Group Accident Insurance Coverage

Choice Plan

SUMMARY OF BENEFITS

Sponsored by: Hanover College

Accident insurance coverage provides a cash benefit when an insured is injured due to a covered Accident.

Eligibility All employees in an eligible class. Issue Ages 17-80.

Emergency Care
Ambulance/Air Ambulance $150/$600
Initial physician office visit/ER visit $75/$150
Major diagnostic care $100

Treatment Care
Hospital admission $1,000
Hospital confinement daily benefit $200
Intensive care daily benefit $400
Alternate care and rehabilitative facility daily benefit $100
Follow-up doctor/patient care up to 6 sessions $50
Transportation for care (up to 3 times per accident) $300
Companion lodging (up to 30 days per accident) $100
Family care per child (up to 30 days) $20

Fractures and Dislocations

Per Surgical Fracture $200-$5,600
Per Non-Surgical Fracture $100-$2,800
Chip Fractures 25% of fracture benefit
Per Surgical Dislocation Injury $300-$4,800
Per Non-Surgical Dislocation Injury $150-$2,400
Partial Dislocation 25% of dislocation benefit

Specific Injuries or Treatments

Transfusions $300
Burns $100-$12,800
Skin Grafts 25% of burn benefit
Joint replacement $1,500-$2,000
Coma $7,500
Concussion $100
Dental crown – once per accident $150
Dental extraction – once per accident $50
Eye (removal of foreign body) once per eye/accident $100
Eye (surgical repair) once per eye/accident $300
Laceration $50-$400
Surgery $250-$1,000
Surgical repair of ligaments/tendons, knee cartilage, rotator cuff, $450-$600
ruptured disc
Transitional Care Benefits
Crutches, wheelchair, walker, other $25-$350
Prosthesis per limb/device $500
Reasonable modifications to home or vehicle $2,500

Accident Death & Dismemberment (AD&D)

Employee Accident Death $75,000
Spouse Accident Death $25,000
Child Accident Death $12,500
Loss of or loss of use of one: hand, foot, arm, leg, eye $7,000
Loss of or loss of use of any one finger, thumb, or toe $300
Common carrier enhanced death benefit 2x benefit amount
Transportation of remains $5,000
Seat belt/helmet AD&D benefit 10% of AD&D
Common disaster enhanced death benefit 2x benefit amount
Catastrophic loss $50,000

Employee level benefit options

Sickness Hospital Confinement Benefit: If an insured is $100 per day
confined to a hospital due to an illness unrelated to an accident,
a daily benefit will be paid up to a maximum of 30 days.

Additional Services
Accident EAP services Included
SM
TravelConnect Included

Monthly Accident Cost Summary*

Tier Base Premium

Employee Only $16.04
Employee & Spouse/Domestic Partner $23.35
Employee & Child(ren) $27.56
Employee & Family $37.34

Group level benefit options

Additional benefits selected by employer for all enrolled employees – cost included in the base coverage rates
above
On the job accident coverage Included
 Employee level benefit options
Additional benefits selected by the employee for an additional cost

Tier Sickness Hospital Confinement Benefit Premium

Employee Only $4.09
Employee & Spouse/Domestic Partner $8.18
Employee & Child(ren) $6.95
Employee & Family $11.42

*The policy is guaranteed renewable. The insurer has the right to increase premium rates on any policy
anniversary after the Policy’s first anniversary, for all policies of like class.

Exclusions
• This accident policy will not cover losses caused by or as a result of:
• Injury occurring prior to the effective date of coverage or after termination of the coverage
• Duty as a member of any military, including Reserves or National Guard
• Travel or flight in or on any Aircraft, except as a fare paying passenger on a regularly scheduled commercial flight
• Participating in high risk or extreme sports, such as, but not limited to, bungee jumping,
parachuting, base jumping, or mountaineering;
• Having cosmetic or elective surgery
• Participating in or attempting to commit a felony
• Being incarcerated in any type of penal or detention facility
• Having a blood alcohol level of .08 grams of alcohol or more per 100 milliliters of blood
• Deliberately using poison, gas, fumes, or drugs (except when prescribed by a Physician and administered
appropriately)
• Committing or attempting to commit suicide or any other self-inflicted injury
• Any sickness, disease (physical or mental), or medical or surgical treatment of these
• Participating in, practicing for, or officiating a semi-professional or professional sport
• Riding in or driving any motor-driven vehicle for race, stunt show, or speed test
• War, act of war, or participation in a riot, insurrection or rebellion
• An injury sustained while residing outside the U.S., U.S. territories, Canada or Mexico for more than 12 months

For assistance or additional information Contact Lincoln Financial Group at

(800) 423-2765; reference ID: HANCOL www.LincolnFinancial.com

NOTE: This is not intended as a complete description of the insurance coverage offered. While benefit amounts stated in this summary are
specific to your coverage, other items may summarize our standard product features and not the specific features of your coverage. Controlling
provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding
contract. A policy will be made available to you that describes the benefits in greater details. Should there be a difference between this summary
and the policy, the policy will govern.
©2014 Lincoln National Corporation
Insurance products policy series GL41 are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit
business in New York, nor is it licensed to do so. In New York, insurance products are issued by Lincoln Life & Annuity Company of New York
(Syracuse, NY). Both are Lincoln Financial Group® companies. Product availability and/or features may vary by state.
Limitations and exclusions may apply. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its
affiliates. Affiliates are separately responsible for their own financial and contractual obligations

Travel ConnectSM services are provided by FrontierMEDEX, Baltimore, MD. Accident EAP services are provided by ComPsych® Corporation,
Chicago, IL. FrontierMEDEX and ComPsych® are not Lincoln Financial Group companies. Each independent company is solely responsible for
its own obligations.