1. science
2. medicine
3. surgery

Cover sheet
Date:
March 30, 2012
To:
From:
Group Insurance Services, Inc.
Tom Weibel
Contact information
Regional group sales office
Service Office
Tom Weibel
475 N. Martingale Road
Ste. 520
Schaumburg, IL 60173
Office: 847-413-9600
Toll-free: 800-847-5852
Fax: 847-413-9150
8801 Indian Hills Drive
Omaha, NE 68114
Office: 800 423-2765
Fax: 877 573-6177
Home Office: Fort Wayne, IN
Why LFG for Worksite Benefits?
Maximize the value of your employee benefits package with flexible, easy-to-use voluntary benefits
from Lincoln Financial Group. We offer flexible service and enrollment options, and a variety of
products to cover you and your employees.
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Employees are able to keep their coverage should they leave their employer
Coverage that is Guaranteed Renewable
No physical exams are required
Flexibility to design a plan that’s just right for your employees
Tools to help educate and empower your employees to make the right choices with confidence
LFG offers a full suite of products to meet your insurance needs
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Universal Life
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Critical Illness
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Accident
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Short and Long Term Disability
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Term Life
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.
Prepared For: GIS Client
Group ID:
Quote Sequence:
Proposed Effective Date: 4/1/2012 or later
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?
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Coverage is Guarantee Issue.
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Coverage is Guarantee Renewable.
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The option to continually build participation through annual enrollment.
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Benefits are paid directly to the covered employee.
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Benefits are paid for multiple injuries related to a single accident.
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Attractive group rates are offered.
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Employees may keep their Accident coverage after separation from their employer.
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Premiums can be paid by employee on a pre-tax or post-tax basis.
COST SUMMARY
Rates shown are Weekly and guaranteed renewable
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Accident Base Coverage
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
$3.91
$5.47
$6.62
$8.76
GROUP LEVEL BENEFIT OPTIONS
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On-the-job Accident Coverage
included
EMPLOYEE LEVEL BENEFIT OPTIONS
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Health Assessment (Wellness) Benefit Available for Employee Election at displayed rate
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
$0.51
$1.02
$0.64
$1.17
Proposal assumptions
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FRQVXOWDQW
OPTION 1
CHOICE PLAN
Emergency care
Ambulance
Air ambulance
Initial physician office visit
Emergency room
Major diagnostic care
Treatment care
Hospital admission
Hospital confinement daily benefit
Intensive care unit daily benefit
Alternate care and rehabilitative facility daily benefit
Follow-up doctor/patient care up to 6 sessions
Transportation for care (up to 3 times per accident)
Companion lodging (up to 30 days per accident)
Family care per child up to 30 days
Fractures (per fracture)
Ankle, arm, collarbone, elbow, foot, hand, jaw, kneecap, shoulder blade, sternum, wrist
Hip
Skull depressed
Leg, pelvis, skull nondepressed, vertebral column
Bones of face, vertebrae, coccyx, rib, nose
Finger, toe
Chip fractures
$150
$600
$50
$150
$100
$1,000
$200
$400
$100
$50
$175
$100
$20
Non-Surg/Surg
$300/$600
$1,400/$2,800
$2,500/$5,000
$500/$1,000
$150/$300
$50/$100
25% benefit
Dislocations (per injury)
Ankle, collarbone sternoclavicular, foot
Collarbone acromio and separation, elbow, hand, lower jaw, shoulder, wrist
Finger, toe
Hip
Knee, except kneecap
$400/$800
$250/$500
$50/$100
$1,200/$2,400
$500/$1,000
Specific injuries or treatments
Transfusions
Burns
Skin grafts
Joint replacement
Coma
Concussion
Dental crown once per accident
Dental extraction once per accident
$150
$100-$6,400
Additional 25%
$1,500-$2,000
$2,000
$100
$150
$50
Eye (removal of foreign body) once per eye/accident
Eye (surgical repair) once per eye/accident
Laceration
Surgery
Arthroscopic
Abdominal or Thoracic
Treatment, per repair
Ligaments/tendons, knee cartilage
Rotator cuff
Ruptured disc
Transitional care benefits
Crutches
Wheelchair for temporary use
Wheelchair for permanent use
Walker for temporary use
Walker for permanent use
Prosthesis per limb/device
Reasonable modifications to home or vehicle in the case of catastrophic loss
Accidental Death & Dismemberment (AD&D)
Accidental Death
Employee
Spouse
Child
Common carrier enhanced death benefit
Transportation of remains
Seat belt/helmet AD&D benefit
Common disaster enhanced death benefit
Loss of or loss of use of one: hand, foot, arm, leg, eye
Loss of or loss of use of any one finger, thumb, or toe
Catastrophic loss
Additional benefits
Accident EAP services
TravelConnectSM
OPTION 1
CHOICE PLAN
$100
$300
$50-$400
$250
$1,000
$300
$300
$400
$25
$50
$350
$25
$50
$500
$2,500
$30,000
$10,000
$5,000
2x benefit amt
$5,000
10% of AD&D
2x benefit amt
$7,000
$300
$50,000
Included
Included
EMPLOYEE LEVEL BENEFIT OPTIONS
Health Assessment Benefit: If an insured undergoes a defined health assessment, a benefit will be paid.
Optional
$50
Exclusions
This accident policy will not cover losses caused by or as a result of:
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Injury occurring prior to the effective date of coverage or after termination of the coverage
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Duty as a member of any military, including Reserves or National Guard
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Travel or flight in or on any Aircraft, except as a fare paying passenger on a regularly
scheduled commercial flight
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Participating in high risk or extreme sports
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Having cosmetic or elective surgery
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Participating in or attempting to commit a felony
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Being incarcerated in any type of penal or detention facility
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Having a blood alcohol level of .08 grams of alcohol or more per 100 milliliters of blood
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Deliberately using poison, gas, fumes, or drugs (except when prescribed by a Physician and
administered appropriately)
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Committing or attempting to commit suicide or any other self-inflicted injury
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Any sickness, disease (physical or mental), or medical or surgical treatment of these
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Participating in, practicing for, or officiating a semi-professional or professional sport
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Riding in or driving any motor-driven vehicle for race, stunt show, or speed test
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War, act of war, or participation in a riot, insurrection or rebellion
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An injury sustained while residing outside the U.S., U.S. territories, Canada or Mexico for
more than 12 months
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.