Page 35 - Looks Salon Colonial Benefits Brochure Book

Looks Salon & Spa
Hospital Confinement Indemnity Plan

Plan 3 - Options 1 & 2

Deductions per year: 12 - Monthly Rates These rates were prepared on 4/8/2025 and are valid for 90 days.

Plan 3 - Option 1
Applicable to policy form Individual Medical Bridge
l $1500 Hospital Confinement Benefit and Outpatient Surgical Procedure Benefit with a calendar year maximum of $2500,
Diagnostic Procedure Benefit, $100 Health Screening Benefit. Daily Hospital Confinement benefit, Enhanced Intensive Care
Unit Confinement benefit
ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENT EMPLOYEE, SPOUSE AND
CHILDREN DEPENDENT CHILDREN
17-49 $60.15 $113.10 $77.35 $130.30
50-59 $77.00 $145.00 $94.20 $162.20
60-64 $99.00 $186.85 $116.20 $204.05
65-75 $123.55 $233.60 $140.75 $250.80

Plan 3 - Option 2 Applicable to policy form Individual Medical Bridge

l $2500 Hospital Confinement Benefit and Outpatient Surgical Procedure Benefit with a calendar year maximum of $4500,
Diagnostic Procedure Benefit, $100 Health Screening Benefit. Daily Hospital Confinement benefit, Enhanced Intensive Care
Unit Confinement benefit
ISSUE AGE EMPLOYEE EMPLOYEE AND SPOUSE EMPLOYEE AND DEPENDENT EMPLOYEE, SPOUSE AND
CHILDREN DEPENDENT CHILDREN
17-49 $86.50 $162.90 $114.30 $190.70
50-59 $113.85 $215.10 $141.65 $242.90
60-64 $147.45 $278.50 $175.25 $306.30
65-75 $185.35 $351.05 $213.15 $378.85

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.
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"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.
Andrew Waller | andrew_waller@verizon.net | (410) 707-1059

Underwritten by Colonial Life & Accident Insurance Company
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