Business Travel Accident Insurance Program

Transcription

1 Business Travel Accident Insurance Program Introduction... 2 Eligibility and Enrollment... 2 Eligibility... 2 Enrollment... 2 Cost... 2 Benefits... 2 Principal Sum... 2 Accident... 2 Benefit... 3 Dismemberment... 3 Paralysis Benefit... 3 Seatbelt Benefit... 3 CIGNA Worldwide Assistance Service... 3 Coverage... 4 Company Business Travel... 4 Travel Not Eligible... 4 Commercial Aircraft... 4 Military Aircraft... 4 Expatriate Employees... 4 Payments... 5 Payment Method... 5 Beneficiary... 5 Assignment of Benefits... 5 Death Claims... 5 Dismemberment Claims... 5 Denied Claims... 6 Reviewing a Denied Claim... 6 Exclusions... 6 Right to Terminate or Amend... 7 Business Travel Accident (1 st Edition) VERSION 1

2 Introduction PCA provides extra benefit protection if you die, are dismembered, or lose your sight as the result of an accident while traveling for the company, as described in the plan. This coverage is fully insured by CIGNA-Life Insurance Company of North America (CIGNA-LINA). Any benefits paid are in addition to, and separate from any benefits paid from the PCA Group Life Insurance Plan. Eligibility and Enrollment Eligibility You are eligible for coverage if you are: A regular, full-time, active, salaried employee who is regularly scheduled to work at least 30 hours per week, or You become eligible for coverage on the first date you are actively at work. If you no longer meet the eligibility requirements Your coverage will end. Enrollment You are automatically enrolled in the plan if you meet the eligibility requirements. Cost You do not make contributions for this coverage. PCA pays the full cost. Benefits Principal Sum Your benefit from the plan is based on your annual base pay (not including bonuses, commissions, overtime or incentive payments). The principal sum is five (5) times your annual base pay. The maximum principal sum is $500,000. Accident The plan pays a benefit if you die or are dismembered as the result of an accident while traveling for the company, as defined elsewhere in this summary plan description (i.e., excludes travel in company owned or leased aircraft). 2

3 Benefit Amount of Benefit 100% of the principal sum (five times annual base pay) Loss Death Loss of both feet Loss of sight in both eyes Loss of one hand and one foot Loss of one hand or one foot and sight in one eye 50 % of the principal sum Loss of one hand or one foot Loss of sight in one eye Loss of speech and hearing 25% of the principal sum Loss of speech or hearing Loss of thumb and forefinger of one hand Dismemberment The terms used above are specifically defined in the insurance contract. The loss must be complete and irreversible, such as the actual severance though or above the joint, or the irrecoverable loss of sight or hearing. Paralysis Benefit The plan also pays a benefit if you become paralyzed as the result of an accident while traveling on business for the company. The loss must cause complete paralysis of a limb without severance, and must be determined by a physician to be complete and irreversible. Quadriplegia: 100% of Principal Sum Paraplegia: 50% of Principal Sum Hemiplegia: 50% of Principal Sum Seatbelt Benefit The plan pays an additional benefit if you are in a fatal auto accident while wearing a properly fastened seatbelt. This benefit is meant to increase auto safety awareness. The benefit pays an additional 10% of the principal sum up to a $25,000 maximum. Claim must be accompanied by official accident report or certification by investigating officer that the insured was wearing properly fastened seatbelt (if official accident report does not verify proper seatbelt use, or if it is unclear whether the insured was properly wearing a seatbelt, we will pay the minimum benefit of $1,000). Valid only when driving or riding in a legally registered private passenger vehicle (car, including policyholder owned cars, station wagon, van, pickup truck or sport utility vehicle). CIGNA Worldwide Assistance Service The Plan s contract with CIGNA provides some special high-level assistance services, medical evacuation and repatriation coverage to covered employees who travel more that 100 miles from their homes. The service is provided through the Worldwide Assistance organization. 3

4 The assistance services help with such thinks as finding lost personal items, use of language interpreters, referrals to medical and legal professionals, case monitoring, travel arrangements, pre-travel information, and messaging to and from family members. Medical evacuation and repatriation costs are covered by the plan but must be authorized by a Worldwide Assistance specialist. Any expenses for services, other than an approved medical evacuation or repatriation, and the general telephone assistance are the responsibility of the employee. To access the Worldwide Assistance services, simply call the number included on the Worldwide Assistance literature (or contact Corporate Human Resources). Trained staff members a generally available 24 hours a day 7 days a week. Coverage Company Business Travel Business travel is defined as travel for authorized PCA business away from your primary work site. You are covered while traveling on company business. On company business means while on assignment for PCA. Your trip begins when you leave your residence or primary work site. Your trip continues until you return to your residence or primary work site, whichever occurs first. Travel Not Eligible You are not covered while: Commuting between your home and your primary work location, and Traveling aboard aircraft owned or leased by the company. If you are dismembered or you die as the result of an accident while traveling on a company owned or leased aircraft: In most cases, a Passenger Voluntary Settlement will be offered through the company s liability insurance coverage. The Passenger Voluntary Settlement is not a part of this plan. The Passenger Voluntary Settlement will require your beneficiary to waive any claims against the company. Commercial Aircraft You are covered while traveling on a commercial aircraft if the aircraft: Is operated by a properly certified pilot Has a current unrestricted air-worthiness certificate, and Is not being used for firefights, power line inspection or exploration. Military Aircraft You are covered while traveling as a passenger on a transport service aircraft operating by: The Military Airlift Command Service (MACS) of the United States or Any similar service of any other country. Expatriate Employees If you are working overseas on a permanent or temporary assignment: You are covered while traveling to and from and while at your assignment at an overseas location. 4

5 Payments Payment Method Your benefit from the Travel Accident Insurance Plan is paid in a lump sum. If you are dismembered, you will receive a lump sum payment from the plan. If you die, your beneficiary will receive the benefit in a lump sum. Beneficiary Your beneficiary is the person (or persons) you wish to receive a benefit from the plan if you die. This is the same beneficiary named under the company supplied Group Term Life Insurance. You may name or change your beneficiary at any time. Fill out the appropriate forms available from the PCA Benefits Center. Your designation or change will become effective when received by the PCA Benefits Center. If you die before designating a beneficiary or if your beneficiary dies before you: Your benefit will be paid in a lump sum in the following order: Any assignee to whom you have assigned coverage Your surviving spouse Your surviving children, and Your estate. Assignment of Benefits You may assign ownership of the insurance to another party. Complete an Assignment of Group Insurance Form and return it to the PCA Benefits Center. Before you assign your travel accident insurance, it is suggested you seek competent counsel from your tax or legal adviser. Neither CIGNA-LINA nor PCA can guarantee the effectiveness of any such assignment. Your assignment is not effective until CIGNA-Life Insurance Company of North America receives it. Death Claims Your beneficiary must: Contact the PCA Benefits Center for the appropriate claim forms to apply for benefits, and Complete the forms and send them to the insurance carrier along with an original certified death certificate. Benefits will be paid as soon as CIGNA-LINA receives acceptable proof of loss. Acceptable proof of loss should include written proof of the occurrence, type and extent of loss. The PCA Benefits Center will contact your beneficiary if any additional documentation is needed. Dismemberment Claims You (or a member of your family) must: Contact the PCA Benefits Center for the appropriate claim forms to apply for benefits, and Complete the forms and send them to the insurance carrier along with a physician s statement verifying your dismemberment. Benefits will be paid as soon as CIGNA-LINA receives acceptable proof of loss. Acceptable proof of loss should include written proof of the occurrence, type and extent of loss. The PCA Benefits Center will contact your beneficiary if any additional documentation is needed. CIGNA-LINA may also require a physical exam by a physician it selects. 5

6 Denied Claims Your, or your beneficiary, will receive a detailed explanation if a claim is denied in full or in part. In this notice, CIGNA-LINA will specify: Reasons for the denial Reference to plan provisions on which the denial is based Additional information or material needed to substantiate the claim Explanation of why the additional information is needed, and The steps to follow to submit the claim for appeal. Your claim will be considered a denied claim if CIGNA-LINA does not: Approve the claim, and Provide you with the notice of denial within 90 days after receiving the claim plus any additional time required (because of special circumstances) to process the claim. CIGNA-LINA must advise you in writing of the need to extend the processing time. This notice, within the initial 90-day period, must specify the circumstances requiring the extension and date you can expect to receive CIGNA-LINA s decision about the claim. Reviewing a Denied Claim You, or your authorized representative, may request a review of a decision by writing CIGNA-LINA within 60 days after the date of a written notice denying benefits. Please refer to the Claims Denial portion of the Health & Welfare Benefits Overview section of this Benefits Handbook for a description of the appeal process. CIGNA-LINA s address is: CIGNA Employee Benefits Companies Greenville, Suite LB 179 Dallas, TX Any correspondence should include the group contract number, which is SGL 580. Exclusions Suicide, attempted suicide or intentionally self-inflicted injuries; Any felony committed by the insured; Any act of war, whether declared or undeclared; Sickness, disease or bodily infirmity (bacterial or viral infection resulting from an accidental wound or cut, or ingesting poisonous food substance are not excluded); Full-time active duty in the armed forces; Traveling in an experimental aircraft or one designed to be used in outer space being operated by a military authority other than Military Aircraft Command, or similar foreign service; Hang gliding or parachuting, except for self-preservation; Piloting or serving as a crew member in any aircraft or as a student taking flying lessons; or Travel in an aircraft owned or leased, operated or controlled by the named organization or any of its subsidiaries. 6

7 Right to Terminate or Amend As the plan sponsor, PCA has the right to terminate or amend the plan in such a way that: You would no longer be eligible for the plan. Your employer would no longer be considered a Participating Employer. The level of benefits available would be reduced. Such a termination or amending the plan may result in a loss of benefits. Other Administrative Information Travel Accident Insurance Plan Plan Name and Number: Type of Plan: Claims Administrator: Type of Administration: Type of Funding: Agent for Service of Process: Packaging Corporation of America Employee Travel Accident Plan, Plan Number 508. Group welfare life and AD&D insurance plan. Life Insurance Company of North America CIGNA Employee Benefits Companies Greenville, Suite 655, LB 179 Dallas, TX Insurance contract. Insurance premiums are paid from the general assets of Participating Employers. Benefits paid through an insurance contract. Life Insurance Company of North America CIGNA Employee Benefits Companies Greenville, Suite 655, LB 179 Dallas, TX Also, service can be made on the Plan Administrator. 7

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