Page 42 - Looks Salon Colonial Benefits Brochure Book

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Critical Illness 1.0 for MD Applicable to policy form CI-1.0

l with Subsequent Diagnosis Coverage, Health Screening Benefit
Non-Tobacco Rates
ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY
$50,000 17-24 $13.45 $20.00 $13.45 $20.00
25-29 $16.45 $25.50 $16.45 $25.50
30-34 $20.45 $31.50 $20.45 $31.50
35-39 $31.45 $48.50 $31.45 $48.50
40-44 $38.95 $60.00 $38.95 $60.00
45-49 $52.95 $81.50 $52.95 $81.50
50-54 $69.95 $108.00 $69.95 $108.00
55-59 $88.45 $135.50 $88.45 $135.50
60-64 $111.45 $171.50 $111.45 $171.50
65-70 $127.45 $195.50 $127.45 $195.50

Tobacco Rates
ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY
$10,000 17-24 $5.15 $7.90 $5.15 $7.90
25-29 $6.35 $9.80 $6.35 $9.80
30-34 $7.95 $12.30 $7.95 $12.30
35-39 $11.05 $17.00 $11.05 $17.00
40-44 $14.35 $22.10 $14.35 $22.10
45-49 $18.45 $28.40 $18.45 $28.40
50-54 $23.25 $35.70 $23.25 $35.70
55-59 $29.55 $45.50 $29.55 $45.50
60-64 $35.65 $54.70 $35.65 $54.70
65-70 $40.65 $62.60 $40.65 $62.60
$20,000 17-24 $8.35 $12.80 $8.35 $12.80
25-29 $10.75 $16.60 $10.75 $16.60
30-34 $13.95 $21.60 $13.95 $21.60
35-39 $20.15 $31.00 $20.15 $31.00
40-44 $26.75 $41.20 $26.75 $41.20
45-49 $34.95 $53.80 $34.95 $53.80
50-54 $44.55 $68.40 $44.55 $68.40
55-59 $57.15 $88.00 $57.15 $88.00
60-64 $69.35 $106.40 $69.35 $106.40
65-70 $79.35 $122.20 $79.35 $122.20

Underwritten by Colonial Life & Accident Insurance Company
Page 2 of 3 See page 3 for Important Notice