Lincoln Voluntary Accident Plan Highlights

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Lincoln Voluntary Accident Plan Highlights

With Voluntary Accident Benefits from Lincoln Financial Group, employees are empowered to protect their income from unexpected expenses related to an accident.

Why choose Lincoln for Voluntary Accident Protection?

 Coverage is Guarantee Issue.

 Coverage is Guarantee Renewable.

 The option to continually build participation through annual enrollment.

 Benefits are paid directly to the covered employee.

 Benefits are paid for multiple injuries related to a single accident.

 Attractive group rates are offered.

 Employees may keep their Accident coverage after separation from their employer.

 Premiums can be paid by employee on a pre-tax or post-tax basis.

COST SUMMARY

Rates shown are Monthly and guaranteed renewable. Final rates are subject to Lincoln Financial Group approval.

Employee Only $16.04

Employee + Spouse $23.35

Employee + Child(ren) $27.56

Employee + Family $37.34

*Additional benefits selected by employer for all enrolled employees - cost included in base coverage rates above.

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Requirements

 There is no minimum enrollment requirement for dependent coverage.

 Employees must be actively at work on the effective date of coverage.

 To be eligible for accident coverage, employees must work a minimum of 20 hours per week.

 Coverage election is available to individuals between the ages of 17 and 80.

 Treatment must be received within the required timelines set forth in the policy.

 Base coverage is required for every insured electing optional benefits.

 Benefits may be subject to taxes. This determination should be made under the advice of a tax consultant.

EMERGENCY CARE

Ambulance $150

Air Ambulance $600

Initial physician office visit $75

Emergency room $150

Major diagnostic care $100

TREATMENT CARE

Hospital admission $1,000

Hospital confinement daily benefit $200 Intensive care unit 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 (PER FRACTURE) NON-SURGICAL/SURGICAL Ankle, arm, collarbone, elbow, foot, hand, jaw,

kneecap, shoulder blade, sternum, wrist

$600/$1,200

Hip $2,800/$5,600

Skull (depressed) $2,500/$5,000

Leg, pelvis, skull nondepressed, vertebral column $1,500/$3,000 Bones of face, vertebrae, coccyx, rib, nose $450/$900

Finger, toe $100/$200

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DISLOCATIONS (PER INJURY) NON-SURGICAL/SURGICAL

Ankle, collarbone sternoclavicular, foot $800/$1,600 Collarbone acromio and separation, elbow, hand,

lower jaw, shoulder, wrist

$500/$1,000

Finger, toe $150/$300

Hip $2,400/$4,800

Knee, except kneecap $1,500/$3,000

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

Arthroscopic $250

Abdominal or Thoracic $1,000

Surgical, per repair Ligaments/tendons, knee cartilage

$450

Rotator cuff $450

Ruptured disc $600

TRANSITIONAL CARE BENEFITS

Crutches $25

Wheelchair for temporary use $50 Wheelchair for permanent use $350 Walker for temporary use $25 Walker for permanent use $50 Prosthesis per limb/device $500 Other medical appliances $25 Reasonable modifications to home or vehicle in

the case of catastrophic loss

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ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)

Employee Accidental Death $75,000 Spouse Accidental Death $25,000 Child Accidental Death $12,500

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 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

Catastrophic loss $50,000

*Accident EAP and TravelConnect services Included

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

 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

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THIS IS NOT A CONTRACT: This illustration was prepared based on the information provided in the Request for Proposal. It is a description of accident coverage available from Lincoln Financial Group and not an offer to contract. More detailed information is available upon request concerning the terms, conditions, and limitations contained in the master policy, if issued. If there are discrepancies between the information contained in this proposal and the master policy, the terms of the master policy will control. State-specific restrictions and requirements may not be addressed in this proposal.

An Application for Group Insurance must be completed by the Employer and approved by Lincoln Financial Group before coverage can become effective.

This proposal is subject to revision if not accepted on or before the Proposed Effective Date shown on the Benefits and Cost Summary page of this proposal.

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates, including insurance company affiliates The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so; and 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.

Affiliates are separately responsible for their own financial and contractual obligations.

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