LindseyWilsonCollege

StudentAccidentPlan

Effective August 1, 2018toAugust1,2019

CLAIMSADMINISTRATOR ARCADMINISTRATORS

P.O.Box12290

Lexington,Kentucky40582 (877)309-2955

CLAIMPROCEDURE

Students should obtain treatment from the Blue Raider Sports Medicine first. If the Blue Raider Sports Medicine office is closed, or if you believe it is an emergency, students should obtain treatment from the nearest Physician or Hospital.

Allhospital andmedical billsmustbe submittedforpaymentto the plan’sClaimsAdministrator within 90 daysafterthefirstdateoftreatment. Failure tofurnish thisinformationwithinthe 90-day period shallnotinvalidatenorreducetheinsured’sclaimifitwas notreasonablypossibletofilethe claimwithin thistime, provided that the claimissubmittedassoon asisreasonablypossible.In no event, exceptintheabsence of legalcapacity,will a claimbehonoredlaterthan one(1)yearfrom the date of lastmedical treatment.

PROVIDERNETWORKS

The Planhascontractedwith HealthLink and MultiPlanasthemedical PreferredProviderOrganizations (PPO)foritsparticipants. Charges atparticipatingprovidersare greatly reduced.

DESCRIPTION

This brochureprovidesabriefdescription oftheimportantfeatures oftheStudent AccidentPlan. It is nota policy. Termsand conditionsofthe coverageare setforthinthe PlanDocument. Allcovered personswillbe notifiedofanymaterialchangesto the Plan. Please retain this brochure forreference.

EFFECTIVEDATE OF COVERAGE

The Student AccidentPlanbecomeseffectiveAugust1,2018andindividualstudentcoverageis provided duringtheperiodforwhich the studentmeetsall eligibility requirements. Coverageunder the Plan terminates at12:01a.m. on August1,2019.

COVERAGE

The Student AccidentPlanisa self-fundedplan sponsored byLindseyWilson Collegeandis administered byARCAdministrators. Allclaimswillbepaid byARCAdministrators as outlined in the PlanDocument. ThePlan coversexpensesincurredforaccidentalbodilyinjuryasoutlinedin the PlanDocument. Asummaryofbenefits isincludedinthis brochure

IMPORTANT NOTICE

Students should obtain treatment from the Blue Raider Sports Medicine first. If the Blue Raider Sports Medicine office is closed, or if you believe it is an emergency, students should obtain treatment from the nearest Physician or Hospital.

Blue Raider Sports Medicine

Office Phone: 270-384-8238 • Fax: 270-384-8239

Office Hours: Mon-Fri 7:30 a.m. – 4:30 p.m.

Nurse Phone: 270-384-8138

Nurse Hours: Tues, Wed, Thurs 8:00 a.m. – 12:30 p.m.

ELIGIBILITY

Allregistered,maincampus studentstakingaminimumofsix(6)credithours aswellas intercollegiateathletesareautomaticallyenrolledintheplan.Coverageismandatoryandcannotbe waived.

ThePlan maintainsitsrighttoinvestigatestudentstatusandattendancerecords toverifythatthe Planeligibilityrequirementshavebeenandcontinuetobemet.IfandwheneverthePlandiscoversthatthePlaneligibilityrequirementshavenotbeenorarenotbeingmet,thePlanwilldeny anyclaimsincurredduring theperiodwhen the eligibilityrequirementswere notmet.

Students must actively attend classes for at least the first 31 days from their effective date of coverage. Online or hybrid courses do not fulfill the eligibility requirements that the student actively attend classes. Any student who does not attend classes during the first 31 days will not be covered under the Policy.

Students must continue to be enrolled in a minimum of six (6) credit hours for the fall and spring semesters to remain eligible for coverage under the plan. Students who withdraw from Lindsey Wilson College, do not enroll in the spring semester or attend classes as required become ineligible for coverage under the plan. Students who no longer meet the eligibility requirements will lose coverage under the plan.

Coverageiseffectiveat12:01 a.m. onAugust1,2018.

Coverageterminates at12:01 a.m. on August1,2019.

EXCESSPROVISION

Evenifyouhaveotherinsurance,thePlanmaycoverunpaidbalances,deductiblesandpay thoseeligiblemedicalexpensesnotcoveredbyotherinsurance.Benefitswillbepaidonthe unpaidbalancesafteryourotherinsurancehaspaid.Nobenefitsarepayable foranyexpense incurredforinjurywhich ispaidor payablebyOtherMedicalinsurance.

WewillnotduplicatebenefitsforexpensescoveredbyanyOtherValidandCollectiblemedical, healthoraccidentinsuranceorprepaymentplan.Ourliabilityforbenefitspayableduetoexpenses incurredwillbelimitedtothepartoftheexpenses,ifany,thatis inexcess ofthetotal benefits payable byOtherValidand Collectibleinsurance on an expense incurred orprovision of servicebasis. Benefits payableunder thePlanwillbe excessand secondarytosuchother coverage.

DEFINITIONS

CoveredCharge:TheReasonableandCustomary Charge incurredfora serviceorsupplywhichis performed orgivenunder the direction ofaDoctorforthe MedicallyNecessary treatmentofan Injury.A Covered Chargeisconsideredincurredonthedate thetreatment orserviceisrendered or the supplyisfurnished.

Doctor:Alegally qualified person licensed in the healing arts andpracticing within the scope ofhis orherlicense and isnotaFamilyMember.

Hospital:Aninstitution licensed,accredited orcertifiedby theStatewhich:Is accreditedbythe JointCommission on AccreditationofHealthcare Organizations;Provides 24-hournursing service bylicensed registered nurses(R.N.);Mainlyprovidesdiagnosticandtherapeutic careunderthe supervision ofDoctorswhile Hospital Confined;and Maintains permanentsurgical facilities orhas an arrangementwith anothersurgical facilitysupervised bya staffofone ormoreDoctors.Hospital also includestax-supportedinstitutions,which arenotrequiredtomaintainsurgicalfacilities. Hospitaldoes not include a place,specialward,floor or otheraccommodation usedfor:custodial

oreducational care;rest;the aged;anursing home;oran institutionmainlyrendering treatmentor servicesforMentalorNervousDisorders;oraninstitutionmainlyrenderingtreatmentorservices forsubstance abuse,exceptasspecifically providedinthe Policy.

HospitalConfined/HospitalConfinement: Confinementin aHospitalforatleast18 consecutive hoursforwhicha roomand boardchargeismadebyreason ofanInjuryforwhich benefits are payable.

Injury:Bodilyinjuryduetoan Accidentwhichresultssolely,directlyandindependentlyofdisease, bodilyinfirmityoranyothercauses.Allinjuries sustainedinanyoneAccident,includingallrelated conditionsand recurrentsymptomsofthese injuriesareconsidered asingle injury.

OtherMedical Insurance:AnyreimbursementfororrecoveryofanyelementofCovered Charges incurredavailablefromanyothersource whatsoever,exceptgifts and donations,but including withoutlimitation: Any individual, group,blanket,orfranchise policyofaccident,disabilityorhealth insurance;any arrangementofbenefitsformembersofa group,whetherinsured or uninsured;

anyprepaid servicearrangementsuch asBlue Cross orBlueShield;individualor group practice plans,or healthmaintenance organizations;anyamountpayablefor hospital, medicalorother health servicesforaccidentalbodilyinjuryarising outofamotorvehicle accidenttothe extentsuch benefits arepayable under anymedicalexpense paymentprovision(bywhatever terminologyused including such benefitsmandated by law)ofanymotorvehicleinsurancepolicy; anyamount payableforservices orinjuriesordiseasesrelated tothe CoveredPerson’sjob to the extent thathe actuallyreceived benefits underaWorker’sCompensation Law.IftheCovered Person enters

into a settlement to giveup hisrightsto recoverfuturemedical expensesthatwouldhave been payableexceptforthat settlement;SocialSecurityDisabilityBenefits,exceptthat OtherMedical Insurance shallnot include anyincrease in SocialSecurityDisability Benefits payabletoa Covered Person afterhebecomesdisabled whileinsured hereunder;any benefits payableunderany programprovidedorsponsoredsolelyorprimarily byanygovernmentalagencyorsubdivision or throughoperation of laworregulation.

Pre-existingCondition:ASickness or Injuryforwhichmedicalcare,treatment,diagnosis or advice wasreceivedorrecommendedwithinthe 6months prior totheCovered Person’s effective date ofcoverageunder the Planora pregnancyexisting on theCovered Person’seffectivedateof coverageunder thePlan.

Reasonable and CustomaryCharges,Feesor Expenses:An amountequaltothelesserof: The actualamountcharged by theprovider;the negotiatedrate, ifany;orthe reasonable chargeas determined bythePaymentSystemsoftwareasshowninthe Schedule.

Sickness:Illness,disease,andComplications ofPregnancy.Allrelatedconditions andrecurrent symptomsofthesameorasimilarcondition willbeconsideredthesameSickness.Sicknesswill also includenormalpregnancy.

PRE-EXISTINGCONDITION LIMITATION

Pre-existing conditions arenotcoveredforthefirstsixmonthsfollowinga Covered Person’sEffectiveDate ofcoverageunder the Plan. Thelimitationwillnotapplyif:

The CoveredPerson hasbeen continuouslycovered under thisPlanformore than 12months. By being “ContinuouslyCovered”meansa person hasbeen continuouslycoveredunder thisPlan and priorstudenthealthinsurancepoliciesissued to the Policyholder. Personswho haveremained continuouslycovered will be coveredfor an Injurywhichwas payablewhile continuouslycovered exceptforexpenses payable underpriorpolicies orinthe absenceofthisPlan. Previouslyenrolled personsmustreenrollforcoverage within30 daysofthe end ofthepriorcoverageinorder to avoid abreakincoveragefor an Injurywhich existed in priorcoverageperiods. Once abreakin continuous coverageoccurs,the definitionofInjurywillapplyindeterminingcoveragefor any Sickness or Injurywhich existed during such break.Orthe individualseeking coverageunder the Plan has anaggregate of18monthsofCreditableCoverageandbecomes eligibleandappliesforcoverage underthe Plan within 63daysoftermination ofpriorCreditable Coverage.The Plan willcreditthe timetheindividualwascovered under priorCreditableCoverage.

EXCLUSIONS

  • Treatment,services orsupplieswhich are notmedically necessary;are notpre- scribed bya doctorasnecessary to treataninjury;aredetermined toexperimental orinvestigationalinnaturebythe Plan;arereceivedwithoutchargeorlegal obligationtopay;wouldnotroutinelybepaidin theabsence ofinsurance;are receivedfromanyfamilymember.
  • Services that are provided normally without charge by the Student Health Center; services for fees provided by the Plan Sponsor; or services rendered by any person employed by the Plan Sponsor, including team doctor and trainers, or any other service provided at no cost.
  • War or any act of war, declared or undeclared, or while in the armed forces of any country
  • Injuriescaused by,orresultingfrom,the use ofalcohol, controlled substance,illegal drugs,oranyotherdrugs ormedicinesthatarenottaken in thedosage orforthe purpose prescribed bythe person’s doctor.
  • Intentionallyself-inflictedinjury,suicide oranyattemptofsuch
  • Anylosscovered bystateorfederalworker’scompensationlaw,employer’sliability law,occupationaldisease law,orsimilar laws oracts.
  • Cosmetic surgeryother than reconstructivesurgeryincidentaltoorfollowing surgery from trauma, infection orotherdiseasesoftheinvolvedpart, orreconstructive surgerybecause ofa congenitaldisease oranomalyasprovidedfordependent newborns.
  • Ridingasa passengerorotherwise in anyvehicleor devicefor aerialnavigation except asafare-paying passengerin an aircraftoperated bya commercialscheduled airline.
  • Participationin a riotorcivil disorder,commission oforattempt to commitafelony, orfighting, exceptinself-defense.
  • Surgery and/ortreatment for acne,allergy,includingallergy testing,nonmalignant warts,molesand lesions,unlessmedicallynecessary;hairgrowth orremoval; sleep disorders,includingtesting thereofandweightreduction.
  • Reproductive/Infertilityservicesincluding,but not limited to: familyplanning;fertility tests;infertility(maleorfemale), including anyservicesorsuppliesrenderedforthe purpose orwith theintent ofinducingconception; premaritalexaminations;impotence,organic or otherwise;tubal ligation;vasectomy; sexualreassignmentsurgery;reversalofsterilizationprocedures.
  • Dentaltreatment, exceptasspecifically providedfor bythe Plan.
  • Normalhealth checkups,preventive testing ortreatment,screeningexamsor testinginthe absence of injury.
  • Eye examinations,prescriptionsor thefittingofeyeglasses and contact lenses,or other treatmentforvisual defects and problems,unless payableasaCovered Expense associated with aninjurycovered bythe Plan.
  • Allformsofabortionand chargesrelated thereto,unlessitis aninvoluntaryand medically unassisted actordeemedmedically necessarybya doctorwiththe sole criteria that themother’slifeisinimmediate danger.
  • InjuryofanyCoveredStudentsustained while:participatingin anyschool, professionalor organized sportscontestorcompetition, traveling to orfromsuch sport, contestorcompetition,duringparticipationinany practice orconditioning program forsuch sport,contestorcompetitionunlessspecifically providedforbythe Plan.
  • Travel inor upon asnowmobile; any two-or-threewheeledvehicle;oranyoff-road motorizedvehiclenotrequiringlicensing asamotorvehicle;bungeejumping, skydiving,parasailingor paragliding.

CLAIMAPPEAL

Once a claimisprocessed and upon receiptofan Explanation ofBenefits (EOB),a

CoveredPerson who disagreeswith howa claimwas processed may appeal thatdecision.

The CoveredPersonmustrequestan appeal in writingwithin 60daysofthedate appearing on the EOB. Theappealrequestmustinclude why theydisagree with the way the claimwas processed.The request mustinclude anyadditionalinformationtheyfeelsupportstheir requestforappeal,e.g.medical records,physician records,etc.

Please submitallappeal requeststo:

ARCADMINISTRATORS

P.O.Box12290

Lexington,Kentucky40582

(877)309-2955