ROSE-HULMAN

INSTITUTE OF TECHNOLOGY

OFFICE OF ADMINISTRATIVE SERVICES

INTERCOLLEGIATE ATHLETIC INSURANCE

A. $0 - $500 -- Primary Deductible Coverage per claim -- This is to be paid by the family or family insurance program.

B. $501 - $50,000 per claim -- Rose-Hulman has an athletic accident insurance policy written through CIGNA Insurance Company. Claims are administered by Anthem Benefit Administrators. Our insurance agent is Acordia Ohio.

This is excess coverage that will pay eligible expenses after any other collectable insurance has been exhausted. The bills incurred by the student athlete must be submitted to the family's insurance policy first. If there is a remaining balance due after the family's insurance has paid, a claim can be filed with CIGNA through Anthem Benefit Administrators. To file claims please see the section titles Claim Procedure on the back of this letter.

The policy will pay for eligible expenses up to 104 weeks from the date of the accident. CIGNA also provides a $10,000 Accidental Death Benefit.

C. $50,001 - $20,000,000 Lifetime Catastrophic Accident Plan through the NCAA Benefits become payable when one of the following events occurs:

$50,000 of medical expenses is incurred within two years of the date of a covered accident by a covered person for injury sustained in such accident:

You can find additional information on the NCAA coverage by viewing their website at "http://www.ncaa.org/insurance".

Catastrophic Plan Highlights

1. Maximum Benefit Amount $20,000,000

2. Home Health Care Maximum Benefit per calendar year $100,000

3. Maximum Benefits period. Lifetime

4. Benefit Percentage. 100%

5. Covered Accident Deductible $50,000

6. Disability Income Benefit Included

7. Adjustment Expenses Benefit. $50,000 Maximum

8. Special Expenses Benefit. $125,000 1st ten years / $50,000 for each 10 year period thereafter

9. Ancillary Illness or Injury Benefit. $100,000 lifetime maximum subject to $2,000 calendar year deductible.

10. College Education Benefit. Maximum lifetime benefit $60,000.

11. Assimilation Benefit. Maximum of $50,000 within 2 years of date of accident

12. Death Benefit. $10,000 for death as a result of a covered accident within 12 months of the accident.

Catastrophic Plan Exclusions

1. Self destruction or attempted self destruction while sane or insane, or intentional self inflicted injury.

2. Insured persons commission of or attempted commission of, a criminal or felonious act.

3. The Insured person being intoxicated, or being under the influence of drugs or narcotics unless a prescribed by a doctor for a medical condition other than drug addiction.

This coverage summary explains the general purpose of the insurance described but in no way changed or affects the insurance afforded under any policy as actually issued. All coverage's will be subject to actual policy conditions, provisions and exclusions.

CLAIM PROCEDURE

All medical bills incurred by your son or daughter, as the result of any injury while participating in an intercollegiate sports program, should be sent directly to your home address. Please follow the following procedure:

A. Submit all bills to your primary family insurance plan first. Keep a copy of these bills, as you will need them to file any outstanding balance with CIGNA. Your primary family insurance policy carrier will do one of the following:

1. After your plan deductible, pay all or a portion of the bills incurred.

2. Not pay the claim and send you a letter of denial. An example might be that your son or daughter may no longer be covered under your primary family policy any longer due to their age or the doctor that treated your son or daughter was not in the HMO/PPO network of your primary family policy.

B. If your primary family policy denies the claim all together or leaves a remaining balance due, forward the following information to Susan Butts in Administrative Services at Rose-Hulman so that she may file the balance with CIGNA:

1. Copy of the original itemized bills from doctor or hospital.

2. Explanation of Benefits (EOB) from primary family insurance plan showing how much they paid and what they declined to pay.

C. Susan will file the claim to CIGNA through Anthem Benefit Administrators. If Anthem Administrators needs any additional information from you to file the claim, please cooperate with them and they will process the claim in the least possible amount of time.

D. Any charges remaining for eligible expenses that are considered to be above "Usual Customary & Reasonable" (UCR) are the responsibility of the family. You may contact those doctors or hospital providers direct and ask if the excess charges, if any, may be waived or adjusted.