Office of Risk Management

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 53702

Policy Number: 9906-76-12

Effective Date: September 15, 2012

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
10700 Research Drive, Suite 450
Milwaukee, WI 53226

Section I - Policy Period

From: September 15, 2012
To: September 15, 2015
Renewed policy period: September 15, 2012 - September 15, 2015
12:01 A.M. standard time at the Policyholder's mailing address shown above.

Section II - Insured Persons

The following are the Insured Persons under this policy:

Class Description
1 All Active Employees and Guests of the Policyholder, while traveling outside the United States..
2 All Active Students of the Policyholder, while traveling outside the United States or on behalf of Class 1 insureds.
3 The Spouse of a Primary Insured Person.
4 The Dependent Child of a Primary Insured Person.

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.

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

Section III - Hazards

The following are the Hazards for which insurance applies:

Class Hazard(s)
1 24 Hour Business Travel, Extraordinary Commutation, Bomb
2 24 Hour Business Travel, Extraordinary Commutation, Bomb
3 Business Travel Family.
4 Business Travel Family

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.

Section IV - Benefits

A) Principal Sum

The following are Principal Sums for each Class:

Class Hazard Principal Sum
1 24 Hour Business Travel $100,000
1 Extraordinary Commutation $100,000
1 Bomb $100,000
2 24 Hour Business Travel $50,000
2 Extraordinary Commutation $50,000
2 Bomb $50,000
3 Business Travel Family $25,000
4 Business Travel Family $10,000

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

Accidental: Benefit Amounts (Percentage of Principal Sum)
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 100%
Paraplegia 75%
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 50%
Uniplegia 25%
Loss of Thumb and Index Finger of the Same Hand 25%

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.

C) Additional Benefits:

The following are Benefit Amounts for all other benefits provided under this policy:

Carjacking

Class Benefit Amount
1 10% of the Principal Sum up to a maximum of $25,000
2 10% of the Principal Sum up to a maximum of $25,000
3 10% of the Principal Sum up to a maximum of $25,000
4 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.

Coma

Class Benefit Amount Maximum Benefit Amount
1 1% per month of the Principal Sum 100% of the Principal Sum
2 1% per month of the Principal Sum 100% of the Principal Sum
3 1% per month of the Principal Sum 100% of the Principal Sum
4 1% per month of the Principal Sum 100% of the Principal Sum

This Benefit Amount is subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract

Medical Evacuation and Repatriation

Class Maximum Benefit Amount Benefit Amount(Hospital Admission Guaranty) Family Travel Expense
1 $500,000 $5,000

Maximum Per Day: $100
Maximum Number of Days: 5

2 $500,000 $5,000 Maximum Per Day: $100
Maximum Number of Days: 5
3 $500,000 $5,000 Maximum Per Day: $100
Maximum Number of Days: 5
4 $500,000 $5,000 Maximum Per Day: $100
Maximum Number of Days: 5

This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract

Natural Disaster

Class Benefit Amount
1 $5,000
2 $5,000
3 $5,000
4 $5,000

This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.

Psychological Therapy

Class Benefit Amount
1 5% of the Principal Sum up to a maximum of $25,000
2 5% of the Principal Sum up to a maximum of $25,000
3 5% of the Principal Sum up to a maximum of $25,000
4 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.

Rehabilitation Expense

Class Benefit Amount
1 5% of the Principal Sum up to a maximum of $25,000
2 5% of the Principal Sum up to a maximum of $25,000
3 5% of the Principal Sum up to a maximum of $25,000
4 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.

Seat Belt and Occupant Protection Device

Class Benefit Amount for Seat Belt Alternate Benefit Amount Benefit Amount for Occupant Protection Device Max Benefit Amount for Seatbelt and Occupant Protection Device
1 10% of the Principal Sum $2,000 10% of the Principal Sum 20% of the Principal Sum to a max of $50,000
2 10% of the Principal Sum $2,000 10% of the Principal Sum 20% of the Principal Sum to a max of $50,000
3 10% of the Principal Sum $2,000 10% of the Principal Sum 20% of the Principal Sum to a max of $50,000
4 10% of the Principal Sum $2,000 10% of the Principal Sum 20% of the Principal Sum to a max of $50,000

This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple Benefits, of the Contract.

Section V - Aggregate Limit of Insurance

$3,000,000 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.

Insurance only applies for the Classes, Hazards, Benefits and Losses that are specifically indicated as insured.

Section VI - 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.

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 being 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 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 from Accidental consumption of a substance contaminated by bacteria.

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.

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 (60) consecutive days of active military service with the armed forces of any country or established international authority.

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.

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.

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.

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.

DISCLAIMER

This insurance document is furnished to you as a matter of information for your convenience. It only summarizes the listed policy(ies) and is not intended to reflect all the terms and conditions or exclusions of such policy(ies). Moreover, the information contained in this document reflects coverage as of the effective date(s) of the policy(ies) and does not include subsequent changes. This document is not an insurance policy and does not amend, alter or extend the coverage afforded by the listed policy(ies). The insurance afforded by the listed policy(ies) is subject to all the terms, exclusions and conditions of such policy(ies).