Try the all-new QuickBooks Online for FREE.  No credit card required.

Proposal Chubb Group of Insurance Companies

Document Sample
Proposal Chubb Group of Insurance Companies Powered By Docstoc
					                  Chubb Access

 Business Travel Accident (BTA 360° )    SM

            Quick Quote*

                    Created for:

                  Presented by:

*Underwritten by Federal Insurance
Company, a member insurer of the Chubb
Group of Insurance Companies.

This proposal provides a brief description of the important features of the policy. For more
details, please ask for a copy of a Specimen Contract. We can also provide alternate plan
designs if needed.

Name of Policyholder:
City:     State:                 Zip Code:

Name of Agency:
Or Agency code:
Contact Name:
Email Address:

Quote Date of Issuance:

This proposal is valid for 90 days from the quote date of issuance. This insurance policy is only for the
listed Policy Type(s) and is based upon the information submitted and rates in effect on this date. If any
of the information submitted for this quotation is altered, we reserve the right to change this quotation
accordingly. Actual coverage afforded is subject to the terms and conditions of the policy as issued.

This proposal does not apply to the extent that trade or economic sanctions or other laws or regulations
prohibit us from offering or providing insurance. To the extent any such prohibitions apply, this
proposal is void from the beginning.

Policy Type                            Business Travel Accident

Annual Cost per Employee               $5.00

Minimum Annual Premium                 $750.00


  1 All Active Full-Time US Employees
  2 The spouse of a Class 1 Insured
  3 The Dependent Child(ren) of a Class 1 Insured

       Spouse and Dependent Child(ren) are not available in policies sitused in NJ.

                                         Page 2 of 9

  1   $300,000
  2   $150,000
  3   $50,000


  1    24 Hour Business Travel – provides 24-hour coverage for relocation travel or travel to, from and
during all business trips

  2   Business Travel Family – provides 24-hour coverage for relocation travel or while spouse is
accompanying employee on a business trip

 3     Business Travel Family – provides 24-hour coverage for relocation travel or while child(ren) is
       accompanying employee on a business trip


Class: All

                                                                                Benefit Amounts
Accidental:                                                                      (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
Loss of Hearing and one of Loss of Hand, Loss of Foot or Loss of Sight
of One Eye
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              100%
One Eye
Quadriplegia                                                                          100%
Paraplegia                                                                             75%
Hemiplegia                                                                             50%
Loss of Hand, Loss of Foot or Loss of Sight of One Eye (Any one of
Loss of Speech or Loss of Hearing                                                      50%
Uniplegia                                                                              25%
Loss of Thumb and Index Finger of the same Hand                                        25%


                                      Page 3 of 9
   1% of Principal Sum per month
   Maximum Benefit Amount: 100% of Principal Sum
   Pays a benefit if an accidental bodily injury causes an insured person to be in a coma.
   Not available in policies sitused in NY.

Medical Evacuation & Repatriation:
   Unlimited Benefit Amount
   If an accidental bodily injury, disease or illness causes an insured person to require medical
      evacuation and/or repatriation, this coverage will pay the costs for such evacuation/repatriation.
   This benefit will also: a) guarantee payment up to $5,000 of the charge made by a hospital prior
      to and as a condition of an insured person’s admission for emergency medical treatment
      (Hospital Admission Guaranty); b) pay the costs for temporary lodging and meals up to $100 per
      day for 5 days incurred for an immediate family member who travels to be with a hospitalized
      insured person (Family Travel Expense); c) pay for an accompanying dependent child to return
      to his or her residence if the insured person is hospitalized while on a trip (Return of Dependent

Out of Country Medical Expense:
    $25,000 Maximum Benefit Amount
    Reimburse medical expenses if an insured person who resides in the United States suffers an
       accidental bodily injury, disease or illness that results in medical expenses being paid while on
       Business Travel outside of the United States.
    Not available in policies sitused in NH.

Political Evacuation:
    $100,000 Maximum Benefit Amount
    Reimburse evacuation expenses if an insured person who resides in the United States is on a
       covered trip and the United States Department of State issues a travel warning advising U.S.
       citizens to depart a country while such insured person is traveling in that country.
    Not available in policies sitused in FL, IN, MD, NH and VA.

Psychological Therapy:
    10% of Principal Sum
    Maximum Benefit Amount: $25,000
    Reimburses expenses incurred for psychological therapy if an insured person suffers a covered
      loss resulting in a physician determining that psychological therapy is required.

Rehabilitation Expense:
    10% of Principal Sum
    Maximum Benefit Amount: $25,000
    Reimburses the cost for rehabilitation required as the result of a loss caused by an insured
      person’s accidental bodily injury.

Seat Belt & Occupant Protection Device:
    10% of Principal Sum
    Occupant Protection Device Benefit Amount 10% of Principal Sum
    Maximum Benefit Amount 20% of Principal Sum up to $50,000

                                       Page 4 of 9
      Pays a benefit if an insured person suffers an accidental bodily injury resulting in a covered loss
       while operating or riding in a private passenger automobile and using a seat belt. Also pays an
       additional benefit if the insured suffers an accidental bodily injury as set forth above and such
       injury is positioned in a seat protected by a properly deployed occupant protection device.
      Alternate Benefit Amount: if it cannot be determined whether an insured person was using a
       seat belt, pays an alternate benefit amount of $2,000.


An aggregate limit of insurance of $2,500,000 applies per Accident. If more than one insured person
suffers a Loss in the same Accident, then we will not pay more than the Aggregate Limit of Insurance.
If an Accident results in benefit amounts becoming payable, which when totaled, exceed the applicable
Aggregate Limit of Insurance, then the Aggregate Limit of Insurance will be divided proportionally
among the insured persons, based on each applicable benefit amount.


There are certain situations not covered in this policy. These policy exclusions include:

Disease or Illness (Does not apply to Medical Evacuation, Repatriation or Out-of-Country Medical)
Suicide or Intentional Injury
Service in the Armed Forces
Specialized Aviation - flying in rocket propelled device
Owned Aircraft, Leased Aircraft or Operated Aircraft
Aircraft Pilot or Crew

                                        Page 5 of 9
Important: Companies in the following industries are not eligible for this particular plan but are
encouraged to complete a full request for quote form and submit for underwriting consideration.

                        Industry                                   SIC Code
                       Agriculture                                0100 – 0799
                         Airlines                                 4512 – 4581
             Amusement Parks, Sports or Sports                    7991 – 7999
                      Construction                                1500 – 1799
                  Correctional Facilities                            9223
                           Fire                                   9224 – 9228
                    Fishing/Hunting                               0800 – 0999
                   Logging/Sawmills                               2411 – 2429
                       Law Firms                                     8111
              (Separate offer for Law Firms is available)
                             Mining                               1000 – 1241
                     Public Administration                        9111 – 9199
                           Oil & Gas                              1300 – 1399
                   Professional Sports Clubs                         7941
                             Police                                  9221
                            Railroad                              4000 – 4013
                             Steel                                3300 – 3329
                             Taxi’s                               4120 – 4130
                        Transportation                            4210 – 4239


Chubb partners with FrontierMEDEX and Affinion Group, two highly experienced service providers to
offer insureds a wide range of services. The following are descriptions of additional services that will
provide the insured with both 24-hour Travel Assistance and Identity Theft protection. FrontierMEDEX
and Affinion are independent service providers. Chubb does not have any ownership interest in
FrontierMEDEX or Affinion.


Medical Evacuation & Repatriation Services:

      Emergency Medical Evacuations
      Transportation to Join a Hospitalized Member
      Return of Dependent Children
      Transportation after Stabilization
      Repatriation of Mortal Remains

Travel Assistance Services:

      Pre-travel Information

                                            Page 6 of 9
      Emergency Travel Arrangements
      Transfer of Funds
      Assist in the Replacement of Lost or Stolen Travel Documents
      Legal Referrals
      Translation Services
      Message Transmittals.
      Emergency Pet Housing and/or Pet Return

Medical Assistance Services:

      Worldwide Medical and Dental Referrals
      Monitoring of Treatment until the traveler is either healthy or transferred to their home hospital
      Facilitation of Hospital Payment
      Transfer of Insurance Information to Medical Providers
      Coordination of Medication, Vaccine and Blood Transfers
      Assist in the Replacement of Corrective Lenses and Medical Devices
      Dispatch of Doctors and Specialists
      Medical Records Transfer
      Continuous Updates to Family, Employer and Home Physician
      Hotel Arrangements for Convalescence

Security Services:

      Political Evacuation
      Hot Spots Alerts


Identity theft services help to provide peace of mind to you and your business travelers who suddenly
find themselves missing important documents while traveling on business. If your business traveler
loses personal or financial documents while traveling on business, a single toll-free call to an identity
theft expert will start the proactive steps needed to defend your employee’s identity and recover lost or
stolen documents.

Affinion Group’s experts will work to get your business traveler out of the crisis situation by:
         Helping to establish a police report.
         Assisting in placing fraud alerts with the three credit bureaus.
         Assisting with the cancellation of lost or stolen U.S. issued credit cards and having new
           cards issued.
         Assisting in replacing lost or stolen important documents relating to credit cards (including
           corporate cards, gas cards, calling/phone cards, store cards, debit cards (if applicable),
           bank accounts/checking/savings, mortgages, auto financing, investments-broker funds,
           stocks, 401K, IRA, student loans, social security records/card, phone service, military
           benefits, passport, driver’s license and other official documents.
         Contacting up to five family members or friends.
         Providing a complimentary membership in a credit protection service when necessary.

                                       Page 7 of 9
In addition, for your business travelers who reside outside of the United States Affinion Group’s experts
         Assist in ordering and reviewing credit bureau records if the person has existing credit
            records in the U.S.
         Offer assistance in canceling non-US based credit cards.
         Communicate with creditors to make them aware of identity theft issues.
         Assist in identifying proper law enforcement to pursue prosecution of criminals.
         Provide convenient legal referrals in the general area if suspected identity theft has created
            legal ramifications.
         Provide telephone interpretation assistance including emergency telephone translation
            services in all major languages and referrals to interpreter services for additional translation
            needs associated with suspected identity theft.

Your business traveler will have unlimited access to services until the problem is resolved.

                                        Page 8 of 9

    DESCRIPTION             # OF ELIGIBLE                      COST PER                     PREMIUM
                               INSURED                         INSURED
Minimum Annual Policy          Up to 150                          N/A             =            $750
Number of employees                                  X             $5.00          =
above 150
TOTAL ANNUAL                                                                      =


It is our intention to accept the proposal of the Business Travel Accident Insurance Policy offered by
Federal Insurance Company, a member insurer of the Chubb Group of Insurance

Signature: _______________________________________________________________________

Title: ___________________________________________________________________________

Company: _______________________________________________________________________

Date: ___________________________________________________________________________

Effective Date of Coverage: _________________________________________________________

Premium Amount:

Producer’s Name:                                     Producer’s Email Address:

Producer’s Phone Number:                             Fax Number:


           Upon completion of this Letter of Intent, please email it to Chubb Access at

           If you have any questions, please call Chubb Access at 1-800-884-3770 or email

Chubb Group of Insurance Companies                   Chubb refers to the insurers of the Chubb Group of
Warren, New Jersey 07059                             Insurance Companies. This literature is descriptive                                        only.

                                       Page 9 of 9

Shared By:
jny jhtw jny jhtw