Safety & Loss Prevention
Declarations
Blanket Accident Insurance Program
Chubb Group of Insurance Companies
15 Mountain View Road, P.O. Box 1615
Warren, New Jersey 07061-1615
Policyholder's Name and Mailing Address
State of Wisconsin/University of Wisconsin
101 E. Wilson, 8th Floor
Madison, WI 53707
Policy Number: 6409-69-79
Effective Date: September 15, 1998 and ongoing
Issued by the stock insurance company indicated below.
Federal Insurance Company
Incorporated under the laws of
Indiana
Producer Number: 0039202
Producer: Aon Risk Services, Inc. of Wisconsin
330 E. Kilbourn Ave. #450
Milwaukee, WI 53202-0000
Section I - Policy Period
From: September 15, 1998 and ongoing
Renewed policy period: September 15, 2001 - September 15 annually
12:01 A.M. standard time at the Policyholder's mailing address shown above.
Section II - Persons Insured
The following are the Persons Insured under this policy:
| Class | Description |
|---|---|
| 1 | All active employees of the policyholder. |
| 2 | Students conducting research, whose expenses are paid by the University and are under the direction of an active employee. |
If an Insured Person is included in more than one Class, the Insured Person will be covered for only the Benefit Amount applicable to one Class. The Insured Person will be considered a member of the applicable Class that provides the Insured Person the largest Benefit Amount for the particular Accident and Loss that has occurred.
An Insured Person is added for coverage as a Class member at any time during the policy period that the Insured Person fits the Class description. An Insured Person is deleted from a Class and coverage ends at the time the Insured Person no longer fits the Class description. All premium adjustments will be made according to the terms of this policy.
Section III - Hazards
The following are the Hazards for which coverage applies:
| Hazards | Form Number |
|---|---|
| Business Travel | 44-02-1381 |
Section IV - Benefits
Benefit Amounts
Accidental Loss of Life and Scheduled Benefits
The following are Loss of Life Benefit Amounts for each Class and corresponding Hazards:
| Class | Benefit Amount |
|---|---|
| [Business Travel] | |
| 1 | $250,000 |
| 2 | $50,000 |
Multiple of salary/compensation applies, refer to the Supplemental Benefit Amounts Declarations.
The following are Losses covered and the corresponding Scheduled Benefit Amounts:
| Accidental Loss of | Percent of Loss of Life Benefit Amount |
|---|---|
| Life | 100% |
| Speech and Hearing | 100% |
| Speech and one of: Hand, Foot or Sight of One Eye | 100% |
| Hearing and one of: Hane, Foot or Sight of One Eye | 100% |
| Both Hands, Both Feet or Sight of Both Eyes or a Combination of a Hand, a Foot or Sight of One Eye | 100% |
| One Hand or One Foot or Sight of One Eye | 50% |
| Speech or Hearing | 50% |
| Thumb and Index Finger of the Same Hand | 25% |
Loss of Use
The following are Loss of Life Benefit Amounts for each Class. The same Hazards apply as stated above for Accidental Loss of Life.
| Class | Benefit Amount |
|---|---|
| 1 | $250,000 |
| 2 | $50,000 |
If an Insured Person has multiple Losses as the result of one Accident, we will pay only the single largest Benefit Amount applicable to the Losses suffered.
Medical Evacuation and Repatiriation
The following is the Medical Evacuation and Repatriation Benefit Amount for each Class. The Medical Evacuation and Repatriation Benefit Amount applies only to the Hazard(s) shown below.
| Class | Hazard | Benefit Amount |
|---|---|---|
| 1 | Business Travel | $50,000 |
| 2 | Business Travel | $50,000 |
Section V - Maximum Limit of Insurance
The following are the maximum amounts we will pay:
| Limit of Insurance |
|---|
| $3,000,000 per Accident |
If more than one (1) Insured Person suffers a Loss in the same Accident, we will not pay more than the maximum Limit of Insurance shown above. If an Accident results in Benefit Amounts becoming payable, which when totalled, exceed the applicable Limit of Insurance shown above, the maximum Limit of Insurance will be divided proportionally among the Insured Persons, based on each applicable Benefit Amount.
Coverage only applies for the Classes, Hazards, Benefit Amounts and Losses that are specifically indicated as covered.
Section IV - Exclusions
Aircraft Owned, Leased or Operated
This insurance does not apply to an Accident occurring while an Insured Person is in, entering, or exiting any aircraft owned, leased or operated by the Policyholderor any aircraft owned, leased or operated by an employee of the Policyholder on behalf of the Policyholder.
This exclusion does not apply to aircraft chartered with pilot or crew on a one time charter basis.
Aircraft Pilot or Crew
This insurance does not apply to an Accident occurring while an Insured Person is in, 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.
Disease or Illness
This insurance does not apply to Loss caused by or resulting from an Insured Person's emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection, or bodily malfunctions.
This exclusion does not apply to Loss resulting from an Insured Person's bacterial infection caused by an Accident or from Accidental consumption of a substance contaminated by bacteria.
Suicide or Intentional Injury
This insurance does not apply to suicide, attempted suicide or Loss that is intentionally self-inflicted.
War
This insurance does not apply to Loss caused by or resulting from a declared or undeclared War. Declared or undeclared War does not include acts of terrorism.