Faculty and professional staff are eligible for insurance coverage while traveling on pre-approved College business, as described in the Business Travel Accident Insurance Plan.
This Summary Plan Description describes business travel accident insurance coverage
available under the Franklin & Marshall College Group Long-term Disability Insurance
Plan (the business travel accident insurance benefit is described herein as the "Group
Business Travel Accident Insurance Plan" or the "Plan"), effective as of July 1, 2013. This
Summary Plan Description is required by The Employee Retirement Income Security Act
(ERISA) of 1974, as amended. The purpose of this Summary Plan Description is to
acquaint employees with the provisions of the Plan, the way in which it is administered,
and participants' rights under the federal law which applies to employee benefit plans.
This Summary Plan Description and the insurer's Group Insurance Policy (the "Group
Policy") form the Plan Document. Every effort has been made to assure the accuracy of
this Summary Plan Description. However, in the event of a discrepancy between this
Summary Plan Description and the Group Policy, the Group Policy shall govern. A copy
of the Group Policy can be obtained, at no cost, by contacting the Plan Administrator (via
the Franklin & Marshall College Human Resources office). The Plan is established for the
benefit of employees, their covered dependents, and their beneficiaries, and is
administered impartially for the benefit of all eligible participants.
This Summary Plan Description and the Group Policy contain important details about
the Plan, including eligibility requirements, coverage, exclusions, and limitations. Plan
participants are strongly encouraged to carefully read this Summary Plan Description
and the Group Policy.
Facts About the Plan
Plan Name: Franklin & Marshall College Group Long-term Disability Insurance Plan (the
"Group Business Travel Accident Insurance Plan")
Plan Number: 503 - Plan 503 also includes the Franklin & Marshall College Group Long-term
Disability Insurance Plan and the Employee Assistance Program, which are each
described in separate Summary Plan Descriptions.
Name, Address, and Telephone Number of Employer/Sponsor: Franklin & Marshall
College ("the College"), Lancaster, PA 17604-3003, (717) 291-3995. Employer shall also
include the Lancaster City Alliance.
Named Fiduciary: Franklin & Marshall College, Lancaster, PA 17604-3003.
Plan Sponsor's Employer Identification Number: 23-1352635
Plan Year: July 1 through June 30
Type of Plan: Welfare Plan (Business Travel Accident Insurance)
Plan Administrator: Franklin & Marshall College, P.O. Box 3003, Lancaster, PA, 17604
Plan Benefits Provided By: Federal Insurance Company, Chubb Group of Insurance
Companies, 15 Mountain View Road, Warren, NJ, 07061-1615
The insurer determines eligibility for coverage and benefits through the Group Policy,
and reviews and pays eligible claims.
Agent for Service of Legal Process: Director, Human Resources, Franklin & Marshall
College, P.O. Box 3003, Lancaster, PA 17604.
Funding: Premiums for group business travel accident insurance are paid by Franklin &
Marshall College, through general employer assets.
Benefits are provided as described in the insurer's Group Policy. A copy of the Group
Policy, including the Schedule of Benefits, is available to any Covered Employee,
dependent, or beneficiary, at no cost, from Franklin & Marshall College, Human
Resources, P.O. Box 3003, Lancaster, PA 17604-3003. The Group Policy
includes important definitions, as well as details about benefits, including coverage
levels, exclusions and limitations, and claims procedures. Covered Employees are
strongly encouraged to read the Group Policy and this Summary Plan Description.
Business Travel Accident Insurance Coverage
The Group Business Travel Accident Insurance Plan provides coverage, subject to
provisions in the Group Policy, to eligible College employees while traveling for preauthorized
College business. Coverage is not provided for death or loss which occurs
while a College employee is commuting to and from the work location.
"Accident" means a sudden, unforeseen, and unexpected event which is: independent of
illness or bodily malfunction; occurs while the employee is insured under the Group
Policy; and is the direct cause of loss.
"Actively Employed" means the employee is performing the material and substantial
duties of his/her regular occupation for the College, for compensation.
"Business Travel" means traveling on assignment at the authorization or direction of the
Policyholder (Franklin & Marshall College); away from the primary place of
employment; on the Policyholder's business; and for periods of 180 days or less.
Coverage begins at the start of Business Travel, whether the point of origin is from the
Covered Employee's residence or regular place of employment, whichever occurs last.
Coverage ends immediately upon return to the Covered Employee's residence or place of
employment, whichever occurs first.
"Covered Employee" means a College employee eligible for coverage through this Plan,
as described below.
"Loss" means an accidental bodily injury.
Accidental Death & Loss Benefits
If a full-time College employee in coverage class 1 as described below dies as the result of
a covered Accident which occurs during pre-authorized Business Travel, the insurer will
provide a benefit to the employee's beneficiary of two hundred, fifty thousand dollars
If a part-time College employee in coverage class 2 as described below dies as the result
of a covered Accident which occurs during pre-authorized Business Travel, the insurer
will provide a benefit to the employee's beneficiary of fifty thousand dollars ($50,000).
The insurer will provide benefits to employees in classes I and 2 for partial, covered
losses, as defined in the Group Policy, which occur due to covered Accidents during preauthorized
Business Travel. Such covered partial loss must occur within one (1) year of
the Accident, and are subject to the Maximum Benefit Amount as described below.
Accidental Loss Of Percent of Loss of Life Benefit Amount (expressed as a percentage of $250,000 for full-time employees in class I, and $50,000 for part-time employees in class 2)
Life 100% ($250,000 for full-time employees in class 1 and $50,000 for part-time employees in class 2)
Speech and Hearing 100%
Speech and one of: Hand, Foot,
or Sight of One Eye 100%
Hearing and one of: Hand, Foot,
or Sight of One Eye 100%
Both Hands, Both Feet, or Sight of Both Eyes, or a combination of any
two of Hand, a Foot,
or Sight of One Eye 100%
One Hand or One Foot
or Sight of One Eye 50%
Speech or Hearing 50%
Thumb and Index Finger
of the Same Hand 25%
Maximum Benefit Amount
If a Covered Employee suffers multiple losses as the result of one covered Accident, the
insurer will pay only the single largest benefit amount applicable to the losses suffered,
as described in the Group Policy.
The maximum benefit payable per covered Accident is $1,500,000. The insurer will not
pay more than the maximum amount when more than one insured individual is injured
in the same covered Accident. If an Accident results in benefit amounts becoming
payable and which exceed the applicable maximum benefit amount, the maximum
amount will be divided proportionally among the eligible insured individuals based on
each applicable benefit amount, per provisions in the Group Policy.
Benefits are not payable in some circumstances as outlined in the Group Policy,
including but not limited to the following:
• this insurance coverage does not apply to an accident which occurs while an
employee is in, entering, or exiting an aircraft owned, leased, or operated by the
Policyholder, an employee of the Policyholder, or on behalf of the Policyholder, and
does not apply to loss which occurs while traveling in an aircraft engaged in
specialized aviation activities as defined in the Group Policy;
• this insurance coverage does not apply to loss which is caused, directly or
indirectly, by or results from an employee's emotional trauma, mental or physical
illness, disease, pregnancy, childbirth or miscarriage, infection, or bodily
• this insurance coverage does not apply to self-inflicted injury;
• coverage does not apply to any loss caused by or resulting from any occurrence
while an injured person is incarcerated after conviction;
• the Group Policy does not cover loss due to repetitive motion injuries or cumulative
• coverage is not provided through the Group Policy for death or loss which occurs
while a College employee is commuting to and from the work location;
• this insurance coverage does not apply to loss caused by or resulting from war or
active military service.
Eligibility and Enrollment
The following classes are eligible for coverage through this Group Business Travel
Accident Insurance Plan:
Coverage Class 1:
• Actively Employed, full-time faculty and professional staff employees: Franklin &
Marshall College employees who are scheduled to work at least 30 hours per week
for wages on a regular basis, including visiting, tenured, non-tenured, and tenuretrack
faculty; full-time employees of the Lancaster City Alliance; the current,
actively employed Spectrometer Technician; and full-time employees of the
Centennial Conference who: (1) are regularly scheduled to work on the Franklin &
Marshall College campus and (2) are paid through the College's payroll system, as
long as otherwise eligible
• Actively Employed, full-time faculty and professional staff employees who are
scheduled to work at least 30 hours per week for wages on an approved 9, 10, or 11
month per year appointment
• Actively Employed faculty on an approved joint appointment: one full-time
position shared by two College faculty members each working at least 1040 hours
• Actively Employed, full-time faculty working a reduced schedule under an
approved Phased Retirement Agreement
Coverage Class 2:
• Actively Employed, part-time College faculty and professional staff: Franklin &
Marshall College employees who are appointed to positions classified as "parttime"
(generally scheduled to work less than 1,000 hours per employment year
and/or less than an average of 30 hours per week for wages), including employees
of the Centennial Conference who: (1) are regularly scheduled to work on the
Franklin & Marshall College campus and (2) are paid through the College's payroll
system, as long as otherwise eligible
Independent contractors, contracted employees, employees on leave of absence or
inactive work status, students, and student employees, those who volunteer their
services to the College without compensation, and retired College employees are not
eligible for coverage through the Plan.
College employees are eligible for business travel accident insurance coverage effective
the first day of appointment to a position in an eligible class. Coverage begins at the start
of pre-authorized Business Travel as described in the Group Policy. Employees are not
required to complete an enrollment or election form.
Election of a Beneficiary
An employee who is a member of an eligible class as described above may designate, in
writing, a beneficiary(ies) for the business travel accident benefit. Such written
designation must be provided to the Plan Administrator (via the Franklin & Marshall
College Human Resources office), in a form acceptable to the Plan Administrator. If no
written designation is provided to the Plan Administrator, in the event a benefit is
payable, it will be payable to the beneficiary(ies) the employee has designated through
the College's Group Life Insurance Plan. If the employee has not designated a
beneficiary through the College's Group Life Insurance Plan, the benefit will be paid to
the employee's estate.
Applying for Benefits
If a Covered Employee dies due to a covered Accident while engaged in Business Travel
on behalf of the College and a benefit under this Plan is payable per the Group Policy, the
Plan Administrator will notify the insurer. The deceased employee's beneficiary or
representative may be required to provide the Plan Administrator and/or insurer a death
certificate before benefits are provided.
If a Covered Employee suffers a bodily loss due to a covered Accident while engaged in
Business Travel on behalf of the College and a benefit under this Plan is payable per the
Group Policy, the employee or his/her designee must notify the Plan Administrator (via
the Human Resources office). The Plan Administrator will then notify the insurer. Notice
must be provided to the Plan Administrator, and in turn, the insurer, within twenty (20)
days of the loss, or as soon as reasonably possible. The insurer may require the injured
employee to provide written proof of loss.
The insurer reserves the right to have the injured or deceased employee examined by a
physician approved by the insurer while a claim is pending, including having an autopsy
performed unless prohibited by law.
Termination of Coverage
Group business travel accident insurance coverage under this Plan will be discontinued
as of the last actual working day prior to:
1) termination of employment or transfer to inactive employment status,
2) commencement of a leave of absence,
3) a transfer to an ineligible class, or
4) any other change in status that leads to loss of eligibility under the Group Policy.
Coverage will also end if Franklin & Marshall College fails to pay the required premium
or terminates the Plan.
Benefit Denials and Claims Procedures
Benefit Denials-- The Plan's procedures for filing claims, making benefit determinations,
and reviewing appeals of denied claims are available to Plan participants and
beneficiaries, at no cost. Such information is provided within the Group Policy, available
upon request, and at no cost, from the Plan Administrator or the insurance carrier. Plan
participants must follow the procedures described in the Group Policy to appeal denial
of a claim for benefits.
Adverse Eligibility / Coverage Determinations-- The Plan Administrator shall have the
responsibility and authority, in its sole discretion, to decide eligibility for coverage
through this Plan. If the Administrator denies a claim for coverage through this Plan, the
Administrator promptly and in writing shall notify the individual of such denial. The
notification of denial will be made not later than within thirty (30) days of receipt of the
individual's claim. This 30 day period may be extended for an additional 15 days due to
circumstances beyond the control of the Plan Administrator, including cases in which a
claim is incomplete. The individual will receive written notice of any such extension,
including the reason for the extension and the date by which a decision by the
Administrator can be expected. The Plan Administrator may secure independent
information or other advice and require such other evidence as deemed necessary to
decide a claim. A written notice of adverse benefit determination will be provided to the
individual, and will include: (1) the specific reason(s) for the denial of benefits, (2) the
specific Plan provision on which the denial is based, (3) a description of any additional
material or information necessary for the individual to complete a claim and an
explanation of why such information is necessary, and (4) an explanation of the right of
appeal and the process to appeal the adverse benefit determination, including an
explanation of the individual's right to review relevant documents and information, and
his/her right to file suit under the Employee Retirement Income Security Act (ERISA)
with respect to any adverse determination after appeal of a claim.
If a claim is denied in whole or in part, the individual may appeal to the Plan
Administrator for review of the claim. The appeal must be made within one hundred,
eighty (180) days of the Plan Administrator's initial notice of adverse benefit
determination. If the appeal is not made within 180 days, the individual will lose his/her
right to appeal and to file suit in court. The individual's written appeal should state the
reasons that he/she believes the claim should not have been denied. It should include
any relevant facts and/or documents to support the claim. The individual may ask
additional questions of the Plan Administrator, make written comments, and may review
(on request and at no charge) documents and other information relevant to the appeal.
The Plan Administrator will review and decide the individual's appeal within a
reasonable time and, within sixty (60) days after receiving the written appeal, shall
render, in writing, a decision. The individual who reviews and decides the appeal will
not be the same individual who originally denied the claim for benefits, or that
individual's subordinate. The Plan Administrator may require additional relevant
information to decide the claim. If the decision on appeal affirms the initial denial of the
individual's claim for benefits under the Plan, he/she will be furnished with a notice of
adverse benefit determination on review, which includes the following: (1) the specific
reason(s) for the denial, (2) the specific Plan provision(s) on which the denial is based, (3)
a statement of the individual's right to review (on request and at no charge) relevant
documents and other information, (4) a description of any internal rule, guideline, or
protocol, if applicable, used to make the benefit determination and a statement that such
rule, guideline, or protocol will be provided to the claimant upon request at no charge,
and (5) a statement of the individual's right to bring suit under ERISA.
Claims and appeals of adverse benefit determinations are to be addressed to Human
Resources, Franklin & Marshall College, P.O. Box 3003, Lancaster, PA 17604-3003.
Plan Amendment, Modification, and Termination
This Plan may be amended or terminated by Franklin & Marshall College at any time.
The Group Policy which provides benefits for this Plan may be amended or terminated
by the Policyholder (Franklin & Marshall College) at any time with prior written notice to
the insurer. Termination will also occur if the Policyholder fails to pay the required
premiums. The insurer may terminate the Group Policy on any premium due date if the
number of persons insured is less than the required minimum, or if the insurer believes
the Policyholder has failed to carry out its obligations relating to the group contract. No
consent of any participant or beneficiary is required to terminate, modify, amend, or
change the Plan.
Statement of ERISA Rights
Participants in the Plan are entitled to certain rights and protections under the Employee
Retirement Income Security Act of 1974, as amended (ERISA). ERISA provides that all
Plan participants are entitled to the following rights:
Receive information about the Plan and benefits-- Examine, without charge, at the Plan
Administrator's office and at other specified locations, all documents governing the Plan
(including, if applicable, insurance contracts and collective bargaining agreements), and a
copy of the latest annual report (Form 5500 Series) filed by the Plan, if the Plan is
required to do so, with the U.S. Department of Labor and available at the Public
Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written
request to the Plan Administrator, copies of documents governing the operation of the
Plan, (including, if applicable, insurance contracts and collective bargaining agreements),
and copies of the latest annual report (Form 5500 Series), if the Plan is required to file
such form, and updated Summary Plan Description. The Plan Administrator may make a
reasonable charge for the copies.
Receive a summary of the Plan's annual financial report, if the Plan is required to
prepare such a report-- The Plan Administrator is required by law to furnish each
participant with a copy of any summary annual report.
Prudent action by Plan Fiduciaries-- In addition to creating rights for Plan participants,
ERISA imposes duties upon the people who are responsible for the operation of an
employee benefit plan. The people who operate this Plan, called "fiduciaries" of the Plan,
have a duty to do so prudently and in the interest of you and other Plan participaparticipants and
beneficiaries. No one, including your employer or any other person, may terminate your
employment or otherwise discriminate against you in any way to prevent you from
obtaining a welfare benefit or exercising your rights under ERISA.
Enforce your rights-- If a claim for a welfare benefit is denied or ignored, in whole or in
part, you have a right to know why this was done, to obtain copies of documents relating
to the decision without charge, and to appeal any denial, all within certain time
schedules. Under ERISA, there are steps participants can take to enforce the above rights.
For instance, if you request a copy of the Plan documents or the latest annual report (if
applicable) 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 $110 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. In addition, if you disagree with the Plan's decision or
lack thereof concerning the qualified status of a domestic relations order or a medical
child support order, you may file suit in 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.
Assistance with Questions
If you have any questions about the Plan, you should contact the Plan Administrator, via
Franklin & Marshall College's Human Resources department. If you have any questions
about this statement or about your rights under ERISA, or if you need assistance in
obtaining documents from the Plan Administrator, you should contact the nearest office
of the Employee Benefits Security Administration, U.S. Department of Labor, listed in
your telephone directory or the Division of Technical Assistance and Inquiries, Employee
Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue
N.W., Washington, D.C. 20210. You may also obtain certain publications about your
rights and responsibilities under ERISA by calling the publications hotline of the
Employee Benefits Security Administration.
In no case will a Plan participant, or anyone acting on a participant's behalf, be entitled to
challenge a decision of the Plan Administrator in court or in any other administrative
proceeding unless and until the claim and appeal procedures described in this Summary
Plan Description and the Group Policy have been complied with and exhausted.
Please note: Faculty and professional staff are asked to register their foreign travel; please see the Employee Foreign Business Travel Web page for information.