Stanford University Risk Management Department

Stanford University

Business Travel Accident Insurance

SUMMARY ANNUAL REPORT

The report which follows provides summarized financial data for the fiscal year of the benefit plan.  The information applies to Plan participants only.

A detailed financial annual report has been filed with the Internal Revenue Service for this plan.  Plan participants and beneficiaries may inspect this report and plan document at the Office of Risk Management.  For a reasonable charge a participant or beneficiary can obtain a copy of the report or plan document by making a written request specifying the desired material.

The Office of Risk Management, 215 Panama Street, Bldg. D, Stanford, CA 94305-6207 is the official Plan Administrator for this benefit plan.  The Office of Risk Management is responsible for day-to-day operation of benefit plans.  Questions about this report and other aspects of the plan may be directed to the Office of Risk Management (650) 723-4555.

Insurance Information

The plan has a contract with the Hartford Life and Accident Insurance Company to pay claims incurred under the terms of the plan.  The total premium is paid by the Office of Risk Management for the plan year September 1 through August 31 for the University and SLAC.

Your Rights to Additional Information

You have the right to receive copies of the full annual report, or any part thereof, on request.  For copies of this annual report, call (650) 723-4555.

Financial Information Available

If applicable, you also have the right to receive from the Plan Administrator on request at no charge, a statement of assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both.

If you request copies of the full annual reports form the Plan Administrator, these two statements and accompanying notes will be included as part of those reports.  These portions are furnished without charge.

Examination of Annual Report

You also have a legally protected right to examine the annual report at the main office of the plan, the Stanford University Office of Risk Management, and at the U.S. Department of Labor in Washington DC, or to obtain copies from the U.S. Department of Labor upon payment of copying costs.  Requests to the Department should be addressed to:

Public Disclosure Room, N4677,
Pension and Welfare Benefit Programs,
Department of Labor,
200 Constitution Avenue NW
Washington, DC  20216


 

Stanford University

Business Travel Accident Insurance

SUMMARY PLAN DESCRIPTION

BUSINESS TRAVEL ACCIDENT INSURANCE OVERVIEW

All eligible faculty and staff of the University, whether full-time or part-time, who risk accidental death or disability while traveling on University business are covered by a Group Business Travel Accident Insurance policy maintained by the University and carried by the Hartford Life and Accident Insurance.  Coverage begins when you start your business trip from your home or regular work location, whichever is last.  Coverage ends when you return to your home or regular work location, whichever is first.  A portion of the full benefit is payable if you should lose a limb or eyesight as a result of the accident.

Eligibility
You are eligible to participate in this travel accident benefit if you:

  • are a regular staff employee; and
  • are in a position scheduled to last at least six months at 50% or more of FTE (four months if covered by Stanford-Local 715 collective bargaining agreement).

When Benefits Are Paid
Business Travel Accident insurance benefits are awarded if, while on authorized travel for Stanford, you should die or suffer a loss of sight or dismemberment of a limb within 365 days of an accident or suffer a permanent total disability within 120 days of an accident (and continuing for at least 12 months).  Benefits are paid for losses due to an accident or unavoidable exposure to the elements in addition to any other benefits you may receive as life insurance benefits.

You are covered while you are a passenger in a vehicle or aircraft being used only for transporting passengers.  You are not covered while riding in, operating, or getting in or out of any vehicle owned, leased or controlled by Stanford, other than to transport passengers.  You are not covered while acting as a pilot or crew member.

For questions regarding coverage, contact Risk Management at (650) 723-4555.

Amount of Coverage
The benefits may vary with benefit class.  The annual salary in the policy is defined as:  “The annual wage or salary, which the insured employee was receiving from the University on the date of this accident.  It does not include commission, bonuses, overtime earnings, incentive pay or any other type of compensation.”

Business Travel Accident Insurance provides partial or full benefits for loss of limb or eyesight.  The benefit payable depends on the type of loss.  If you die or lose a limb or eyesight due to and within 365 days after an accident, the following benefit will be paid.

Travel Injury % of Total
Benefit Paid
Loss of two limbs, sight in both eyes,
or combination of two losses
100%
Life 100%
Loss of one limb or sight of one eye 50%
Loss of speech 50%
Loss of hearing in both ears 50%
Loss of thumb & index finger of same hand 25%

Loss of a limb means the actual severance of a hand or a foot at or above the wrist or ankle.  The loss of an eye is entire and irrevocable loss of the sight in that eye.

If you have more than one loss due to the same accident, the benefit will be for the loss that pays the highest amount but never more than the amount payable for the loss of life.

If you are in a vehicle that sinks or is wrecked or stranded and your body is not found within one year, you will be considered to have died as a result of an accident and the benefit will be paid to your designated beneficiary.

Total and Permanent Disability
The Business Travel Accident Insurance Plan can pay you a benefit if you become totally and permanently disabled due to an accident and within 120 days after the accident claim has been filed.  If you remain totally and permanently disabled for 12 consecutive months, you will receive your principal sum minus any amount the plan previously paid to you.

You are considered totally and permanently disabled if you are prevented from engaging in any employment for which you are reasonably qualified by education, training and experience and such disability has continued for at least 12 continuous months and your disability is total, continuous and permanent at the end of the 12 month period.  Proof of disability satisfactory to the insurance company will be required.

For eligibility for this benefit, please refer to the Certificate of Insurance available through the Risk Management Department.

Benefit Limitation
There is a total limit of $5,000,000 for one accident.  Consequently, Stanford recommends that the number of employees traveling together on Stanford business be limited, so that this maximum coverage amount is not exceeded.  If more than one employee is involved in the same accident, the maximum benefit payable is $5,000,000. 

The amount of principal sum applicable to the insured person shall be the percentage shown below:  

Age at Date of Loss % of Principal Sum
69 and younger 100%
70 - 74 80%
75 - 79 55%
80 - 84 35%
85 and older 20%

What Is Not Covered

Business Travel Accident insurance does not cover losses resulting from:
Exclusions:  This policy does not cover any loss resulting from:

  1. Intentional self-inflicted Injury, suicide or attempted suicide whether sane or insane, (in Missouri, while sane);
  2. Injury sustained while in the armed forces of any country or international authority;
  3. Injury sustained while on any aircraft, unless, and only to the extent, a Hazard specifically describes such coverage;
  4. Injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a prescription, including sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless the drug is taken as prescribed or administered by a licensed physician;
  5. Injury sustained while committing or attempting to commit a felony;
  6. Injury sustained while legally intoxicated from the use of alcohol (not applicable to residents of Minnesota).
  7. Everyday commuting to and from work; bona fide leaves of absence and vacations
  8. Travel while on sabbatical unless the travel is under a grant or contract on behalf of Stanford University;
  9. Sickness or disease (except a pus-forming infection occurring through an accidental cut or wound);
  10. While riding in, operating or getting in or out of any vehicle owned, leased or controlled by Stanford, other than to transport passengers;
  11. Travel or flight as a pilot operator or crew member in any vehicle or device for aerial navigation;
  12. Loss resulting from war or act of war, whether declared or undeclared, occurring within the geographical limits, the territorial waters, or the airspace above: (a) the United States, Canada; and (b) any country of which the Insured Person is a Permanent Resident.

Assignment of Insurance
Some employees may wish to assign their benefits from the Business Travel Accident Insurance Plan.  Be sure you clearly understand that an assignment of benefits results in an irrevocable transfer of all present and future rights to the insurance being assigned.  This includes your right to designate a beneficiary.  You should assign your benefits only upon your legal or tax advisor’s recommendation.  If you wish to make an assignment, contact Risk Management, (650) 723-4555 for the appropriate form.

Cost:
Stanford pays the entire cost of Business Travel Accident insurance coverage.

HOW TO FILE A CLAIM FOR BENEFITS

Benefits will be paid to the beneficiary(s) designated under the Group Life Program; otherwise to the beneficiary(s) designated under the Retirement Plan; otherwise to the employee’s estate.  University employee beneficiary forms are available from the Office of Total Compensation web site: http://benefitsu.stanford.edu/life/index_life.html, at SLAC Benefits Office at (650) 926-2357.  To receive a benefit from Employee Life, Dependent Life, AD&D, or Business Travel Accident, you (or your beneficiary if death has occurred) must submit written proof of loss to the Office of Total Compensation within 20 days if reasonably possible to do so.  Three claim forms are used for Business Travel Accident and are available from the Risk Management web site: http://www.stanford.edu/dept/Risk-Management/docs/forms/bustravelaccident.html

The claimant or family can submit claim form (found at: http://www.stanford.edu/dept/Risk-Management/docs/forms/bustravelaccident.html) to:  The Hartford, Attn: Group Life Claims, P.O. Box 2999, Hartford, CT 06104-2999.      Fax: (888) 563-1124.

The Risk Management office will initiate the payment of a claim under Business Travel Accident insurance.

WHEN COVERAGE ENDS

Accident, death and life insurance coverage terminates when:

  • You retire;
  • Your employment appointment drops to less than 50% FTE;
  • You end your regular employment with the University.  If you terminate employment, coverage ends the last day of that month; or
  • Stanford terminates the plan.

If you die on or before the last day of the month in which your coverage under this plan ends, your beneficiary will receive the amount of insurance in effect just before coverage ended.

Business Travel Accident insurance coverage also stops the date you go on a leave of absence whether approved or unapproved.  This includes medical leave, personal leave, family leave, military leave and leave due to total disability.  The definition of eligibility is limited to “active” employees and poses no threat to the employee’s position in the University.

IF A CLAIM IS DENIED

If a claimant’s claim is partially or wholly denied, he or she will receive a notice from the Hartford Life and Accident Insurance:

  • Stating the specific reason(s) for the denial and a specific reference to the pertinent provision of the official plan documents on which the denial is based;
  • Describing and explaining any additional material or information required of the claimant to make the claimant’s claim valid;
  • Explaining what steps must be taken to have the claim denial reviewed: and
  • Explaining that the initial decision will be a final decision unless the decision is appealed.

If a claimant wants to have the denied claim reviewed, the claimant must send a written request for a review of the claim to the Hartford Life and Accident Insurance no later than 60 days after the date the notice of denial is received by the claimant.  Any claimant filing a timely request for review may:

  • Submit additional materials for consideration on review including a written explanation of the issues and comments on the issues; and
  • Review, upon written request, all materials and official plan documents applicable to the claim.

The claimant or family can submit claim form (found at: http://www.stanford.edu/dept/Risk-Management/docs/forms/bustravelaccident.html) to:  The Hartford, Attn: Group Life Claims, P.O. Box 2999, Hartford, CT 06104-2999. Fax: (888) 563-1124.

Hartford Life and Accident Insurance will review the denied claim if a timely request for review is filed by the claimant.  The claimant will receive a written decision of the Plan Administrator on the review of a denied claim within 60 days of the date the Hartford Life and Accident Insurance receives the request for review or, if special circumstances require a delay in the decision, the claimant will receive a notice of the reasons for the delay within the same period.

A delayed decision will be issued no later than 120 days after the date the Hartford Life and Accident Insurance receives the claimant’s request for review.  The claimant will receive a written decision of the Hartford Life and Accident Insurance on the review of a denied claim within 60 days of the date the Hartford Life and Accident Insurance receives the request for review or, if special circumstances require a delay in the decision, the claimant will receive a notice of the reasons for the delay within the same period.

A delayed decision will be issued no later than 120 days after the date Hartford Life and Accident Insurance received the claimant’s request for review.  The written decision of the insurance company will explain the reasons for the decision and will refer to the provisions of the plan on which it is based.  If, for any reason, the claimant does not receive a written decision within the time limits just described, he or she may assume the claim has been denied on review.

The Hartford Life and Accident Insurance has full discretion to make all factual determinations, to decide all requirements for eligibility and to interpret the terms of each plan summarized in this SPD.  The decision of the Hartford Life and Accident Insurance on review will be final, binding and conclusive and will be afforded the maximum deference permitted by law.

No legal action, grievance, or arbitration proceeding against the plan, the University, Hartford Life and Accident Insurance, the plan or claims administrator or any other person for the recovery of any benefits will be commenced until the plan’s claims procedures as set forth in this Section have been exhausted.  All legal action against the plan, the University, Hartford Life and Accident Insurance, the plan or claims administrator or any other person for the recovery of any benefits must be commenced within the applicable statute of limitations.

PLAN OPERATION

Plan Sponsor and Plan Administrator

The plans described in this SPD are sponsored by:

The Board of Trustees of Leland Stanford Jr. University
c/o Office of Risk Management
215 Panama Street, Bldg. D
Stanford, CA 94305-6207
650-723-4555                 

You can direct questions about your benefits to the Office of Risk Management,  (650) 723-4555 or the SLAC Benefits Office at (650) 926-2357.

Stanford has appointed a plan administrator to handle the operation of plans, to interpret plan provisions, and to make final decisions about such issues as eligibility and payment of benefits.  The plan administrator for the benefits covered in this booklet is the Risk Management office.  You can contact the plan administrator at the address given above or by calling 650-723-4555.

Service of Legal Process
In the event any legal action is necessary, Stanford University has designated the Office of the General Counsel as the appropriate department to receive service of legal process.

Plan Identification

  • Stanford University’s employer identification number, assigned by the Internal Revenue Service, is 94-1156365-N.
  • Business Travel Accident Plan identification number is 509.

You should use both the plan and Stanford numbers when inquiring about a plan.

Official Plan Document
In the event of any difference between this SPD, including its interpretation, and the official Plan document, the Plan document will govern.  A copy of the Plan document is available for inspection at the Department of Risk Management.

Collective Bargaining Agreements
Health and welfare plans are provided for all eligible employees regardless of collective bargaining status except that long-term care is available only to employees who are eligible for the flexible benefits program, Educated Choices.

Plan Changes or Termination
The University reserves the right to change or terminate the Plan at any time.  Plan changes or terminations are subject to any relevant collective bargaining agreements.  Participants will be informed in writing of any material changes made and of their rights under any such changes.  Change or termination of the Plan will not affect any claim incurred prior to the effective date of the change or termination.

Employee Rights
Neither eligibility for nor participation in this Plan constitutes any guarantee of employment.

Plan Year
The 12-month period is used to maintain a plan’s fiscal records.  The plan year for all but one of Stanford’s plans is January 1 through December 31.  The plan year for the Business Travel Accident benefit is September 1 through August 31.

YOUR RIGHTS TO BENEFITS

ERISA - The Employee Retirement Income Security Act of 1974 - is a federal law that sets standards and defines procedures for employee benefit plans.  However, Stanford did not create your benefit plans because of ERISA.  These plans were adopted to help you and your family meet security and benefits needs.

Your Benefits under ERISA
ERISA assures you of certain rights, including rights to information.  Among those rights is the right to an accurate summary of your benefits.  This SPD and the University Guide Memo 27.1 provide that summary.  You may obtain more information about any of the plans.  ERISA provides that Plan participants shall be entitled to:

  • Examine, without charge, at the Risk Management office, all Plan documents, collective bargaining agreement and copies of all documents filed by the Plan with the U.S. Department of Labor, such as detailed annual reports and Plan descriptions.
  • Obtain copies of all Plan documents and other Plan information upon written request to the Plan Administrator of the Department of Risk Management.  A reasonable charge may be made for the copies.
  • Receive a summary of the Plan’s annual financial report.  The Plan Administrator is required by law to furnish each participant with a copy of the summary annual report.

In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan.  The people who operate your Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries.  No one, including your employer, our unions, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA.

If your claim for a benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial.  You have the right to have the Plan review and consider your claim.  Under ERISA, there are steps you can take to enforce the above rights.  For instance, if you request materials from the Plan and do not receive them within 30 days, you may file suit in a federal court.  In such a case the court may require the Plan Administrator to provide the materials and pay you up to $100 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator.

If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court.  If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court.  The court will decide who should pay court costs and legal fees.  If you are successful, the court may order the person you have sued to pay these costs and fees.  If you lose, the court may order you to pay these costs and fees; for example, if it finds your claim is frivolous.

If you have any questions about your Plan, you should contact the Plan Administrator in care of the Risk Management Department.

If you have any questions about this statement or about your rights under ERISA, you should contact the nearest Area Office of the U.S. Department of Labor/Management Services Administration, Department of Labor.

FUTURE OF THE PLANS

While Stanford expects to continue the plans described in this SPD, benefit plans for both active employees and retirees may be amended or terminated at any time.  For example, a plan may be changed because of federal regulations, or it may be ended for business reasons.  You will be informed of any changes that are made and told how the changes affect your benefits, if at all.

Should any of the plans be modified, any claims incurred before the amendment date will be paid in accordance with the plan provisions in effect before the modification.  Any claims incurred on or after the amendment date will be paid according to the new provisions.

If any plan terminates, all eligible claims incurred during the remainder of the calendar year in which the termination occurs will be paid to the extent of available plan assets.

 



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Last modified: Wednesday, 21-May-2014 18:18:30 PDT
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