Attachment_5__Technical_Attachment_5 _Business_Travel_Accident_Insurance_Policy.pdf
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Attachment 5 Technical Attachment 5 Business Travel Accident Insurance Policy
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Business Travel Accident
INSURANCE PROGRAM
Issued by
FEDERAL INSURANCE COMPANY
FOR
The Office of the Comptroller of the Currency
Chubb Underwriting Office: FEDERAL INSURANCE COMPANY 202 Hall's Mill Road P.O. Box 1600 Whitehouse Station, New Jersey 08889-1600
Words and phrases that appear in bold print have special meaning and are defined in the Definitions section(s) of this policy. Defined terms include the plural.
Throughout this policy the words "We", "Us" and "Our" refer to the Company providing this insurance.
Please Read This Policy Carefully
BTA5000
Table of Contents Insuring Agreement
Premium Summary
Schedule Of Benefits
Hazards
Contract
I - Insurance
II - Eligibility
III - Extensions
IV - Maximum Payment for Multiple Losses and Multiple Benefits
V - Territory
VI - Exclusions
VII - Definitions
VIII - General Provisions
Endorsements
Applications
BTA5001
Insuring Agreement
Section I
Chubb Group of Insurance Companies 15 Mountain View Road, P.O. Box 1615 Warren, New Jersey 07061-1615
Policyholder's Name and Address:
The Office of the Comptroller of the Currency
250 E STREET, SW
WASHINGTON, DC 20219
Issued by the stock insurance companyPolicy Number: 9906-76-95 indicated below:Effective Date: 1/1/2010 FEDERAL INSURANCE COMPANYAnniversary Date: January 1 Incorporated under the laws of
INDIANA
BTA5002
Section II Policy Period and Company
Policy Period
To: 1/1/2015From: 1/1/2010 12:01 A.M. standard time at the Policyholder's address shown in Section I of the Insuring Agreement.
This insurance is provided by the Company in consideration of payment of the required premium.
The insurance under this policy begins on the Effective Date shown in Section I of the Insuring Agreement.
The insurance under this policy ends on the last day of the Policy Period shown in Section II of the Insuring Agreement.
The Policyholder's acceptance of this policy terminates any prior policy of the same policy number, effective with the inception of this policy.
Company
The Company issuing this policy has caused this policy to be signed by it's authorized officers, but this policy shall not be valid unless also signed by a duly authorized representative of the Company.
FEDERAL INSURANCE COMPANY (Incorporated under the laws of INDIANA)
SecretaryPresident
Authorized Representative
BTA5004
Premium Summary
Section I - Premium Due Date
01/01/2010
Section II - Premium Payment
The Policyholder shown in Section I of the Insuring Agreement is responsible for the collection and remittance of all required premiums. Premiums are calculated and payable as follows:
Business Travel Accident $80,465, payable in five annual installments of $16,093
Amount Due:
Any premiums shown as subject to adjustment will be adjusted as stated in the Premium Provisions under Section VIII - General Provisions of the Contract.
BTA5006
Schedule of Benefits
Chubb Group of Insurance Companies 15 Mountain View Road, P.O. Box 1615 Warren, New Jersey 07061-1615
Policyholder's Name:
The Office of the Comptroller of the Currency
Issued by the stock insurance company indicated below:
FEDERAL INSURANCE COMPANY
Incorporated under the laws of
INDIANA
BTA6000
Section I - Insured Persons
The following are the Insured Persons under this policy:
DescriptionClass All Active Full-Time Employees of the Policyholder1 The Prospective Employees and Guests of the Policyholder2 The Spouse or Domestic Partner of a Primary Insured3 The Dependent Child(ren) of a Primary Insured4
BTA6002
If, subject to all the terms and conditions of this policy a person is eligible for insurance under multiple Classes of Insured Persons described above, then such person will only be insured under the Class which provides the Insured Person the largest Benefit Amount for the loss that has occurred.
BTA6004
Section II - Qualification Period
For Insured Persons in an eligible Class on the Effective Date: none For Insured Persons entering an eligible Class after the Effective Date: none
BTA6008
Section III - Hazards
The following are the Hazards for which insurance applies:
Hazard(s)Class 24 Hour Business Travel1 Non-Employee Business Travel2 Business Travel Family3 Business Travel Family4
If, subject to all the terms and conditions of this policy an Insured Person has insurance for covered loss on the date of an Accident, covered under multiple Hazards described above, then only one Benefit Amount will be paid. This Benefit Amount shall be the largest Benefit Amount applicable under all such Hazards.
BTA6010 (Ed. 7/06)
Section IV - Benefits
A) Principal Sum
The following are Principal Sums for each Class:
Principal SumHazardClass Five (5) times Salary subject to a Minimum of $50,000 and a Maximum of $1,000,000
24 Hour Business Travel1
$50,000Non-Employee Business Travel2 $50,000Business Travel Family3 $10,000Business Travel Family4
BTA6012
B) Accidental Death and Dismemberment Benefits:
This benefit applies to all Classes of Insured Persons. The following are Losses insured and the corresponding Benefit Amount expressed as a percentage of the Principal Sum:
Class(es) All
Benefit Amounts (Percentage of Principal Sum)
Accidental:
100%Loss of Life 100%Loss of Speech and Loss of Hearing
100% Loss of Speech and one of Loss of Hand, Loss of Foot or Loss of Sight of One Eye
100% Loss of Hearing and one of Loss of Hand, Loss of Foot or Loss of Sight of One Eye
100% Loss of Hands (Both), Loss of Feet (Both), Loss of Sight or a combination of any two of Loss of Hand, Loss of Foot or Loss of Sight of One Eye
100%Quadriplegia 75%Paraplegia 50%Hemiplegia
50% Loss of Hand, Loss of Foot or Loss of Sight of One Eye (Any one of each)
50%Loss of Speech or Loss of Hearing 25%Uniplegia 25%Loss of Thumb and Index Finger of the same hand
This Benefit Amount is subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.
BTA6016
If an Insured Person has multiple Losses as the result of one Accident, then We will pay only the single largest Benefit Amount applicable to the Losses suffered, as described in Section IV - Maximum Payment For Multiple Losses and Multiple Benefits of the Contract.
BTA6018
C) Additional Benefits
The following are Benefit Amounts for all other benefits provided under this policy:
Checked Baggage Class 1
Maximum Benefit Amount $1,000 Jewelry and Watches $250 Cameras, Video Recorders and other Electronic equipment $250
Class 2 Maximum Benefit Amount $1,000
Jewelry and Watches $250 Cameras, Video Recorders and other Electronic equipment $250
Class 3 Maximum Benefit Amount $1,000
Jewelry and Watches $250 Cameras, Video Recorders and other Electronic equipment $250
Class 4 Maximum Benefit Amount $1,000
Jewelry and Watches $250 Cameras, Video Recorders and other Electronic equipment $250
The Benefit Amounts shown above for Jewelry and Watches and for Cameras, Video Recorders and other Electronic equipment are part of and not in addition to the Maximum Benefit Amount for Checked Baggage.
Payment of these Benefit Amounts reduces and does not increase the Maximum Benefit Amount for Checked Baggage.
This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.
BTA6094
Carjacking Class 1
Benefit Amount 10% of the Principal Sum up to a maximum of $25,000 Class 2
Benefit Amount 10% of the Principal Sum up to a maximum of $25,000 Class 3
Benefit Amount 10% of the Principal Sum up to a maximum of $25,000 Class 4
Benefit Amount 10% of the Principal Sum up to a maximum of $25,000 This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.
BTA6024
Coma Class 1
Benefit Amount 1% per month of the Principal Sum Maximum Benefit Amount 100% of the Principal Sum
Class 2 Benefit Amount 1% per month of the Principal Sum Maximum Benefit Amount 100% of the Principal Sum
Class 3 Benefit Amount 1% per month of the Principal Sum Maximum Benefit Amount 100% of the Principal Sum
Class 4 Benefit Amount 1% per month of the Principal Sum Maximum Benefit Amount 100% of the Principal Sum
This Benefit Amount is subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.
BTA6032
Medical Evacuation and Repatriation Class 1
Maximum Benefit Amount $250,000 Benefit Amount(Hospital Admission Guaranty) $5,000 Family Travel Expense
(Maximum Per Day) $100 (Maximum Number of Days) 5
Class 2 Maximum Benefit Amount $250,000
Benefit Amount(Hospital Admission Guaranty) $5,000 Family Travel Expense
(Maximum Per Day) $100 (Maximum Number of Days) 5
Class 3 Maximum Benefit Amount $250,000
Benefit Amount(Hospital Admission Guaranty) $5,000 Family Travel Expense
(Maximum Per Day) $100 (Maximum Number of Days) 5
Class 4 Maximum Benefit Amount $250,000
Benefit Amount(Hospital Admission Guaranty) $5,000 Family Travel Expense
(Maximum Per Day) $100 (Maximum Number of Days) 5
The Benefit Amounts shown above for Hospital Admission Guaranty and Family Travel Expense, are part of, and not in addition to, the Maximum Benefit Amount for Medical Evacuation and Repatriation. This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.
BTA6056 (Ed. 7/06)
Psychological Therapy Class 1
Benefit Amount 5% of the Principal Sum up to a maximum of $25,000 Class 2
Benefit Amount 5% of the Principal Sum up to a maximum of $25,000 Class 3
Benefit Amount 5% of the Principal Sum up to a maximum of $25,000 Class 4
Benefit Amount 5% of the Principal Sum up to a maximum of $25,000 This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.
BTA6072
Rehabilitation Expense Class 1
Benefit Amount 5% of the Principal Sum up to a maximum of $25,000 Class 2
Benefit Amount 5% of the Principal Sum up to a maximum of $25,000 Class 3
Benefit Amount 5% of the Principal Sum up to a maximum of $25,000 Class 4
Benefit Amount 5% of the Principal Sum up to a maximum of $25,000 This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.
BTA6074
Seat Belt and Occupant Protection Device Class 1
Benefit Amount for Seat Belt 10% of the Principal Sum Alternate Benefit Amount $2,000 Benefit Amount for Occupant Protection Device 10% of the Principal Sum Maximum Benefit Amount for Seat Belt and Occupant Protection Device 20% of the Principal Sum to a maximum of $50,000 Class 2
Benefit Amount for Seat Belt 10% of the Principal Sum Alternate Benefit Amount $2,000 Benefit Amount for Occupant Protection Device 10% of the Principal Sum Maximum Benefit Amount for SeatBelt and Occupant Protection Device 20% of the Principal Sum to a maximum of $50,000 Class 3
Benefit Amount for Seat Belt 10% of the Principal Sum Alternate Benefit Amount $2,000 Benefit Amount for Occupant Protection Device 10% of the Principal Sum Maximum Benefit Amount for SeatBelt and Occupant Protection Device 20% of the Principal Sum to a maximum of $50,000 Class 4
Benefit Amount for Seat Belt 10% of the Principal Sum Alternate Benefit Amount $2,000 Benefit Amount for Occupant Protection Device 10% of the Principal Sum Maximum Benefit Amount for SeatBelt and Occupant Protection Device 20% of the Principal Sum to a maximum of $50,000 This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.
BTA6080
Section V - Aggregate Limit of Insurance
$5,000,000 per Accident
If more than one (1) Insured Person suffers a Loss in the same Accident, then We will not pay more than the Aggregate Limit of Insurance shown above. If an Accident results in Benefit Amounts becoming payable, which when totaled, exceed the applicable Aggregate Limit of Insurance shown above, then the Aggregate Limit of Insurance will be divided proportionally among the Insured Persons, based on each applicable Benefit Amount.
BTA6088
Insurance only applies for the Classes, Hazards, Benefits and Losses that are specifically indicated as insured.
BTA6090
Hazards
Business Travel Family Hazard
Business Travel Family Hazard means all circumstances, subject to the terms and conditions of this policy, to which a Dependent of a Primary Insured Person may be exposed while traveling in connection with the Primary Insured Person's Business Travel or Relocation Travel, provided that all such travel is authorized by, and at the expense of, the Policyholder.
The insurance under this Business Travel Family Hazard begins at the actual start of Business Travel or Relocation Travel whether the point of origin is from the Dependent's residence or regular place of employment, whichever occurs last. This Business Travel Family Hazard ends immediately upon return to a Dependent's residence or regular place of employment, whichever occurs first.
This Business Travel Family Hazard includes Personal Excursion.
Limitation on Business Travel Family Hazard
With respect to this Business Travel Family Hazard:
1) no person insured as a Primary Insured Person can be insured as a Dependent; and
2) no person shall be insured as a Dependent of more than one Primary Insured Person.
BTA5514
Non-Employee Business Travel Hazard
Non-Employee Business Travel Hazard means all circumstances, subject to the terms and conditions of this policy, arising from and occurring while a Primary Insured Person is:
1) on Business Travel;
2) on Relocation Travel; or
3) on assignment for the purpose of furthering the Policyholder's business interests, at the Policyholder's authorization, direction and expense.
Insurance under this Non-Employee Business Travel Hazard begins at the actual start of Business Travel, Relocation Travel or assigned travel, whether the point of origin is from a Primary Insured Person 's residence or regular place of employment, whichever occurs last. Insurance under this Non-Employee Business Travel Hazard ends immediately upon return to a Primary Insured Person 's residence or regular place of employment, whichever occurs first.
BTA5511
24 Hour Business Travel Hazard
24 Hour Business Travel Hazard means all circumstances, subject to the terms and conditions of this policy, arising from and occurring while the Primary Insured Person is on Business Travel or Relocation Travel.
Insurance under this 24 Hour Business Travel Hazard begins at the actual start of Business Travel or Relocation Travel whether the point of origin is from the Primary Insured Person's residence or regular place of employment, whichever occurs last. Insurance under this 24 Hour Business Travel Hazard ends immediately upon return to the Primary Insured Person's residence or regular place of employment, whichever occurs first.
24 Hour Business Travel Hazard does not include Commutation. 24 Hour Business Travel Hazard includes Personal Excursion.
BTA5528
Contract
Section I - Insurance
Subject to all the terms and conditions of this policy and the payment of required premium, We will provide the following insurance:
Accidental Death and Dismemberment
We will pay the applicable Benefit Amount, shown in Section IV-B of the Schedule of Benefits, if an Accident results in a covered Loss not otherwise excluded. The Accident must result from an insured Hazard and occur while an Insured Person is insured under this policy, while it is in force. The covered Loss must occur within one (1) year after the Accident.
BTA5010
Carjacking
We will pay the Benefit Amount for Carjacking, shown in Section IV-C of the Schedule of Benefits, if an Insured Person suffers a covered Loss resulting from Accidental Bodily Injury due to Carjacking.
The Benefit Amount for Carjacking is payable in addition to any other applicable Benefit Amounts under this policy.
BTA5016
Checked Baggage
We will reimburse the Primary Insured Person up to the Maximum Benefit Amount for Checked Baggage, shown in Section IV-C of the Schedule of Benefits, for amounts actually paid by the Primary Insured Person for direct physical loss or damage to Checked Baggage and personal property contained therein, if direct physical loss (including theft) or damage of Checked Baggage occurs during Business Travel while in the possession of the Common Carrier.
The Checked Baggage Benefit is excess over any other insurance (including homeowners) or indemnity (including any reimbursements by the airline, cruise line, railroad, station authority, occupancy provider) available to the Primary Insured Person. Our liability will be the actual cash value (replacement cost less depreciation) of the articles at the time of loss.
With respect to Jewelry and Watches, and Cameras, Video Recorders and other electronic equipment, Our payment is limited to the Benefit Amount as shown in Section IV-C of the Schedule of Benefits. In no event will we pay more than the Maximum Benefit Amount as shown in Section IV-C of the Schedule of Benefits in any twelve (12) consecutive month period regardless of the number of Checked Baggage claims made in that twelve (12) month period.
We will not reimburse the Insured Person for loss of documents or valuable papers, money, securities, tickets, checks, traveler's checks or furs.
BTA5017
Coma
We will pay the Benefit Amount for Coma, shown in Section IV-C of the Schedule of Benefits, if Accidental Bodily Injury causes an Insured Person to:
1) lapse into a Coma within thirty (30) days after the Accident;
2) remain in a Coma for thirty (30) consecutive days; and
3) be confined to a Hospital or other licensed facility to receive Medically Necessary treatment for Coma, prescribed and supervised by a Physician, within the first thirty (30) days following the Accident.
The Benefit Amount for Coma will be the percentage of the Insured Person's Principal Sum, shown in Section IV - C of the Schedule of Benefits. The Benefit Amount for Coma is payable monthly subject to the Maximum Benefit Amount for Coma shown in Section IV-C of the Schedule of Benefits.
Brief lapses from Coma will not be considered an interruption of the consecutive thirty (30) day period, or cause a discontinuance in Our payment, if the lapses and subsequent Coma recurrences are due to the same Accident.
The Coma monthly payment will be made until the earliest of the date:
1) the Insured Person dies;
2) the Insured Person is no longer in a Coma; or
3) total payments equal the Maximum Amount for Coma, shown in Section IV-C of the Schedule of Benefits.
If an Insured Person dies within 365 days after the Accident, then We will pay a lump sum equal to the Insured Person's Principal Sum, less any Benefit Amount for Coma already paid.
BTA5024
Medical Evacuation and Repatriation
If an Insured Person's Accidental Bodily Injury, disease or illness occurs while insured under a Hazard and requires the Medical Evacuation or Repatriation of the Insured Person while the Insured Person is on a covered trip, then We will pay the Covered Expenses for such Medical Evacuation or Repatriation up to the Benefit Amount for Medical Evacuation and Repatriation, shown in Section IV-C of the Schedule of Benefits. The Benefit Amount for Medical Evacuation or Repatriation is payable in addition to any other applicable Benefit Amounts under this policy.
This insurance applies only if the covered trip:
1) is more than 100 miles from the Insured Person's primary residence; and
2) lasts no more than 180 consecutive days.
The Medical Evacuation or Repatriation must be ordered by a Physician, who certifies that the Medical Evacuation or Repatriation is necessary to prevent death or serious deterioration of the Insured Person's medical condition. The Medical Evacuation or Repatriation must be approved and arranged by Our Assistance Services Administrator.
If an Insured Person's Accidental Bodily Injury, disease or illness occurs during an insured Hazard and requires Emergency Medical Treatment while the Insured Person is on a covered trip, then We will guarantee payment of the Hospital Admission Guaranty incurred for such Emergency Medical Treatment up to the Benefit Amount for Hospital Admission Guaranty, shown in Section IV-C of the Schedule of Benefits. The Assistance Services Administrator must approve the Hospital Admission Guaranty.
If an Insured Person's Accidental Bodily Injury, disease or illness occurs during an insured Hazard and requires a Hospital stay for more than five (5) day(s) while the Insured Person is on a covered trip, then We will pay the Benefit Amount for Family Travel Expense, if all the following conditions are met:
1) the Insured Person is confined to a Hospital; and
2) the Hospital is at least seventy five (75) miles from the Insured Person's permanent residence;
and
3) all transportation arrangements for an Immediate Family Member are made by Our Assistance Services Administrator and are by the most direct and economical route.
If an Insured Person's Accidental Bodily Injury, disease or illness occurs during an insured Hazard and requires a Hospital stay for more than five (5) day(s) while the Insured Person is on a covered trip, then We will pay for an accompanying Dependent Child to return to his or her primary residence. All transportation arrangements must be made by Our Assistance Services Administrator and shall be by the most direct and economical route.
The Benefit Amount for Medical Evacuation or Repatriation is payable on an excess basis. We will determine the charges for Medical Evacuation or Repatriation. We will then reduce that amount by amounts already paid or payable by any Other Plan. We will pay the resulting Benefit Amount. The Benefit Amounts for Hospital Admission Guaranty, and Family Travel Expense, are part of, and not in addition to, the Maximum Benefit Amount for Medical Evacuation and Repatriation. In no event will We pay more than the Maximum Benefit Amount for Medical Evacuation or Repatriation shown in Section IV-C of the Schedule of Benefits.
With respect to Medical Evacuation and Repatriation only, the Disease or Illness Exclusion in Section VI - General Exclusions of the Contract does not apply.
BTA5046 (Ed. 7/06)
Psychological Therapy Expense
We will reimburse Psychological Therapy Expense up to the Benefit Amount for Psychological Therapy Expense, shown in Section IV-C of the Schedule of Benefits, if an Accidental Bodily Injury causes an Insured Person to suffer a covered Loss resulting in a Physician's determination that Psychological Therapy is required for:
1) such Insured Person; or
2) a Dependent .
The Benefit Amount for Psychological Therapy Expense is payable on an excess basis. We will determine the charge for the Psychological Therapy Expense. We will then reduce that amount by amounts already paid or payable by any Other Plan. We will pay the resulting Benefit Amount, but in no event will We pay more than the Benefit Amount for Psychological Therapy Expense shown in Section IV-C of the Schedule of Benefits.
The Benefit Amount for Psychological Therapy Expense will be paid:
1) to the natural person who incurs the expense; and
2) in addition to any other applicable Benefit Amounts under this policy.
The Benefit Amount for Psychological Therapy Expense will be paid until the earlier of the date on which:
1) the total Benefit Amount for Psychological Therapy Expense, shown in Section IV-C of the
Schedule of Benefits, has been paid; or
2) two (2) years have elapsed from the date of a covered Loss.
BTA5062
Rehabilitation Expense
We will reimburse Rehabilitation Expense up to the Benefit Amount for Rehabilitation Expense, shown in Section IV-C of the Schedule of Benefits, if Accidental Bodily Injury causes an Insured Person to suffer a covered Loss which:
1) prevents an Insured Person from performing all the duties of such Insured Person's regular occupation; and
2) requires such Insured Person to obtain Rehabilitation, as determined by a Physician approved by Us.
The Benefit Amount for Rehabilitation Expense is payable on an excess basis. We will determine the charge for the Rehabilitation Expense. We will then reduce that amount by amounts already paid or payable by any Other Plan. We will pay the resulting Benefit Amount, but in no event will We pay more than the Benefit Amount for Rehabilitation Expense shown in Section IV-C of the Schedule of Benefits.
The Benefit Amount for Rehabilitation Expense is payable in addition to any other applicable Benefit Amounts under this policy. We will pay the Benefit Amount for Rehabilitation Expense to the natural person who incurs the expense.
We will pay the Benefit Amount for Rehabilitation Expense until the earlier of the date on which:
1) the total Rehabilitation Expense Benefit Amount, shown in Section IV-C of the Schedule of
Benefits, has been paid; or
2) two (2) years have elapsed from the date of the Accidental Bodily Injury.
BTA5066
Seat Belt and Occupant Protection Device
We will pay the Benefit Amount for Seat Belt shown in Section IV-C of the Schedule of Benefits if an Insured Person suffers an Accidental Bodily Injury resulting in a covered Loss of Life while such Insured Person is operating or riding in a Private Passenger Automobile, and using a Seat Belt.
The Seat Belt must have been properly secured, and used in accordance with the recommendations of its manufacturer. If it cannot be determined whether an Insured Person was using a Seat Belt, then the Alternate Benefit Amount for Seat Belt, shown in Section IV-C of the Schedule of Benefits will be paid.
We will also pay the Benefit Amount for an Occupant Protection Device, shown in Section IV-C of the Schedule of Benefits, if an Insured Person suffers an Accidental Bodily Injury as set forth above and such Insured Person is positioned in a seat protected by a properly deployed Occupant Protection Device.
The Benefit Amount for an Occupant Protection Device will only be paid if We pay a Benefit Amount for Seat Belt other than an Alternate Benefit Amount .
Verification of the actual use of the Seat Belt and proper operation of the Occupant Protection Device at the time of an Accident must be part of an official report of such Accident or be certified, in writing, by an investigating police officer.
In no event will a Benefit Amount for Seat Belt be paid if an Insured Person is operating or riding as a passenger in any vehicle used for a race or contest of any type.
The Benefit Amount for Seat Belt and Benefit Amount for Occupant Protection Device are payable in addition to any other applicable Benefit Amounts under this policy.
In no event will Our total payments of a Benefit Amount for Seat Belt and a Benefit Amount for Occupant Protection Device exceed the Maximum Benefit Amount, shown in Section IV - C of the Schedule of Benefits.
BTA5070
Section II - Eligibility, Effective Date and Termination
Eligibility
A person becomes insured under this policy if:
1) such person is a member of an eligible Class of Insured Persons as shown in Section I of the
Schedule of Benefits;
2) such person has completed any required Qualification Period as shown in Section II of the Schedule of Benefits; and
3) the required premium for such person has been paid.
BTA5080
Effective Date of Insurance for an Insured Person
Insurance for an Insured Person becomes effective on the latest of:
1) the effective date of this policy;
2) the date on which such person first meets the eligibility criteria as an Insured Person; or
3) the beginning of the period for which required premium is paid for such Insured Person.
BTA5082
Termination of Insurance for an Insured Person
Insurance for an Insured Person automatically terminates on the earliest of:
1) the termination date of this policy;
2) the expiration of the period for which required premium has been paid for such Insured Person;
3) the date on which a person no longer meets the eligibility criteria as an Insured Person.
BTA5084
Section III - Extensions Of Insurance
Extensions of Insurance are subject to the provisions of Section I-Insurance of the Contract, and all other policy terms and conditions.
Disappearance
If an Insured Person has not been found within one (1) year of the disappearance, stranding, sinking, or wrecking of any Conveyance in which an Insured Person was an occupant at the time of the Accident, then it will be assumed, subject to all other terms and conditions of this Policy, that an Insured Person has suffered Loss of Life insured under this policy.
BTA5088
Exposure
If an Accident resulting from an insured Hazard causes an Insured Person to be unavoidably exposed to the elements and as a result of such exposure an Insured Person has a Loss, then such Loss will be insured under this policy.
BTA5090
Section IV - Maximum Payment for Multiple Losses and Multiple Benefits
For any Benefit Amount identified as subject to this provision in the Schedule of Benefits, payment of such Benefit Amount will reduce the Principal Sum. If, subject to all the terms and conditions of this policy, an Insured Person is entitled to receive payment of multiple Benefit Amounts as the result of one (1) Accident, then the maximum We will pay for all benefits shall not exceed the Principal Sum.
For any Benefit Amount identified as not subject to this provision in the Schedule of Benefits, payment of such Benefit Amount will be in addition to any Principal Sum payable under this policy.
If, subject to all the terms and conditions of this policy, an Insured Person suffers multiple covered Losses as the result of one (1) Accident, then We will only pay the single largest Benefit Amount applicable to all such covered Losses.
For the purposes of this provision the definition of Loss includes Coma.
BTA5092
Section V - Territory
This insurance applies worldwide.
BTA5094
Section VI - General Exclusions
The following exclusions apply to all benefits or Hazards under this policy. Additional exclusions, limitations or conditions may also apply to specific benefits or Hazards. Please read this entire policy carefully.
Owned Aircraft, Leased Aircraft, or Operated Aircraft
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly, an Insured Person being in, entering, or exiting any aircraft:
1) owned, leased or operated by the Policyholder or on the Policyholder's behalf; or
2) operated by an employee of the Policyholder on the Policyholder's behalf.
BTA5095 (Ed. 7/06)
Aircraft Pilot or Crew
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly, an Insured Person entering, or exiting any aircraft while acting or training as a pilot or crew member.
This exclusion does not apply to passengers who temporarily perform pilot or crew functions in a life-threatening emergency.
BTA5098 (Ed. 7/06)
Disease or Illness
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly, an Insured Person's emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection, bodily malfunctions or medical or surgical treatment thereof.
This exclusion does not apply to an Insured Person's bacterial infection caused by an Accident or by Accidental consumption of a substance contaminated by bacteria.
BTA5102 (Ed. 7/06)
Incarceration
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly any occurrence while an Insured Person is incarcerated after conviction.
BTA5106
Service in the Armed Forces
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly, an Insured Person participating in military action while in active military service with the armed forces of any country or established international authority. However, this exclusion does not apply to the first sixty (60) consecutive days of active military service with the armed forces of any country or established international authority.
BTA5116
Specialized Aviation
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly, an Insured Person traveling or flying on any aircraft engaged in Specialized Aviation Activities.
BTA5118
Suicide or Intentional Injury
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly, an Insured Person's suicide, attempted suicide or intentionally self-inflicted injury.
BTA5120
Trade Sanctions
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss when:
1) the United States of America has imposed any trade or economic sanctions prohibiting insurance of any Accident, Accidental Bodily Injury or Loss; or
2) there is any other legal prohibition against providing insurance of any Accident, Accidental Bodily Injury or Loss.
BTA5122
War
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly, a declared or undeclared War.
BTA5126DC
Section VII - Definitions
For the purpose of these definitions, the singular includes the plural and the plural includes the singular, unless otherwise noted.
Accident or Accidental
Accident or Accidental means a sudden, unforeseen, and unexpected event which:
1) happens by chance;
2) arises from a source external to an Insured Person;
3) is independent of illness, disease or other bodily malfunction or medical or surgical treatment thereof;
4) occurs while the Insured Person is insured under this policy which is in force; and
5) is the direct cause of loss.
BTA5600
Accidental Bodily Injury
Accidental Bodily Injury means bodily injury, which:
1) is Accidental;
2) is the direct cause of a loss; and
3) occurs while an Insured Person is insured under this policy, which is in force.
Accidental Bodily Injury does not mean a Repetitive Motion Injury.
BTA5602 (Ed. 7/06)
Actively at Work or Active Work
Actively at Work, or Active Work means a person is performing the material and substantial duties of his or her regular occupation for compensation.
BTA5606
Assistance Services Administrator
Assistance Services Administrator means the organization that contracts with the Company to provide Medical Evacuation and Repatriation services to an Insured Person.
BTA5610
Benefit Amount
Benefit Amount means the amount stated in the Schedule of Benefits for this policy which applies:
1) at the time of an Accident;
2) to an Insured Person; and
3) for the applicable Hazard.
BTA5612
Business Travel
Business Travel means travel by a Primary Insured Person who is :
1) away from such Primary Insured Person's regular place of employment;
2) at the authorization, direction and expense of the Policyholder;
3) on the Policyholder's business; and
4) for periods of 180 days or less.
Business Travel does not include Commutation. Business Travel includes Personal Excursion.
BTA5622 (Ed. 7/06)
Carjacking
Carjacking means the unlawful forced removal or detention of an Insured Person while operating or riding as a passenger in, boarding or alighting from, a Private Passenger Automobile during the theft or attempted theft of such Private Passenger Automobile. The Carjacking must be confirmed in writing by a police report in the jurisdiction where the Loss occurs.
BTA5626
Checked Baggage
Checked Baggage means suitcases or other containers specifically designated for carrying personal property, for which a claim check has been issued to the Primary Insured Person by a Common Carrier. The Checked Baggage must be in the possession, care and control of the Common Carrier.
BTA5627
Class
Class means the categories of Insured Persons described in Section I of the Schedule of Benefits.
BTA5628
Coma
Coma means a profound state of unconsciousness, as determined by a Physician according to the Glasgow Coma Scale, from which an Insured Person cannot be aroused to consciousness even by powerful stimulation.
BTA5632
Commission
Commission means the actual commission paid by the Policyholder during the twelve (12) months immediately preceding the date of the Accident. During the first twelve (12) months a Primary Insured Person is employed the commission will be calculated by multiplying the average monthly commission at the time of the Accident by twelve (12).
BTA5640
Common Carrier
Common Carrier means any motorized land, water or air Conveyance; operated by an organization other than the Policyholder; organized and licensed for the transportation of passengers for hire and operated by an employee or an individual under contract. Common Carrier does not include any Conveyance used for recreational activities.
BTA5644
Commutation
Commutation means travel between a Primary Insured Person's residence and regular place of employment.
BTA5646
Company
Company means FEDERAL INSURANCE COMPANY.
BTA5648
Conveyance
Conveyance means any motorized craft, vehicle or mode of transportation licensed or registered by a governmental authority with competent jurisdiction.
BTA5650
Covered Expenses
1) With respect to Medical Evacuation, Covered Expenses means the cost for:
1) a land, water or air Conveyance, required to transport an Insured Person during a Medical Evacuation. Special transportation by, but not limited to, air ambulances, land ambulances and private motor vehicles must:
a) be recommended by an attending Physician; and
b) comply with the standard regulations of the Conveyance transporting an Insured Person.
The means of transportation that is best suited to accommodate an Insured Person, based on the seriousness of an Insured Person's condition, will be used.
2) medical supplies and services which are:
a) ordered or prescribed by an attending Physician; and
b) are, in the opinion of an attending Physician, necessarily incurred in connection with the Medical Evacuation of an Insured Person.
2) With respect to Repatriation, Covered Expenses means the cost for:
1) Repatriation of an Insured Person; and
2) medical supplies and services which:
a) are ordered or prescribed by an attending Physician;
b) are, in the opinion of an attending Physician, necessarily incurred in connection with Repatriation of an Insured Person; and
c) are the necessary expenses for embalming, cremation, transportation and purchase of a shipping container as required by applicable law or regulation.
With respect to Medical Evacuation and Repatriation, all transportation arrangements made for an Insured Person will be by the most direct and economical route. All Covered Expenses must be arranged and receive the prior approval of Our Assistance Service Administrator.
Covered Expenses do not include those expenses incurred by an Insured Person for Accidental Bodily Injury, illness or disease, which occurs while an Insured Person is:
1) traveling against the advice of a Physician; or
2) traveling for the purpose of obtaining medical treatment.
BTA5654
Dependent
Dependent means a Dependent Child, Spouse or Domestic Partner of a Primary Insured Person.
BTA5660
Dependent Child
Dependent Child means a Primary Insured Person's unmarried child from the moment of birth, including a natural child, grandchild, stepchild or adopted child from the date of placement with a Primary Insured Person. The Dependent Child must be primarily dependent upon such Primary Insured Person for maintenance and support, and must be:
1) under the age of nineteen (19);
2) under the age of twenty five (25) if enrolled as a full-time student at an Institution of Higher Learning; or
3) classified as an Incapacitated Dependent Child.
BTA5662
Domestic Partner
Domestic Partner means a person designated by a Primary Insured Person who is registered as a Domestic Partner or legal equivalent under laws of the governing jurisdiction or who:
1) is at least 18 years of age and competent to enter into a contract;
2) is not related to the Primary Insured Person by blood;
3) has exclusively lived with the Primary Insured Person for at least twelve (12) months prior to the date of enrollment;
4) is not legally married or separated; and
5) as of the date of enrollment, has with the Primary Insured Person at least two (2) of the following financial arrangements:
a) a joint mortgage or lease;
b) a joint bank account;
c) joint title to or ownership of a motor vehicle or status as a joint lessee on a motor vehicle lease; or
d) a joint credit card account with a financial institution.
Neither the Primary Insured Person nor the Domestic Partner can be married to, nor be in a civil union with anyone else.
BTA5666 (Ed. 7/06)
Emergency Medical Treatment
Emergency Medical Treatment means Hospital treatment for a medical condition which:
1) arises suddenly and unexpectedly; and
2) if left untreated could result in Loss of Life, or in serious deterioration of an Insured Person's medical condition.
BTA5674
Family Travel Expense
Family Travel Expense means actual costs incurred by an Immediate Family Member for temporary lodging, transportation and meals while traveling to and from visits with an Insured Person.
BTA5678
Full-time Employee
Full-time Employee means an employee who works at least 30 hours per week.
BTA5684
Gainful Occupation
Gainful Occupation means an occupation, including self employment, that is or can be expected to provide an Insured Person with an income equal to at least 60% of the Insured Person's monthly earnings within twelve (12) months after the Insured Person's return to work.
BTA5688
Hazard
Hazard means the circumstances for which this insurance is provided as stated in Section III of the Schedule of Benefits and described in the Hazard Section of this policy.
BTA5696
Hemiplegia
Hemiplegia means complete and irreversible loss of all motion and all practical use of one arm and one leg on the same side of the body that lasts longer than 365 days as determined by a Physician approved by Us.
BTA5702
Hospital
Hospital means a public or private institution which:
1) is licensed in accordance with the laws of the jurisdiction where it is located;
2) is accredited by the Joint Commission on Accreditation of Hospitals;
3) operates for the reception, care and treatment of sick, ailing or injured persons as in-patients;
4) provides organized facilities for diagnosis and medical or surgical treatment;
5) provides twenty-four (24) hour nursing care;
6) has a Physician or staff of Physicians; and
7) is not primarily a day clinic, rest or convalescent home, assisted living facility or similar establishment and is not, other than incidentally, a place for the treatment of alcoholics or drug addicts.
BTA5712
Hospital Admission Guaranty
Hospital Admission Guaranty means any charge or expense made by a Hospital prior to and as a condition of an Insured Person's admission.
BTA5714
Immediate Family Member
Immediate Family Member means an Insured Person's:
1) Spouse or Domestic Partner;
2) children including adopted children and stepchildren;
3) legal guardians or wards;
4) siblings or siblings-in-law;
5) parents or parents-in-law;
6) grandparents or grandchildren;
7) aunts or uncles;
8) nieces and nephews.
Immediate Family Member also means a Spouse's or Domestic Partner's children, including adopted children and stepchildren; legal guardians or wards; siblings or siblings-in-law; parents or parents-in-law;
grandparents or grandchildren; aunts or uncles; nieces or nephews.
BTA5716
Incapacitated Dependent Child
Incapacitated Dependent Child means a child who, as a result of being mentally or physically challenged, is permanently incapable of self-support and permanently dependent on a Primary Insured Person for support and maintenance. The incapacity must have occurred while the child was:
1) under the age of nineteen (19); or
2) under the age of twenty five (25) if enrolled as a full-time student at an Institution of Higher Learning.
BTA5718
Institution of Higher Learning
Institution of Higher Learning means any accredited public or private college, university, professional trade or vocational school beyond the twelfth (12th) grade.
BTA5724
Insured Person
Insured Person means a person, qualifying as a Class member under Section I of the Schedule of Benefits:
1) who elects insurance; or
2) for whom insurance is elected,
3) and on whose behalf premium is paid.
BTA5728
Leased Aircraft
Leased Aircraft means an aircraft not owned by the Policyholder, which is subject to a written lease agreement between the Policyholder and the lessor. The Policyholder uses the aircraft as it wishes for the term of the written lease agreement. The Policyholder cannot alter or sell the aircraft without the consent of the lessor. Leased Aircraft does not include aircraft which are chartered for single trips.
BTA5730 (Ed. 7/06)
Loss
Loss means Accidental:
Loss of Foot Loss of Hand Loss of Hearing Loss of Life Loss of Sight Loss of Sight of One Eye Quadriplegia Paraplegia Hemiplegia Loss of Speech Uniplegia Loss of Thumb and Index Finger
Loss must occur within one (1) year after the Accident.
BTA5732
Loss of Foot
Loss of Foot means the complete severance of a foot through or above the ankle joint. We will consider such severance a Loss of Foot even if the foot is later reattached. If the reattachment fails and amputation becomes necessary, then We will not pay an additional Benefit Amount for such amputation.
BTA5734
Loss of Hand
Loss of Hand means complete severance, as determined by a Physician, of at least four (4) fingers at or above the metacarpal phalangeal joint on the same hand or at least three (3) fingers and the thumb on the same hand. We will consider such severance a Loss of Hand even if the hand, fingers or thumb are later reattached. If the reattachment fails and amputation becomes necessary, then We will not pay an additional Benefit Amount for such amputation.
BTA5736
Loss of Hearing
Loss of Hearing means permanent, irrecoverable and total deafness, as determined by a Physician, with an auditory threshold of more than 90 decibels in each ear. The deafness cannot be corrected by any aid or device, as determined by a Physician.
BTA5738
Loss of Life
Loss of Life means death, including clinical death, as determined by the local governing medical authority where such death occurs within 365 days after an Accident.
BTA5740
Loss of Sight
Loss of Sight means permanent loss of vision. Remaining vision must be no better than 20/200 using a corrective aid or device, as determined by a Physician.
BTA5742
Loss of Sight of One Eye
Loss of Sight of One Eye means permanent loss of vision of one eye. Remaining vision in that eye must be no better than 20/200 using a corrective aid or device, as determined by a Physician.
BTA5744
Loss of Speech
Loss of Speech means the permanent, irrecoverable and total loss of the capability of speech without the aid of mechanical devices, as determined by a Physician.
BTA5748
Loss of Thumb and Index Finger
Loss of Thumb and Index Finger means complete severance, through the metacarpal phalangeal joints, of the thumb and index finger of the same hand, as determined by a Physician. We will consider such severance a Loss of Thumb and Index Finger even if a thumb, an index finger or both are later reattached.
If the reattachment fails and amputation becomes necessary, then We will not pay an additional Benefit Amount for such amputation.
BTA5750
Medical Evacuation
Medical Evacuation means the emergency transportation of an Insured Person from the location where such Insured Person is injured or becomes ill to the nearest Hospital where appropriate medical care and treatment can be provided.
BTA5756
Medically Necessary
Medically Necessary means a medical or dental service, supply or course of treatment which:
1) is ordered or prescribed by a Physician;
2) is appropriate and consistent with the patient's diagnosis;
3) is in accord with current accepted medical or dental practice; and
4) could not be eliminated without adversely affecting the patient's condition.
BTA5758
Medical Services
Medical Services means Medically Necessary services, including but not limited to:
1) medical care and treatment by a Physician;
2) Hospital room and board and Hospital care, both inpatient and outpatient;
3) drugs and medicines required and prescribed by a Physician;
4) diagnostic tests and x-rays prescribed by a Physician;
5) transportation of an Insured Person in an emergency transportation vehicle from the location where such Insured Person becomes injured to the nearest Hospital where appropriate medical treatment can be obtained;
6) dental care and treatment due to Accidental Bodily Injury;
7) physical therapy, including diathermy, ultrasonic, whirlpool or heat treatment, adjustment, manipulation, massage and the office visit associated with such therapy;
8) treatment performed by a licensed medical professional when prescribed by a Physician, if hospitalization would have been otherwise required;
9) rental of durable medical equipment;
10) artificial limbs and other prosthetic devices;
11) orthopedic appliances or braces.
BTA5760 (Ed. 7/06)
Occupant Protection Device
Occupant Protection Device means either an air bag, which inflates for added protection to the head and chest areas, or any other personal safety restraint system other than a Seat Belt recognized by the U.S.
National Highway Transportation Safety Board.
BTA5764
Operated Aircraft
Operated Aircraft means any aircraft not owned by the Policyholder but over which the Policyholder exercises control. Operated Aircraft includes an aircraft for which the Policyholder pays operating expenses.
BTA5768
Other Plan
Other Plan means any other insurance or payment source for Medical Services or disability, including but not limited to health coverage, disability insurance, worker's compensation insurance; or coverage provided or required by any law or statute, including, automobile insurance "fault" or "no-fault", employer sick leave or salary continuation plan, or similar benefit provided or required by governmental plan or program.
BTA5770
Owned Aircraft
Owned Aircraft means any aircraft to which the Policyholder holds legal or equitable title.
BTA5772
Paraplegia
Paraplegia means complete and irreversible loss of all motion and all practical use of both legs that lasts longer than 365 days, as determined by a Physician approved by Us.
BTA5774
Personal Excursion
Personal Excursion means travel or activities that are unrelated to the Policyholder's business and which take place away…
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