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ACCIDENT INSURANCE

ACCIDENT PRODUCT GUIDE

IN THE U.S., SOMEONE EXPERIENCES A MEDICALLY CONSULTED INJURY EVERY 2 SECONDS AT HOME, EVERY 6 SECONDS AT WORK, AND EVERY 8 SECONDS WHILE DRIVING A VEHICLE.1

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About 60% of personal bankruptcies in the U.S. are medical-related.2

In the U.S., a medically consulted injury occurs every second, and an accidental death occurs every 4 minutes.1

Each year, more than 3.5 million children ages 14 and younger get hurt playing sports or participating in recreational activities.3

Nearly one in every nine people in the U.S. seek medical attention for an injury each year.1

Accidental injuries are the leading cause of death for people under age 44, and are the fifth leading cause of death for all ages.1

WHY ACCIDENT INSURANCE?

4 QUICK REFERENCE GUIDE

6 INTRODUCTION

7 PLAN DESIGN INFORMATION Eligibility – Basic Requirements Funding Options (Contribution Types) Coverage Types Plan Types Accident Coverage Election & Coverage Tiers

8 BENEFIT INFORMATION Benefits Benefit Categories/Packages Ability Assist® Employee Assistance Program HealthChampionSM Health Care Support Service

9 BENEFIT DEMONSTRATION

Everyday Accident Serious Accident

10 UNDERWRITING GUIDELINES & RATE INFORMATION

Preferred Information Requested for an Accident Quote

Participation Assumptions Rate Structure Renewability & Rate Guarantee Period

11 BENEFIT LIMITATIONS & EXCLUSIONS Limitation Exclusions

11 CLAIMS PAYMENT

11 ABOUT SECTION 125 PLANS

12 KEY ACCIDENT DEFINITIONS

13 STATE FILING STATUS & SPECIFIC EXCEPTIONS

14 ELIGIBILITY – EXPANDED REQUIREMENTS & PROVISIONS

Employee & Dependent Eligibility Eligibility Waiting Period (EWP) Continuity of Coverage from a Prior Policy Coverage Effective Date (When Insurance

Begins) Health Insurance Requirement Continuation Options Portability

15 ENROLLMENT Annual Open Enrollment Enrollment Strategy Enrollment Methods

15 ADMINISTRATION Group Contract Billing Types

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CONTENTS

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QUICK REFERENCE GUIDE

PLAN DESIGN & BENEFIT INFORMATION OPTIONS AVAILABLE

Eligibility Basics • Employee (EE) – 4-49 lives: 30 hours/week; Under age 80 – 50+ lives: 20 hours/week; Under age 80

• Spouse (SP) – Under age 80• Child(ren) (CH) – Under age 26

• Work hours can be set by the employer; Minimum is 16/week

• Term age range is 65-85• CH term age range is 18-26

Funding Options 100% employee-paid (voluntary) • 100% employer-paid (non-contributory)

• ER/EE cost sharing - contingent on group size (contributory)

Coverage Type Off-job (non-occupational) 24 hour (on and off-job)

Plan Type • Choice of 3 standard schedules• Each standard schedule includes all 3

categories/packages: - Emergency, Hospital5 & Treatment Care - Specified Injury & Surgery - Catastrophic

Custom-built plan: - Start with a choice of Plan

1, 2 or 3 benefit levels for Emergency, Hospital & Treatment Care

- Add Specified Injury & Surgery (1, 2 or 3) and/or Catastrophic (1, 2 or 3)

Benefits Cash benefits for more than 80 accidental injuries, related expenses and treatments

Coverage Election • One plan offered to EEs• Choice of coverage tiers:

Choice of 2 plans offered to EEs (e.g. choice of standard Plan 1 or standard Plan 3)

UNDERWRITING & RATE INFORMATION OPTIONS AVAILABLE

Preferred Info to Quote • Group – Name, state, SIC, effective date, current participation

• Employee census not required

Underwriting Type Guaranteed Issue

Participation 100% EE-paid

- 4-49 lives: 4 enrolled lives

- 50+ lives: 10 enrolled lives

• 100% employer-paid – 100%

of eligible lives

• ER/EE cost sharing

- ER/EE cost sharing - contingent

on group size

Rate Structure Composite rates by coverage tier

(EE only, EE & SP, EE & CH or Family)

Rate Guarantee Period 2 years 1 and 3 years

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QUICK REFERENCE GUIDE con’t.PRODUCT PROVISIONS OPTIONS AVAILABLE

Emergency, Hospital & Treatment Care Benefit Package • Includes benefits for each covered person for: Initial care, diagnostic and emergency services;

Hospital admission and confinement6; Follow-up care…and more• Treatment/service time frame ranges from 72 hours to 365 days

For larger groups:

- Certain benefits may be removed from the plan design

- Alternate amounts and # of visits/days/nights/trips available

Detail Plan 1 Plan 2 Plan 3Acupuncture/Chiro/PT < 10 each/acc $25 $25 $50Ambulance – Ground/Air 1 each/acc $200/$600 $300/$900 $400/$1200

Blood/Plasma/Platelets 1/acc $150 $200 $300

Child Care < 30 days/acc $25/day $25/day $30/day

Diagnostic Exam/X-Ray 1 each/acc $100/$50 $200/$50 $300/$75

Emerg. Dental – Extract/Crown 1/acc $50/$150 $100/$300 $150/$450

Emergency Room/Urgent Care 1 each/acc $100/$50 $150/$75 $200/$100

Hospital Admission 1/acc $500 $1000 $1500

Hospital Confinement (Daily/ICU) < 365 days/ < 30days

$100/$300 $200/$400 $300/$600

Lodging < 30 nights acc $100 $125 $150

Medical Appliance 1/acc $50 $100 $150

Physician Visit (Initial/Follow-Up) 1/acc/< 3/acc $50 $75 $100

Rehabilitation Facility < 15 days $50 $100 $150

Transportation < 3 trips/acc $200 $300 $500

Specified Injury & Surgery Benefit Package • Includes benefits for each covered person for: Dislocations and fractures; Burns, lacerations and

concussions; Surgery…and more• Injury/treatment time frame ranges from 72 hours to 365 days

For larger groups:

- Certain benefits may be removed from the plan design

- Alternate amounts and # of visits/days/nights/trips available

Detail Plan 1 Plan 2 Plan 3

Burn 1/acc < $5000 < $10K < $15K

Concussion 3/year $100 $150 $200

Dislocations(Dis) 1/joint < $2000 < $4000 < $8000

Fractures(Fx) 1/acc < $3000 < $6000 < $9000

Eye – Debris Removal/Surgical 1/acc $100/$300 $200/$400 $300/$600

Joint Replacement 1/acc $1500 $2000 $3000

Lacerations 1/acc < $400 < $600 < $600

Surgeries 1 each/acc < $1000 < $1500 < $2000

Catastrophic Benefit Package • Includes benefits for each covered person for: Death and dismemberment; Coma and paralysis;

Prosthesis…and more• Injury/service time frame ranges from 90 days to 365 days

For larger groups:

- Certain benefits may be removed from the plan design

- Alternate amounts available

Detail Plan 1 Plan 2 Plan 3Accidental Death – EE – $20K $30K $50K

Accidental Death – SP/CH – 50% of EE benefit/25% of EE benefit

Common Carrier Death – 3x death benefit

Coma 1/acc $5000 $10K $15K

Dismemberment /Paralysis 1 each/acc < $20K < $30K < $50K

Home Health Care < 30 days/acc $50

Prosthesis 2/acc < $1000 < $1500 < $2000

ENROLLMENT OPTIONS AVAILABLE

Enrollment Type Annual open enrollment

Dependent Benefits Same benefit amounts as EE, except for death benefits • For dislocation/fracture amounts, SP can be 50% & CH 25% of EE amounts

• Can be removed from plan

Portability Included; Extended continuation may be offered instead of portability in some states

Can be removed from plan

Ability Assist® EAP7 24/7/365 access to help for financial, legal or emotional issues

HealthChampion℠7 Administrative and clinical support following serious illness or injury

INTRODUCTIONAccident insurance from The Hartford provides a certificate holder with cash benefits when an accidental injury occurs, for either the primary insured or an insured dependent. More than 80 accidental injuries and treatments are covered, including emergency treatment, diagnostic exams, specific injuries, hospitalization, follow-up/recovery care (such as physical therapy and chiropractic care), and catastrophic injuries (such as death or dismemberment).

This insurance is indemnity based and provides first dollar benefits, helping to provide financial protection and peace of mind following an accident. There are no annual or lifetime claim limits. Claims are payable as long as the coverage remains in-force, no matter how many accidents an insured has, and regardless of other types of insurance the insured may have, including health insurance. There is no coordination of benefits.

The cash benefit can be used however the insured chooses, from paying for unexpected and/or uncertain medical expenses (including health insurance deductibles, copays or travel to facilities) to helping with general living and everyday expenses.

Accident insurance can be offered on an employee-paid (voluntary) basis or paid in whole or in part by the employer (noncontributory or contributory). It can be an important addition to employee benefits in the following ways:

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Health Insurance – An ideal time to introduce an accident plan is when an employer institutes health insurance plan changes that shift costs to employees. For the past decade or longer, employee deductibles, co-pays/co-insurance and out-of-pocket maximums have been increasing as employers attempt to manage rising medical care costs while still offering competitive benefits.

Accident insurance can also help employees manage the uncovered expenses associated with injury treatment and recovery, such as travel and lodging while receiving care, in addition to helping cover expenses not covered by health insurance.

Workers’ Compensation Insurance – “Monday morning accidents” (in which an employee gets hurt over the weekend and claims the accident happened at work on Monday) – are a significant, expensive problem for employers. A 24-hour accident plan may help reduce these types of claims.

Disability Insurance – Accident insurance can help with additional costs that arise from medical treatment or recovery from an accident, costs that disability benefits may not fully cover. A typical short- or long-term disability plan will replace 50–70 percent of an employee’s earnings after an elimination period that can be weeks or months long, leaving many employees short on income.

Some forms of disability/income replacement insurance offset other benefits. Accident insurance, however, is not considered an offset against any other forms of insurance or benefits.

Life Insurance – The catastrophic coverage available through The Hartford’s accident insurance provides benefits in the event of an accidental death. These death benefits are paid in addition to the life insurance offered to employees or, in certain circumstances, can even replace the accidental death and dismemberment coverage available with many life insurance plans.

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ELIGIBILITY – BASIC REQUIREMENTS

Accident insurance is available to employer groups. To be eligible:

• Employees must be actively working a minimum of 20 hours each week (30 hours for groups with 49 lives or less), unless otherwise requested by the policyholder.

• Employees and spouses must be under age 80.

• Child(ren) must be under age 26.

Alternate eligibility criteria are available.

FUNDING OPTIONS (CONTRIBUTION TYPES)

Accident insurance is typically offered as a 100% employee-paid (voluntary) benefit, but as employers continue to move toward high deductible health insurance plans (HDHPs) and other approaches that increase employees’ out-of-pocket expense, cost sharing and employer-paid funding options are a growing means to help offset the financial impact to employees.

To support the varied needs of our customers, the following funding options are available from The Hartford:

• 100% employee-paid (voluntary)

• Employer/employee cost sharing (contributory)

• 100% employer-paid (non-contributory)

COVERAGE TYPES

Two coverage types are available:

• Off-job (non-occupational) coverage provides benefits for covered accidents that occur while an insured is not working.

• 24-hour (on and off-job) coverage provides benefits for covered accidents that occur any time of day, including when an insured is working.

PLAN TYPES

The Hartford has three standard plan designs: Plan 1, Plan 2 and Plan 3. Each plan offers a full schedule of benefits for everyday injuries, treatment and services, as well as benefits for catastrophic injuries and death.

The benefits within each plan design increase incrementally, with Plan 1 offering the most economical benefits and Plan 3 the richest benefits. Each standard plan design includes the following categories/packages of benefits:

• Emergency, Hospital & Treatment Care

• Specified Injury & Surgery

• Catastrophic

Our accident product is also designed to be flexible. If one of the standard plan designs isn’t the right fit for a group, the following customization options are available:

• Customized packages – A group can offer a choice of low, medium or high benefit levels in one or more packages: 1) Emergency, Hospital & Treatment Care, 2) Specified Injury & Surgery, and/or 3) Catastrophic. The Emergency, Hospital & Treatment Care package is required, and can be offered on its own for a basic plan of accident insurance.

• Tailored benefit amounts – For larger groups, specific benefit amounts within the schedule can be adjusted to a desired amount, or a benefit can be removed from the plan design entirely (to match a plan that was in-force with a different insurance carrier, for example).

For example, if a group wants to offer a low cost accident plan but employees don’t have enough AD&D insurance, low (Plan 1) amounts can be offered for the Emergency, Hospital & Treatment Care and Specified Injury & Surgery packages, and high (Plan 3) amounts can be offered for the Catastrophic package.

The Hartford welcomes the opportunity to work with our customers to develop an accident plan design that best meets the needs of the group and its employees.

ACCIDENT COVERAGE ELECTION & COVERAGE TIERS

For voluntary or contributory plans, insurance for eligible persons is selected at time of enrollment. The employee may elect one of the following coverage tiers:

• Employee Only • Employee & Spouse

• Employee & Child(ren) • Employee & Family

The policyholder determines whether one or more plan designs will be available to employees at the time of enrollment. One plan design is recommended to simplify the enrollment process, but a choice of plans may be offered. For example, if a group has a large range of incomes across its employees, a choice of Plan 1 (most economical) and Plan 3 (richest benefits) may be offered, allowing employees to choose the plan that best works within their budget.

For noncontributory plans, the policyholder determines who will be insured (employee only, employee and family, etc.).

PLAN DESIGN INFORMATION

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EMERGENCY, HOSPITAL & TREATMENT CARE

Acupuncture

Ambulance (Ground or Air)

Blood Products

Child Care

Chiropractic Care

Diagnostic Exams

Emergency Dental Treatment

Emergency Room

Hospital Admission & Confinement

Lodging

Medical Appliances

Physician Visits (Initial & Follow-Up)

Physical Therapy

Rehabilitation Facility Confinement

Transportation

Urgent Care

X-rays

SPECIFIED INJURY & SURGERY

Burns Eye Injuries

Concussions Joint Replacement

Dislocations Lacerations

Fractures

Surgeries:

• Arthroscopic • Abdominal/Thoracic

• Hernia Repair • Knee

• Ligament • Rotator Cuff

• Ruptured Disc • Tendon

CATASTROPHIC

Accidental Death Home Health Care

Common Carrier Death Paralysis

Coma Prosthesis

Dismemberment

BENEFIT INFORMATIONBENEFITS

When a claim is submitted, the insured or policyholder receives their plan’s scheduled benefit amount(s) in one lump sum. It is common for several claims to occur following an accident, so as additional treatments occur and claims are submitted, lump sums will continue to be paid.

Please refer to the Quick Reference Guide at the start of this product guide, for the standard scheduled benefit amounts available with Plan 1, Plan 2 and Plan 3.

BENEFIT CATEGORIES/PACKAGES

As previously stated, The Hartford’s accident plan is organized into three standard categories/packages that allow for easy customization of the plan design, if one of our standard plan types isn’t the right fit for a group. The types of benefits within each package are as follows:

The Emergency, Hospital & Treatment Care package is required for all plans. On its own, this package offers basic accident protection, covering 18 of the 20 most frequent accident claims experienced after an accident.4 When offered with additional packages, it provides a strong core for the product. When customizing a plan design, it can be offered on its own or with one or more of the other packages.

The Specified Injury & Surgery package is optional when customizing a plan design. Benefits in this package are paid for specific injuries, which is uncommon among insurance products. Health insurance, for example, will pay for the services and treatment associated with an injury, but won’t pay a benefit to an insured for an injury itself. Benefits for specific types of surgeries are also available. And, the other two highest frequency claims of the top 20 are in this package: fractured arms (forearm, wrist or hand) and fractured or dislocated fingers/toes.

The Catastrophic package is also optional when customizing a plan design. The benefits in this package are very similar to the benefits offered by accidental death and dismemberment (AD&D) insurance. If a group’s employees don’t have access to AD&D insurance (either stand-alone or attached to a life insurance product) or don’t have enough AD&D insurance, then the Catastrophic package can be an important part of an accident plan. However, if a group’s employees already have appropriate levels of AD&D insurance, it may make sense to remove this package from an accident plan to avoid over-insurance and reduce the premium.

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ABILITY ASSIST® EMPLOYEE ASSISTANCE PROGRAM

The employee assistance program (EAP) provides an employee and any dependents 24/7/365 access to trained professionals and resources for assistance with financial, legal and emotional issues, whether personal or work-related. Services are offered through ComPsych5. Dependents do not have to be insured to use this service.

HEALTHCHAMPIONSM HEALTH CARE SUPPORT SERVICE

When an employee or dependent becomes seriously ill or injured, this advocacy service can help guide employees through health care options, ensure they are connected with the right resources and help resolve issues related to health care and recovery (administrative and/or clinical). Services are offered through ComPsych5. Dependents do not have to be insured to utilize this service.

BENEFIT DEMONSTRATIONFor the demonstration of the benefits payable under key product provisions, assume the following:

• Joe, his wife Mary and their son Jack are insured with group accident insurance from The Hartford.

• Joe and family are insured for The Hartford’s Accident Plan 2 (standard plan design).

INJURY/TREATMENT/SERVICE BENEFIT AMOUNT

Ground Ambulance $300

Emergency Room $150

X-ray $50

CT (Diagnostic Exam) $200

Dislocated Knee (Closed) $900

Concussion $150

Brace (Medical Appliance) $100

Follow-Up Visits $150 ($75 x 2)

PT Sessions $200 ($25 x 8)

TOTAL BENEFITS: $2,200

EVERYDAY ACCIDENT

During gym class at school, Jack is playing basketball. He trips, falls hard on his knee and hits his head on the gym floor. He is taken to the emergency room (ER) by ambulance. In the ER, Jack’s knee is examined by the doctor with an X-ray, and he has a CT scan to check for a head injury.

He is diagnosed with a dislocated knee and a concussion. His knee is adjusted and put in a brace, and he is released from the ER. Jack visits his family doctor twice for follow-up care, and has eight physical therapy (PT) sessions for his knee.

A health insurance deductible of $1,500 had to be met before Jack’s insurance would begin covering his treatment, followed by 20 percent coinsurance. The benefits paid by the accident insurance plan helped Jack’s parents cover these out-of-pocket expenses.

SERIOUS ACCIDENT

Joe is an avid motorcycle rider. On his way home from work during evening hours, he is hit by a car and thrown over 30 feet from his bike. Even though he always wears a helmet, the impact of his landing knocked it off, and Joe has multiple serious injuries.

He is airlifted to the emergency center at an area trauma center. Diagnostic exams and X-rays show that he has a skull fracture, a badly broken thigh bone and abdominal trauma requiring surgery.

After Joe is treated and in recovery, he is fully admitted to the hospital where he stays for 10 days before being released to a rehabilitation facility where he spends another 10 days. He is released, but requires a wheelchair and crutches for mobility.

Over the next several months, Joe follows up with his family physician, and receives regular physical therapy and chiropractic care. A health insurance deductible of $1,500 had to be met before Joe’s insurance would begin covering his treatment, followed by 20 percent coinsurance.

The benefits paid by the accident insurance plan helped Joe cover his out-of-pocket expenses and supplement his income while he was not working.

INJURY/TREATMENT/SERVICE BENEFIT AMOUNT

Air Ambulance $900

Emergency Room $150

Diagnostic Exam(s) $200

X-ray(s) $50

Skull Fracture (Closed) $750

Thigh Fracture (Open) $4,000

Abdominal Surgery $1,500

Hospital Admission $1,000

Hospital Confinement $2,000 ($200 x 10)

Rehabilitation Confinement $1,000 ($100 x 10)

Medical Appliance(s) $100

Follow-Up Visits $225 ($75 x 3)

PT Sessions $250 ($25 x 10)

Chiropractic Sessions $250 ($25 x 10)

TOTAL BENEFITS: $12,375

UNDERWRITING GUIDELINES & RATE INFORMATION

PREFERRED INFORMATION REQUESTED FOR AN ACCIDENT QUOTE

The following group information is preferred for The Hartford to issue a quote for accident insurance:

• Name

• Situs state (primary location)

• SIC

• Desired effective date

• Number of eligible lives

• Current participation percentage and coverage tiers(if replacement/takeover)

An employee census is not required to receive a quote.

Certain industries (SICs) may be ineligible to receive an accident quote. These industries may be eligible to receive a quote for other group products from The Hartford.

PARTICIPATION ASSUMPTIONS

The Hartford’s participation assumptions for accident insurance vary by funding option/contribution type:

• 100% employee-paid (voluntary) . . . . . . . . . . . . . . . . . . . . . . . Groups with 49 lives or less: 4 enrolled lives Groups with 50 lives or more: 10 enrolled lives

• 100% employer-paid (non-contributory) . . . . . . . . . . . . . . . . 100% of eligible lives

• Employer/employee cost sharing (contributory) . . . . . . . . Contingent on group size

RATE STRUCTURE

A composite rate applies to each coverage tier included in a plan:

• Employee Only

• Employee & Spouse

• Employee & Child(ren)

• Employee & Family

RENEWABILITY & RATE GUARANTEE PERIOD

Group accident insurance offered by The Hartford is annually renewable. A two-year rate guarantee period is standard. Alternative periods are available.

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BENEFIT LIMITATIONS & EXCLUSIONS

LIMITATIONS

There is no limit to the number of accidents that are covered. As long as insurance remains in-force, benefits remain payable. There may be a limit, however, to the number of times a specific benefit is payable per accident or during an insured’s lifetime. In addition, certain benefits are only payable if the injury is incurred or treatment is received within a specified period of time after an accident occurs. Please refer to the Quick Reference Guide at the start of this product guide or to a sample certificate for the standard frequencies and durations associated with each benefit provision.

EXCLUSIONS

Benefits under the policy are not payable for loss that results from or is caused by:

• Suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted injury

• War or act of war, whether declared or undeclared, or a nuclear, chemical, biological or radiological event

• A covered person’s participation in a felony, riot or insurrection

• A covered person’s service in the armed forces or units auxiliary to it

• A covered person’s taking drugs, unless as prescribed by or administered by a physician, or being intoxicated as defined by the jurisdiction in which the cause of loss was incurred

• While a covered person is on any aircraft: as a pilot, crewmember or student pilot; as a flight instructor or examiner; if it is owned, operated or leased by or on behalf of the policyholder, or any employer or organization whose eligible persons are covered under the policy; or being used for tests, experimental purposes, stunt flying, racing or endurance tests

• Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft

• Riding in or driving any motor-driven vehicle in a race, stunt show or speed test

All exclusions may not be applicable, or may be adjusted, as required by state regulations in the situs state of a group.

CLAIMS PAYMENT

Benefits under the policy are payable to the employee, even if benefits are paid as the result of an accident experienced by a dependent. Any benefits due or unpaid in the event the employee becomes deceased are payable to the employee’s designated beneficiary(ies) or to the employee’s estate in the absence of a beneficiary.

ABOUT SECTION 125 PLANS

Section 125 plans (also known as cafeteria plans) allow employees to contribute to employer-sponsored benefit plans with pre-tax dollars, which increases an employee’s take-home pay while reducing an employer’s payroll tax liability. While such plans are appealing for these reasons, inclusion of accident insurance in this type of plan may cause the benefits paid under the plan to be taxable as income to the recipient, reducing the value of the benefits received at a time when they are needed most. Careful consideration of the impact to benefits paid is advised before placing accident insurance through a cafeteria plan on a pre-tax basis.6

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Accident – A sudden, unforeseeable event that causes an injury and that occurs while a certificate is in force, occurs while the covered person’s insurance is effective; and is not subject to any exclusion in the policy.

Chip Fracture – An injury where small fragments of bone are chipped from the bones main structure. These are also known as avulsion fractures.

Coma – Complete unconsciousness with inability to respond to external or internal stimuli for a continuous period of at least 168 hours. The diagnosis of a coma must be made by a physician. Coma includes a medically induced coma.

Concussion – A traumatic brain injury resulting in immediate and transient alteration in brain function, including alteration of mental status and level of consciousness.

Dislocation – A completely separated joint. Open reduction of a dislocation means a surgical procedure, and closed reduction of a dislocation means a non-surgical procedure.

Dismemberment – The total and irrevocable loss of any of the limbs included in the schedule of a certificate.

Emergency Room – A specified area within a hospital that is designated for the emergency care of accidental injuries. This area must: be staffed and equipped to handle trauma; be supervised and provide treatment by physicians; and provide 24 hours a day service by registered graduate nurses (RNs).

Fracture – A broken bone which can be seen by x-ray. Open reduction of a fracture means a surgical procedure, and a closed reduction of a fracture means a non-surgical procedure.

Injury or Injuries – A bodily injury sustained by a covered person that is the direct result of an accident, and is independent of disease or bodily infirmity or any other cause.

Hospital – An institution:

• licensed to operate as a hospital pursuant to law;

• primarily and continuously engaged in providing or operating either on its premises or in facilities available to the hospital on a prearranged basis and under the supervision of a staff of licensed physicians, medical,

diagnostic and major surgical facilities for the medical care and treatment of sick or injured persons on an in-patient basis for which a charge is made; and

• providing twenty-four hour nursing service by or under the supervision of registered nurses (RNs).

Hospital does not include: convalescent homes, or convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitative care; or facilities for the aged, drug addicts or alcoholics.

Laceration – A cut of at least 2 inches in length requiring sutures.

Medical Appliance – A walking boot that extends above the ankle; a brace for the neck, back, knee or leg; cane; crutches; walker; and wheelchair.

Paralysis – An injury to the brain or spinal cord that results in loss of use or loss of movement of multiple limbs (arms and/or legs). Paraplegia means the complete and irreversible paralysis of both legs. Quadriplegia means the complete and irreversible paralysis of both arms and both legs.

Rehabilitation Unit – An appropriately licensed facility that provides rehabilitation care services on an inpatient basis. Rehabilitation care services consist of the combined use of medical, social, educational and vocational services to enable patients disabled by accidental injury to achieve the highest possible functional ability. Services are provided by or under the supervision of an organized staff of physicians. The rehabilitation unit may be part of a hospital or a freestanding facility. A rehabilitation unit is not a nursing home, an extended care facility, a skilled nursing facility, a rest home or home for the aged, a hospice care facility, a place for alcoholics or drug addicts, or an assisted living facility.

Second Degree Burn – A burn in which damage penetrates into some of the underlying layers of skin.

Third Degree Burn – A burn which extends to all layers of skin.

Urgent Care Facility – A facility or place other than a physician’s office, hospital or an emergency room that provides emergency or urgent care and treatment to injured people. Such facility may be a 24-hour clinic.

KEY ACCIDENT DEFINITIONS (IN ALPHABETICAL ORDER)

The definitions that follow may be adjusted as required by state regulations for the situs state of a group. Only key definitions are provided below. Please refer to The Hartford’s sample/annotated accident certificate as a reference for all definitions included within a policy.

STATE FILING STATUS & SPECIFIC EXCEPTIONSREVISED AS OF 08/10/15 The following exceptions to the information presented in this guide are required by regulations in the situs state of a group. (If no variations are listed, then no variations apply to that state.) This information is subject to change.

STATE/TERR.

FILING STATUS

MAX CHILD AGE (AVAILABLE RANGE)

MINIMUM LOSS RATIO

MAX COMMISSION

REQUIRED BENEFITS OTHER

STANDARD – 26 (18-26) 50% 25% – –

AK Approved Extended continuation is offered instead of portability

AL Approved

AR Approved Children eligible regardless of marital status

AZ Approved

CA Approved

CO Approved 25 (18-25) 60% 15% Lodging, transportation and child care benefits are not available

CT Approved 26 required Ground Ambulance; Air Ambulance; Ingestion/Consumption of Controlled Drug

Air ambulance benefit is payable for charges incurred; Physical Therapy benefit includes occupational therapy; Children eligible regardless of marital status

DC Approved 26 (19-26) Ground Ambulance; Air Ambulance; Emergency Room

DE Approved

FL Approved Extended continuation is offered instead of portability; Lodging benefit is not available; Min. work hours < 25; Children eligible regardless of marital status

GA Approved Children eligible regardless of marital status

GU Approved

HI Approved

IA Approved All surgery, death, dismemberment, concussion, emergency care, fracture, laceration and x-ray benefits

ID Approved 25 required Certain exclusions are not available

IL Approved 26 required Children may be covered to age 30 in certain circumstances following military service; Certain exclusions are not available

IN Approved 26 required 60% 15%KS Approved Chiropractic Care is called "Spinal Manipulation"

KY Approved 60% 15%

LA Approved 26 (21-26)

MA Approved 26 required

MD Approved 60% 15% Second opinion benefit is available if inpatient treatment is denied

ME Approved 26 (19-26) Minimum death and dismemberment benefit (all dismemberments) is $2,000; Minimum Daily Hospital Confinement benefit is $500

MI Approved Certain exclusions are not available

MN Approved 25 required 65% 10% Certain exclusions are not available

MO Approved 26 required

MS Approved Certain exclusions are not available

MT Approved 25 required All surgery, death, dismemberment, concussion, emergency care, fracture, laceration and x-ray benefits

Termination age for employee and spouse is not allowed

NC Approved

ND Approved 26 (22-26)

NE Approved 26 (19-26)

NH Approved 26 required Certain exclusions are not available; A single benefit amount is available for burns, lacerations, dental care and eye injuries, regardless of severity of the injury; Skin graft benefit is not available; Children are eligible regardless of marital status

NJ Approved 26 (19-26) Certain exclusions are not available

NM Approved 25 required Elig. waiting period < 6 months

NV Approved Certain exclusions are not available

NY 65% 10% (50+ lives) Max commission for <50 lives is 15%

OH Approved 26 (19-26) 60% 15%

OK Approved

OR Approved Elig. waiting period < 60 days

PA Approved

PR Not available

RI Approved

SC Approved

SD Approved Certain exclusions are not available

TN Approved 26 (24-26)

TX Approved 26 (25-26)

UT Approved 26 required Eligibility waiting periods are not available

VA Approved 25 (19-25)

VT Approved Extended continuation is offered instead of portability; Children eligible regardless of marital status; Certain exclusions are not available

WA Approved 26 required 65% 10% (100+ lives) Max commission for <100 lives is 15%; One year allowed (from date of accident) to receive treatment/service for most benefits; Certain exclusions are not available

WI Approved

WV Approved

WY Approved

13

ELIGIBILITY – EXPANDED REQUIREMENTS & PROVISIONS

EMPLOYEE & DEPENDENT ELIGIBILITY

Active employees who work for the policyholder for the minimum required hours are eligible for accident insurance once any eligibility waiting period has been satisfied. As noted previously, the minimum requirement is 20 hours per week (30 hours for groups with 49 lives or less) unless otherwise requested by the policyholder.

An employee’s spouse and child(ren) are eligible for accident insurance once the employee becomes eligible, or on the date the dependent is acquired. If an employee is eligible for insurance as both an employee and a spouse under the policy, the employee may only be insured as an employee or as a spouse, not both. No child(ren) can be insured as a dependent of more than one employee.

Employees and spouses must be under age 80 to be eligible, and child(ren) must be under age 26 and unmarried to be eligible. Alternate eligibility criteria are available.

14

ELIGIBILITY WAITING PERIOD (EWP)

The Hartford does not require an EWP, but the policyholder may choose to incorporate one into the plan design to coordinate with eligibility for other products. Any period of time between 30 days and 12 months is acceptable for an EWP.

CONTINUITY OF COVERAGE FROM A PRIOR POLICY

Coverage for an employee who was insured with a prior carrier on the day before the policy effective date with The Hartford, but is not actively at work on the policy effective date, may be insured through the Continuity provision for a specified period of time (subject to certain conditions).

COVERAGE EFFECTIVE DATE (WHEN INSURANCE BEGINS)

Coverage becomes effective on the first day of the month following the date the employee or dependent becomes eligible or enrolls for insurance, whichever is later (subject to certain conditions).

HEALTH INSURANCE REQUIREMENT

Certain states may requires that any insured person have some form of primary health insurance in effect, such as major medical insurance or a combination of basic hospital and basic medical insurance, to be eligible to purchase accident insurance.

CONTINUATION OPTIONS

In the event insurance under the policy would otherwise end, a variety of continuation options and durations are available, including: personal leave of absence, military leave, layoff, furlough, status change, disability insurance, sickness/injury, labor dispute, sabbatical leave, severance and FLMA/protected leaves. Continuous premium payment is required for all forms of leave.

PORTABILITY

An employee, or spouse in certain circumstances, has the ability to continue insurance (including coverage for any dependent child(ren)) when insurance ends with the policyholder without having to respond to any health questions, by remitting premium directly to The Hartford. This insurance is issued under The Hartford’s group accident portability policy and allows portees a choice of three plan designs. The choice in plan design allows portees to choose the coverage and premium level that best suits their financial protection needs at time of port. In certain states, extended continuation (continuation of the originating group plan with same rates and benefits) will be offered instead of portability.

15

ENROLLMENT

ENROLLMENT METHODS

The following enrollment methods are supported by The Hartford for the accident product:

• On-site group enrollment meetings with personalized enrollment forms and materials

• Online enrollment through BenSelect, The Hartford’s online enrollment platform (powered by Selerix Systems)

Available enrollment services may vary based on the size of the group.

ADMINISTRATION

GROUP CONTRACT

The Hartford offers accident insurance through a group contract administered on a group platform. Use of a group contract simplifies the administration process in that the contract is issued in the domicile state of the group, resulting in one certificate for all employees regardless of where they reside. This enables consistency in the product regardless of where employees reside, allowing for more effective employee education and enrollment planning.

BILLING TYPES

The Hartford offers the convenience of two types of billing for accident insurance: list billing and file feed billing. With list-billing, The Hartford bills the exact amount due based on census information reported to us by the policyholder prior to the billing date. With file feed billing, no physical bill is produced. Amounts due are calculated based on the eligibility file provided by the group, and as long as the premium paid remains within a predetermined threshold, the account remains current. Each policyholder tracks the benefit changes and determines the actual premium due.

Available billing types may vary based on the size of the group. Two electronic file formats are accepted for eligibility/billing administration:• Pass 3.1• HIPAA 834

ANNUAL OPEN ENROLLMENT

The Hartford supports annual open enrollment of the accident product. During an annual period selected by the policyholder, employees may elect accident insurance for themselves or their dependents, without providing health information.

Insurance may only be elected by employees during this annual period. If an employee does not make an election during the enrollment period and later wishes to do so, the employee must wait until the next annual period, unless otherwise allowed by the policy due to a change in family status (life event).

ENROLLMENT STRATEGY

A successful enrollment is vital to the success of any accident plan. To ensure the initial and ongoing success of an accident plan with The Hartford, our local enrollment professionals will help a group develop an enrollment strategy that meets the needs of a group and its employees, including any of the following:

• Comprehensive enrollment timeline

• Online benefits education via MyTomorrow®

• Easy-to-understand, comprehensive educational materials (benefit highlight sheets, email drips, newsletters, postcards, payroll stuffers, etc.)

• Personalized enrollment packages showing coverage amounts and the cost of coverage

• On-site support at benefit fairs

• HR training and support

• Call center support

Available enrollment services may vary based on the size of the group.

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the issuing companies listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. This guide explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this guide and the policy, the terms of the policy apply. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Benefits are subject to state availability.1 ��National Safety Council. Injury Facts 2014 Edition. Itasca, IL: National Safety Council; 2014.2 ��The American Journal of Medicine. “Medical Bankruptcy in the United States, 2007: Results of a National Study.” August 2009.3 ��Johns Hopkins Medicine, “Sports Injury Statistics.” Web (http://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/sports_injury_statistics_90,P02787/). 01 Dec 2014.4 �As used in this instance, highest frequency claims refers to the actual number of claims expected, not benefit volume.�5 ��Hospital does not include: (a) convalescent homes, or convalescent, rest or nursing facilities; (b) facilities affording primarily custodial, educational or rehabilitory care; or (c) facilities for the aged, drug addicts

or alcoholics.6 ��Confinement means being an inpatient in a medical facility for a period of at least 1 days due to an injury sustained in an accident.7 �Services are provided through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability for

the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. ComPsych is a registered trademark and HealthChampion is a service mark of ComPsych Corporation

8 �This information is written in connection with the promotion or marketing of the matter(s) addressed in this material. The information cannot be used or relied upon for the purpose of avoiding IRS penalties. These materials are not intended to provide tax, accounting or legal advice. As with all matters of a tax or legal nature, policyholders and/or individual insureds should consult tax or legal counsel for advice.

5441 NS 08/15 © 2015 The Hartford Financial Services Group, Inc. All rights reserved.

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