.21

Tobacco Rates
ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY
$10,000 16-29 $21.87 $35.49 $22.88 $36.40
30-39 $30.82 $48.69 $31.75 $49.62
40-49 $50.23 $78.18 $51.28 $79.24
50-59 $79.38 $124.14 $80.43 $125.19
60-64 $114.30 $177.18 $115.33 $178.31
$20,000 16-29 $27.67 $44.19 $29.28 $45.60
30-39 $41.92 $65.19 $43.35 $66.62
40-49 $73.43 $112.98 $75.08 $114.64
50-59 $121.98 $189.44 $123.63 $191.09
60-64 $184.30 $284.18 $185.93 $286.01
$50,000 16-29 $45.07 $70.29 $48.48 $73.20
30-39 $75.22 $114.69 $78.15 $117.62
40-49 $143.03 $217.38 $146.48 $220.84
50-59 $249.78 $385.34 $253.23 $388.79
60-64 $394.30 $605.18 $397.73 $609.11

Important Notice
Insurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to an
outline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage may
not be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
© 2021 Colonial Life & Accident Insurance Company
"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.

Underwritten by Colonial Life & Accident Insurance Company
Page 1 of 2 See page 1 for Important Notice