AIG Business Travel Accident (BTA) Insurance Summary Plan Description - August 15, 2010
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AIG Business Travel Accident (BTA) Insurance Summary Plan Description August 15, 2010
AIG BTA Insurance Plan i Table of Contents ABOUT YOUR PARTICIPATION ........................................................................... 2 Who Is Eligible......................................................................................................... 2 When Coverage Begins........................................................................................... 3 Naming a Beneficiary .............................................................................................. 3 Paying for Coverage................................................................................................ 3 When Coverage Ends ............................................................................................. 3 YOUR BTA INSURANCE BENEFITS..................................................................... 4 How the Plan Works ................................................................................................ 4 Death Benefit........................................................................................................... 5 Exposure and Disappearance Benefit ..................................................................... 6 Reduction of Coverage............................................................................................ 7 What is Not Covered ............................................................................................... 8 HOW TO REACH THE PLAN ................................................................................. 9 CLAIMS PROCEDURES ........................................................................................ 9 Filing a Claim........................................................................................................... 9 If You Receive an Adverse Benefit Determination................................................. 10 Procedures for Appealing an Adverse Benefit Determination................................ 11 YOUR RIGHTS UNDER ERISA............................................................................ 12 Receive Information About Your Plan and Benefits............................................... 12 Prudent Actions by Plan Fiduciaries...................................................................... 12 Enforce Your Rights .............................................................................................. 13
AIG BTA Insurance Plan ii Assistance with Your Questions ............................................................................ 13 PLAN ADMINISTRATION..................................................................................... 14 Plan Sponsor......................................................................................................... 14 Plan Administrator ................................................................................................. 14 Agent for Service of Legal Process ....................................................................... 15 Identification Numbers........................................................................................... 15 Plan Year............................................................................................................... 15 Organization Providing Insurance Services........................................................... 15 Plan Funding ......................................................................................................... 15 Plan Document...................................................................................................... 15 Future of the Plan.................................................................................................. 16 Limitation on Assignment ...................................................................................... 16 YOUR EMPLOYMENT.......................................................................................... 16
AIG BTA Insurance Plan 2 This booklet summarizes the main provisions of the AIG Life Insurance Business Travel Accident (BTA) Insurance Plan, effective August 15, 2010, and serves as the summary plan description (SPD) for these benefits. It describes the benefits as they apply to eligible employees. The plan is offered under the Visa Welfare Benefits and Cafeteria Plan. We encourage you to read this SPD carefully and share it with your family members. If you have any questions about your benefits, please contact the Visa Benefits Help Line at 650-432-5093. Note, also, that the summary plan description is only a summary. Complete details of the insurance plan are contained in a legal plan document. If there is any difference between the information in this booklet and in the legal plan document, the plan document will govern. ABOUT YOUR PARTICIPATION This section includes important information about your participation in the AIG BTA Insurance Plan, including eligibility information, when coverage begins, naming a beneficiary, paying for coverage and when coverage ends. Who Is Eligible You are eligible for company-paid BTA insurance and you are automatically covered by the plan as soon as you meet the plan’s eligibility requirement. You are eligible for the AIG BTA insurance if you are: • An active, full-time employee working at least 30 hours per week. • A non-employee director Your spouse/domestic partner and dependent children may also be eligible for BTA insurance if they are asked or authorized to travel with you on behalf of Visa, and Visa pays their travel expenses.
AIG BTA Insurance Plan 3 When Coverage Begins As a new employee, you are automatically covered by company-paid BTA insurance on your first active day at work. Your coverage continues as long as you are a full-time active employee working a minimum of 30 hours per week. Naming a Beneficiary You must name one or more beneficiaries to receive your BTA insurance payment in the event of your death. You will be asked to do this in writing when you first enroll. You can name more than one beneficiary and can change your beneficiary designation at any time you choose. To designate or update a beneficiary, complete and return the Request for Change of Beneficiary Designation to your Benefits Department. Forms are available online in the forms section at http://benefitsource.visa.com/. Note: You may want to update your beneficiary designation every so often — for example, if you get married or divorced, you may want to name a new beneficiary. If you fail to name a beneficiary, your BTA insurance benefits will be paid automatically to any surviving spouse, then to any surviving children, then to any surviving parents, then to any surviving siblings and then to your estate. Paying for Coverage Visa pays the full cost of the BTA insurance it provides to you. When Coverage Ends In general, coverage under the AIG BTA Insurance Plan will end on the day your employment ends. Coverage may also end for other reasons, such as: Visa terminates this BTA insurance plan You are no longer eligible for benefits Your death.
AIG BTA Insurance Plan 4
YOUR BTA INSURANCE BENEFITS
The AIG BTA Insurance Plan is designed to offer protection in case you or your
eligible spouse/domestic partner or dependent child(ren) dies or is injured as a
direct result of an accident that occurs while you and/or your eligible
spouse/domestic partner or dependent child(ren) are traveling on Visa business.
The death benefit is provided in addition to your Visa-sponsored life and AD&D
insurance.
How the Plan Works
You are covered under the AIG BTA Insurance Plan if you are working on
authorized company business away from your usual work location. Your coverage
begins at the actual start of business travel, whether from home or work, whichever
comes last, and continues until you return to your home or work, whichever comes
first. A non-business trip taken during the course of the business trip is covered if
you travel within 100 miles of your original destination and for 3 days or less. The
amount of your BTA benefit depends on the severity of the injury as described in the
chart below.
If you lose… The plan will pay…
Your life 100% of your benefit
Any combination of a hand, foot or
sight of an eye
Loss of speech and hearing (both
ears)
Quadriplegia
Loss of sight in both eyes
Paraplegia 75% of you benefit
A hand 50% of your benefit
A foot
Sight in one eye
Loss of speech or hearing (both
ears)
Hemiplegia
A thumb and index finger on the 25% of your benefit
same hand
Uniplegia
If the same accident causes more than one of these losses, only the highest amount
that applies will be paid.AIG BTA Insurance Plan 5
Definitions
Loss of speech ⎯ The total and irrecoverable loss of the entire ability to speak.
Loss of hearing ⎯ Permanent and total and irrecoverable loss of the entire
ability to hear in that ear.
Loss of a hand or foot ⎯ The complete severance through or above the wrist or
ankle joint.
Loss of an eye ⎯ The total and irrecoverable loss of sight in the eye.
Loss of a thumb and index finger ⎯ Severance through or above the joints
between the fingers and the hand (metacorpophalangeal joints) of both digits.
Severance ⎯ The complete separation and dismemberment of any limb from
the body. Hands and feet are considered limbs.
Quadriplegia - The complete and irreversible paralysis of both upper and both
lower limbs.
Paraplegia – The complete and irreversible paralysis of both lower limbs
Hemiplegia – The complete and irreversible paralysis of the upper and lower
limbs of the same side of the body
Uniplegia – The complete and irreversible paralysis of one limb.
Limb - The entire arm or entire leg
Death Benefit
If you or your covered spouse/domestic partner or dependent Child(ren) should die
as the result of a covered accident while traveling on company business ⎯ and
within 365 days of the accident — the plan will pay:
If you die ⎯five times your annual base salary, up to $5,000,000
If you are a non-employee director and you die - $1,000,000
If your spouse/domestic partner dies — $25,000AIG BTA Insurance Plan 6
If your dependent child(ren) - $10,000
*Annual base earnings do not include bonuses, overtime, or commissions.
Exposure and Disappearance Benefit
Death benefits may be payable in cases of disappearance. You or your covered
dependent are assumed to be dead if:
• The body has not been found within one year after the disappearance of a
vehicle in which the person was an occupant at the time of its
disappearance
• The vehicle in which you were traveling disappears due to an accidental
forced landing, is stranded, sinks or is wrecked.
The plan pays the full death benefit for an accident if you are unavoidably exposed
to the elements after the vehicle you were traveling in disappears, sinks, is stranded
or wrecked during a company business trip.
Coma Benefit
If injury renders the covered person comatose within 90 days of the date of the
accident and if the coma continues for 30 consecutive days, a monthly payment
equal to 1 percent of the benefit as long as the person remain comatose or until the
100 percent of the benefit is reached for the accident.
Emergency Evacuation Benefit
Emergency Evacuation expenses are paid if you suffer an injury or emergency
sickness that warrants your emergency evacuation while you are more than 100
miles from your primary residence up to a maximum of $100,000.
Home Alteration and Vehicle Modification Benefit
If you suffer an accidental dismemberment or paralysis for which a payment is made
under the plan, payment up to $10,000 may be made for certain home alterations
and vehicle modifications made within one year of the accident.AIG BTA Insurance Plan 7 Rehabilitation Benefit If you suffer an accidental dismemberment or paralysis for which a payment is made under the plan, payment up to $10,000 may be made for certain covered rehabilitative expenses incurred within two years of the accident. Repatriation of Remains Benefit If you suffer a loss of life due to an injury outside a 100 miles radius from your primary residence, payment of up to $50,000 may be made for covered expenses incurred to return your body to the primary residence. Seat Belt and Air Bag Benefit Rider If you suffer accidental death while operating or riding as a passenger in and automobile and wearing a properly fastened, original, factory installed seat belt, an additional amount may be payable of the lesser of 10,000 or 10% of the insured’s Principal Sum. An additional benefit may be payable if a Seat Belt benefit is payable if the insured person is positioned in a seat protected by a properly functioning, original, factory installed supplemental restraining system that inflates on impact. The additional amount payable is the lesser of 10,000 or 10% of the Insured’s Principal Sum. Reduction of Coverage When you reach age 70 your BTA insurance will be reduced as follows: On or after you reach… Your coverage will equal… Age 70 65% of the original benefit Age 75 45% of the original benefit Age 80 30% of the original benefit Age 85 or older 15% of the original benefit
AIG BTA Insurance Plan 8
What is Not Covered
The AIG BTA Insurance Plan does not cover:
Commute travel, which is travel directly to and from your home to your usual
place of work
Travel while you are not working, such as vacations and leaves of absence
Personal deviation- A non-business trip taken during the course of the business
trip is not covered if you travel more than 100 miles from your original destination
and for more than 3 days.
You are also not covered for a loss that is caused by, contributed to, or results from:
Suicide, attempted suicide or any intentional injury, while sane or insane
Injuries sustained while on active duty in the armed forces, National Guard, or
organized reserve corps of any country or international authority
Taking part in a felony
Travel or flight in any spacecraft or flight in any aircraft (except as described
under the “Aircraft Restrictions” listed below)
Injury incurred while you are operating or riding in a vehicle which you or your
spouse/domestic partner or dependent child is a crew member.
If you are under the influence of any narcotics or intoxicants not prescribed by a
doctor.
Losses caused by declared or undeclared war or acts of war
Aircraft Restrictions
Benefits will be paid for losses that result from an accident that occurs while riding in
or getting on or off an aircraft if:
The aircraft is not being used for test or experiment and
You are not the pilot, member of the crew, flight instructor, student pilot learning
to fly or examiner andAIG BTA Insurance Plan 9
The aircraft is not owned, operated, leased or controlled by you (controlled by
you means you may use it as you wish for more than 10 days in a row or more
than 15 days in any year) and
The aircraft has a valid certificate of airworthiness and
The aircraft is flown by a pilot with a valid license and
The aircraft is not a military aircraft, other than a transport aircraft flown by the
U.S. Military Airlift Command (MAC), or a similar transport service of another
country and
The aircraft is not being used for crop dusting, spraying or seeding, fire fighting,
sky writing, sky diving or hang gliding, pipeline or power line inspection, aerial
photography or exploration, racing, endurance tests, stunt or acrobatic flying or
any operation requiring a special permit from the FAA and
The aircraft is not owned, leased or controlled by Visa.
HOW TO REACH THE PLAN
The AIG BTA Insurance Plan is administered by AIG and underwritten by American
International Companies. To submit a claim or ask questions, contact AIG at:
American International Companies
Accident and Health Claim Division
PO BOX 15701
Wilmington, DE 19850-5701
302-594-2000
CLAIMS PROCEDURES
Filing a Claim
To receive BTA benefits, you or your beneficiary must send AIG written notice within
20 days of the occurrence of the covered loss. The written notice should include
your name and policy number. Upon receipt of the notice, AIG will send a claim
form. The claim form and proof of loss must be returned to AIG within 90 days of the
covered loss. Benefits will be paid once AIG processes your claim.AIG BTA Insurance Plan 10
Written notices and claim forms can be sent to:
American International Companies
Accident and Health Claim Division
PO BOX 15701
Wilmington, DE 19850-5701
302-594-2000
If You Receive an Adverse Benefit Determination
The claim administrator will provide you with a notification of any adverse benefit
determination, which will set forth:
The specific reason(s) for the adverse benefit determination
Reference to the specific plan provisions on which the benefit determination is
based
A description of any additional material or information necessary for you to
perfect the claim and an explanation of why that material or information is
necessary
A description of the plan’s appeal procedures and time limits applicable to such
procedures, including a statement of your right to bring a civil action under
ERISA after an adverse determination on an appeal.
If you receive an adverse benefit determination (i.e., any denial, reduction, or
termination of a benefit, or a failure to provide or make a payment), the plan’s claim
administrator will notify you of the adverse determination within a reasonable period
of time, but not later than 90 days after receiving the claim. This 90-day period may
be extended for up to an additional 90 days, if the claim administrator both
determines that special circumstances require an extension of time for processing
the claim, and notifies you, before the initial 90-day period expires, of the special
circumstances requiring the extension and the date by which the plan expects to
render a determination.
In the event an extension is necessary due to your failure to submit necessary
information, the plan’s time frame for making a benefit determination on review isAIG BTA Insurance Plan 11
tolled (i.e., stopped) from the date the claim administrator sends you the extension
notification until the date you respond to the request for additional information.
Procedures for Appealing an Adverse Benefit Determination
You, or your authorized representative, have 60 days following the receipt of a
notification of an adverse benefit determination within which to appeal the
determination. You have the right to:
Submit written comments, documents, records and other information relating to
the claim for benefits
Request, free of charge, reasonable access to and copies of all documents,
records and other information relevant to your claim for benefits
Request a review that takes into account all comments, documents, records and
other information submitted by you relating to the claim, regardless of whether
the information was submitted or considered in the initial benefit determination.
The claim administrator will notify you of the plan’s benefit determination on review
within a reasonable period of time, but not later than 60 days after receipt of your
request for review by the plan. This 60-day period may be extended for up to an
additional 60 days, if the claim administrator both determines that special
circumstances require an extension of time for processing the claim, and notifies
you, before the initial 60-day period expires, of the special circumstances requiring
the extension and the date by which the plan expects to render a determination on
review.
In the event an extension is necessary due to your failure to submit necessary
information, the plan’s time frame for making a benefit determination on review is
tolled (i.e., stopped) from the date the plan administrator sends you the extension
notification until the date you respond to the request for additional information.
The claim administrator’s notice of an adverse benefit determination on appeal will
contain all of the following information:
The specific reason(s) for the adverse benefit determinationAIG BTA Insurance Plan 12
Reference to the specific plan provisions on which the benefit determination is
based
A statement that you are entitled to receive, upon request and free of charge,
reasonable access to and copies of, all documents, records and other
information relevant to your claim and
A statement describing any voluntary appeal procedures offered by the plan and
your right to obtain the information about such procedures and a statement of
your right to bring an action under ERISA.
YOUR RIGHTS UNDER ERISA
As a participant in the plan, you are entitled to certain rights and protections under
the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides
that all plan participants shall be entitled to:
Receive Information About Your Plan and Benefits
Examine, without charge, at the plan administrator’s office and at other specified
locations, such as worksites, all documents governing the plan, including
insurance contracts and a copy of the latest annual report (Form 5500 Series)
filed by the plan with the U.S. Department of Labor and available at the Public
Disclosure Room of the Pension and Welfare Benefit Administration.
Obtain, upon written request to the plan administrator, copies of documents
governing the operation of the plan, including insurance contracts and copies of
the latest annual report (Form 5500 Series) and updated summary plan
description. The administrator may make a reasonable charge 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 this summary annual
report.
Prudent Actions by Plan Fiduciaries
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 soAIG BTA Insurance Plan 13 prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a plan benefit or exercising your rights under ERISA. Enforce Your Rights If a claim for a plan benefit is denied or ignored, in whole or in part, you or your beneficiary has the 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 you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report 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 administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file a 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 medical child support order, you may file suit in a 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 Your Questions If you have any questions about your plan, you should contact the plan administrator. 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
AIG BTA Insurance Plan 14 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. PLAN ADMINISTRATION This information about the administration of the plan is provided in compliance with the Employee Retirement Income Security Act (ERISA) of 1974, as amended. While you should not need these details on a regular basis, the information may be useful if you have specific questions about the plan. Plan Sponsor The name, address and telephone number of the plan sponsor are: Visa Inc. 900 Metro Center Blvd. Foster City, CA 94404 650-432-3200 This plan is a welfare benefit plan providing BTA insurance. It is a component of the Visa Welfare and Cafeteria Plan. Plan Administrator The name, address and telephone number of the plan administrator are: Global Head of Human Resources 900 Metro Center Blvd. Foster City, CA 94404 650-432-3200 The administration of the plan will be under the supervision of the plan administrator. To the fullest extent permitted by law, the plan administrator will have the discretion to determine all matters relating to eligibility, coverage and benefits under the plan. The plan administrator will also have the discretion to determine all
AIG BTA Insurance Plan 15 matters relating to interpretation and operation of the plan. Any determination by the plan administrator, or any authorized delegate, shall be final and binding. Agent for Service of Legal Process The name, address and telephone number of the agent for service of legal process are: Visa Inc. 900 Metro Center Blvd. Foster City, CA 94404 650-432-3200 Identification Numbers The Employer Identification Number (EIN) assigned by the Internal Revenue Service to Visa Inc. - 26-0267673 The plan number for the AIG BTA Insurance Plan is 501. Plan Year The plan year for the AIG BTA Insurance Plan is January 1 through December 31. Organization Providing Insurance Services Listed below are the name, address and phone number of the organization that provides insurance services. These services include administering claims and providing customer assistance. American International Companies Accident and Health Claim Division PO Box 15701 Wilmington, DE 19850-5701 302-594-2000 Plan Funding The AIG BTA Insurance Plan is fully insured, which means AIG assumes financial responsibility and adjudication of paying claims. Plan Document This booklet is intended to help you understand the main features of the plan. It should not be considered a substitute for the plan document, which governs the operation of the plan. That document sets forth all of the details and provisions
AIG BTA Insurance Plan 16 concerning the plan and is subject to amendment. If any questions arise that are not covered in this booklet or if this booklet appears to conflict with the official plan document, the text of the official plan document will determine how questions will be resolved. Future of the Plan It is Visa’s intent that the AIG BTA Insurance Plan will continue indefinitely. However, Visa reserves the right to amend, modify, suspend or terminate the plan, in whole or in part, by action of the Global Head of Human Resources or Visa’s board of directors. Any such action would be taken in writing and maintained with the records of the plan. Plan amendment, modification, suspension or termination may be made for any reason, and at any time. If the plan is terminated AIG will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The extra protection provided through AIG is not unlimited. Coverage is not provided for your BTA insurance or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk. Limitation on Assignment Your rights and benefits under the plan cannot be assigned, sold or transferred to your creditors or anyone else. YOUR EMPLOYMENT Your eligibility or your right to benefits under the plan are not a guarantee of employment. The company’s employment decisions are made without regard to the benefits to which you are entitled upon employment. This summary plan description provides detailed information about the plan and how it works. This SPD does not constitute an expressed or implied contract or guarantee of employment.
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