Page 46 - Product Summary of Colonial Life_Neat

Plan Designs and Options (employer selections)

Plan 1
Available benefits HSA compliant Plan 2 Plan 3 Employers choose up to two plan designs to offer to their employees.
(where available)
Hospital confinement offers 8 lump-sum benefit levels, ranging from
Hospital confinement „ „ „
$500 - $5,000; employer selects amount.
Observation room is payable after receiving treatment in a hospital
Observation room „ „ „
observation room for less than 20 hours.
Rehabilitation unit confinement is payable when confined to an inpatient
Rehabilitation unit
confinement „ „ „ rehabilitation facility (either as part of a hospital or stand-alone) immediately
following a hospital confinement.
Waiver of premium eliminates premium for policy and applicable riders after 30
Waiver of premium „ „ „ continuous days of a named insured’s covered hospital or rehabilitation
unit confinement.
Outpatient surgical procedure pays a lump-sum benefit per covered
Outpatient surgical surgical procedure; three options ranging from $500 to $3,000; employer
procedure „ „
selects one option.
Diagnostic procedure pays a lump-sum benefit from $250 to
Diagnostic procedure „
$500 per specified diagnostic procedure.

Plan 1
Employer optional benefits HSA compliant Plan 2 Plan 3 Employers may choose up to two optional benefits to add to their plans.
(where available)
Health screening benefit provides one benefit per covered person,
Health screening „ „ „ per calendar year, for 24 different health screening tests ($50 or $100);
employer selects amount.
Medical treatment package benefits include:*
„ Air ambulance: $1,000 per benefit
„ Ambulance: $100 per benefit
„ Appliance: $100 per benefit
Medical treatment package „ „ „ „ Doctor’s office visit: $25 per visit
„ Emergency room visit: $100 per visit
„ X-ray: $25 per benefit
* Plan 1 provides benefits for covered accidents only.

Plan Levels and Options (employee selections)

Employee plan choices Employees may select the coverage type and level that best provides for themselves and their families.

„ Plan design (from selections made available by employer)
„ Hospital confinement level (from those made available by employer)
„ Spouse and dependent child coverage
„ Optional riders below

Plan 1 Employees may also choose optional riders to add to their policies
Employee optional riders HSA compliant Plan 2 Plan 3 at an additional cost.
(where available)
Daily hospital confinement pays a $100 benefit for each day of covered
Daily hospital confinement „ „ „
hospital confinement.
Enhanced intensive care „ „ „ Enhanced intensive care unit confinement pays a $500 benefit for
unit confinement each day of covered confinement in an intensive care unit.

To enroll in this product, the employee must have minimum This product has exclusions and limitations that may affect benefits payable.
essential coverage confirmed at point of enrollment. Plan design and benefits vary by state and may not be available in all states.
If employer selects two plan designs, a maximum of two hospital confinement Benefits subject to maximums and calendar year maximums. See your
levels will be allowed per plan design, separated by no more than $1,000. The Colonial Life benefits representative for complete details.
separation of $1,000 does apply across plans.
©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. 4-15 | 101590