Insurance underwritten by:National Union Fire Insurance Company of Pittsburgh, Pa.

with its principal place of business in New York, NY (“the Company”)

This brochure is valid in all states EXCEPT: Colorado (under 10 lives), Florida (under 51 lives), New Hampshire, New Mexico (under 10 lives), New York*, Rhode Island, and Washington.

*Alternative plan design and rate options are available in New York. Please contact your AIG representative for information.

AIG Accident and Health Product Brochure

FOR MOTOR CARRIERS

PASSENGER ACCIDENT INSURANCE PROGRAM

IMPORTANT: This brochure provides only a brief summary of the Program available for sale under policy series C11695DBG. The Program provides insurance for covered accidents incurred while insureds are participating in Covered Activities.

Passenger Accident Insurance Coverage

Why Passenger Accident Insurance?If a passenger riding as a guest in a truck or motor carrier becomes injured in the event of an accident, the passenger can sue not only the trucking or motor carrier company but the driver of the vehicle as well. This insurance provides accident medical benefits to authorized passengers who are injured while traveling with a driver operating a vehicle under the authority of the motor carrier.

EligibilityClass 1: All guest passengers 18 years of age and over who accompany the drivers (employee drivers and/or independent contractors) while the driver is operating and under lease on authorized trips on behalf of the Policyholder and whose names are on file with the Policyholder.

Class 2: All guest passengers under the age of 18 and who accompany the drivers (employee drivers and/or independent contractors) while the driver is operating and under lease on authorized trips on behalf of the Policyholder and whose names are on file with the Policyholder.

The term “passenger” shall mean an individual riding as a passenger, who is neither an employee of the Policyholder nor one who is receiving remuneration or compensation of any kind for this activity. Hitchhikers, helpers, and co-drivers are not covered. Passengers must be wearing a seat belt. D

ID Y

OU

KNO

W? Passenger vehicle

occupant deaths represented

64 percent of the 35,092

motor vehicle crash deaths

in 2015.1

1 Insurance Institute for Highway Safety Highway Loss Data Institute, http://www.iihs.org/iihs/topics/t/general-statistics/fatalityfacts/passenger-vehicles, viewed October 2016

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Covered ActivitiesCoverage is provided while riding as an authorized passenger while in or on, or immediately boarding or alighting from the covered vehicle.

Guest passenger coverage is provided only while the operator of the vehicle is performing his/her occupational duties.

Benefits

Accidental Death Benefit If Injury results in the death of the Insured within 365 days of the date of the accident causing the Injury, the policy will pay 100 percent of the Accidental Death Benefit Maximum Amount.

Accidental Dismemberment BenefitIf Injury to an Insured results in any one of the losses specified below, directly and independently of all other causes, within 365 days of the date of the accident causing the Injury, the policy will pay the percentage of the Accidental Dismemberment Maximum Amount specified for that loss.

For Loss Of Percentage

Both Hands or Both Feet 100%

One Hand and One Foot 100%

One Hand and Sight in One Eye 100%

One Foot and Sight in One Eye 100%

Sight in Both Eyes 100%

Speech and Hearing in Both Ears 100%

Sight in One Eye 50%

One Hand or One Foot 50%

Speech or Hearing in Both Ears 50%

Hearing in One Ear 25%

Thumb and Index Finger of Same Hand 25%

Benefits (Continued)

Accident Medical Expense BenefitIf the Insured suffers an Injury that requires treatment by a Physician within 90 days of the date of the accident causing the Injury, the policy will pay the usual and customary charges incurred for medically necessary Covered Accident Medical Services², up to the Accident Medical Expense Maximum Amount for all Injuries caused by the same accident. Benefits are payable for covered charges incurred within 52 weeks of the date of the accident causing the Injury. Maximum Dental benefit is $250 per tooth per accident.

Each available plan allows for Accident Medical Expense Benefits to be provided on a primary basis. Primary coverage means that our policy provides coverage for covered accident medical expenses regardless of other insurance coverage available to the Insured.

Emergency Evacuation with Family Travel Benefit If an Insured suffers an Injury or Emergency Sickness that warrants his or her Emergency Evacuation while he or she is outside a 100 mile radius from his or her current place of primary residence, the policy will pay for Covered Emergency Evacuation Expenses reasonably incurred up to the maximum amount per Insured for all Emergency Evacuations due to all Injuries from the same accident or all Emergency Sicknesses from the same or related causes.

Family Travel Benefit – Following an Emergency Evacuation for which an Emergency Evacuation benefit is payable the policy will pay for expenses reasonably incurred:

1. to return to their current place of primary residence, with an attendant if necessary, any of the Insured’s Children who were accompanying the Insured when the Injury or Emergency Sickness occurred; but not to exceed the cost of a single one-way economy airfare ticket less the value of applied credit from any unused return travel tickets per person.

2. to bring one person chosen by the Insured to and from the hospital or other medical facility where the Insured is confined if the Insured is alone and if the place of confinement is outside a 100 mile radius from the Insured’s place of primary residence; but not to exceed the cost of one round-trip economy airfare ticket.

Travel Guard Group, Inc. must make all arrangements and must authorize all expenses in advance for any Emergency Evacuation benefits to be payable.

Repatriation of RemainsIf an Insured suffers loss of life due to Injury or Emergency Sickness while outside a 100 mile radius from his or her current place of primary residence, the policy will pay for covered expenses reasonably incurred to return his or her body to his or her current place of primary residence, but not exceeding the Maximum Amount per Insured.

Covered expenses include, but are not limited to, expenses for: (1) embalming or cremation; (2) the most economical coffins or receptacles adequate for transportation of the remains; and (3) transportation of the remains by the most direct and economical conveyance and route possible.

Travel Guard Group, Inc. must make all arrangements and must authorize all expenses in advance for this benefit to be payable.

Travel Guard Services 1. Travel Medical Assistance

2. Worldwide Travel Assistance

3. Security Assistance

4. VIP Concierge Services

5. ID Theft Recovery Services

6. Member Website Access

Limitation on Multiple Benefits

If an Insured suffers one or more losses from the same accident for which amounts are payable under the Accidental Death Benefit and Accidental Dismemberment Benefit, the maximum amount payable under all these Benefits combined will not exceed the amount payable for the largest of these losses.

Aggregate Limit

The maximum amount payable under the policy may be reduced if more than one Insured suffers a loss as a result of the same accident, and if amounts are payable for those losses under one or more of the following Benefits provided by the policy: Accidental Death Benefit, Accidental Dismemberment Benefit. The maximum amount payable for all such losses for all Insureds under those benefits combined will not exceed the amount shown as the Aggregate Limit. If the combined maximum amount otherwise payable for all insureds must be reduced to comply with this provision, the reduction will be taken by applying the same percentage of reduction to the individual maximum amount other-wise for each Insured for all such losses under all those benefits combined.

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2. Covered Accident Medical Service(s) means any of the following services: a) services of a Physician; b) private duty nursing by a registered nurse (R.N.) or Licensed Practical Nurse (LPN); c) laboratory tests; d) radiological procedures; e) anesthetics and the administration of anesthetics; f) blood, blood products and artificial blood products, and the transfusion thereof; g) physical therapy and occupational therapy; h) rental of durable medical equipment; i) artificial limbs, artificial eyes or other prosthetic appliances; j) medicines or drugs administered by a Physician or that can be obtained only with a Physician’s written prescription; k) use of an Ambulatory Medical Center; l) Hospital’s most common semi-private room and board (or room and board charge in an intensive care unit), Hospital ancillary services (including but not limited to use of the operating room or emergency room); m) ambulance service to or from a Hospital.

Maximum Benefit Amounts

Benefits Plan 1 Plan 2 Plan 3

Accident Medical Expense Dental Maximum

$100,000 $250 (per tooth per accident)

$200,000 $250 (per tooth per accident)

$300,000 $250 (per tooth per accident)

Deductible per Injury $0 $0 $0

Accidental Death Class 1: $100,000 Class 2: $10,000

Class 1: $200,000 Class 2: $20,000

Class 1: $300,000 Class 2: $25,000

Accidental Dismemberment Class 1: $100,000 Class 2: $10,000

Class 1: $200,000 Class 2: $20,000

Class 1: $300,000 Class 2: $25,000

Emergency Evacuation $100,000 $100,000 $100,000

Repatriation of Remains $50,000 $50,000 $50,000

Aggregate Limit $1,000,000 $2,000,000 $3,000,000

Annual Premium Rates

Rates may vary based upon prior claims history.

Total Number of Drivers Plan 1 Plan 2 Plan 3

1-50 $500 $785 $1,000

51-100 $735 $1,175 $1,565

101-200 $1,470 $2,315 $3,130

201-300 $2,450 $3,855 $5,215

Reduction Schedule

The Maximum Amount used to determine the amount payable for a loss will be reduced if an Insured is age 70 or older on the date of the accident causing the loss with respect to any of the following Benefits provided by this Policy: Accidental Death Benefit, Accidental Dismemberment Benefit. The Maximum Amount is reduced to a percentage of the Maximum Amount that would be used if the Insured were under age 70 on the date of the accident, according to the following schedule:

AGE ON DATE OF ACCIDENT PERCENTAGE UNDER AGE 70 – MAXIMUM AMOUNT

70-74 65%

75-79 45%

80-84 30%

85 and older 15%

Premium for an Insured age 70 or older is based on 100% of the coverage that would be in effect if the Insured were under age 70.

“Age” as used above refers to the age of the Insured on the Insured’s most recent birthday, regardless of the actual time of birth.

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Continued >

Passenger Accident Insurance ProgramSend completed form to PABrochureIntake@aig.com. Contact your local representative with questions.

PRODUCER INFORMATION

Producer of Record: ___________________________________________________________________________________________

Producer Company Name: ______________________________________________________________________________________

Street Address: _______________________________________________________________________________________________

City: _________________________________________________________________ State: _________ ZIP: ____________________

Phone: ____________________________________________ Email: ___________________________________________________

Website Address: _____________________________________________________________________________________________

Are you the incumbent? Yes No(Only appropriately licensed and appointed producers can sell, solicit, and negotiate insurance products with prospective customers.)

Standard commission for this program is 15 percent.

PROPOSED POLICYHOLDER INFORMATION

Proposed Policyholder Legal Name: _______________________________________________________________________________

Street Address: _______________________________________________________________________________________________

City: ________________________________________________ State: ___________________________ ZIP: __________________

Phone: ____________________________________________ FEIN Number: _____________________________________________

Website Address: _____________________________________________________________________________________________

CHOICE OF COVERAGEThe premium rates shown below are per policy year. Rates may vary based upon prior claims history.

Choose the plan you want: Plan 1 Plan 2 Plan 3

1-50 Drivers: $500 $785 $1,000

51-100 Drivers: $735 $1,175 $1,565

101-200 Drivers: $1,470 $2,315 $3,130

201-300 Drivers: $2,450 $3,855 $5,215

AIG Accident and Health Questionnaire

PROPOSED COVERAGE EFFECTIVE DATECoverage becomes effective on the proposed date only if the insurance company has received the completed questionnaire and approved the risk on or before the proposed effective date. If the completed questionnaire is received after the proposed effective date, coverage will not take effect until the insurance company receives and accepts the questionnaire and approves the risk. Please enter the proposed effective date in the spaces below. The coverage period is one (1) year from the organization’s Policy effective date.

______ / _______ / _________

APPROVALWe will review the completed questionnaire promptly and notify you if coverage will be provided, or if there are any problems, miscalculations or omissions that would prevent us from issuing coverage.

PREVIOUS INSURANCE (rates may vary from this brochure based on prior claim history)If an accident insurance program has been in force for your organization, please give full details for the past three (3) years:

Policy year: ___________________ ___________________ ___________________

Total premium: $ ___________________ $ ___________________ $ ___________________

Total paid claims: $ ___________________ $ ___________________ $ ___________________

Number of claims: ___________________ ___________________ ___________________

Name(s) of previous carrier(s): ____________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Upon review, more detail may be requested.

Check here if no prior coverage

All information on the questionnaire is correct to the best of my knowledge. I understand that the insurance company must accept and approve this questionnaire before coverage is effective. I agree that the insurance company may audit my records to verify proper payment. By signing below, I acknowledge that I have read, understand and agree to the terms and conditions of this coverage as presented in this brochure.

Officer’s name (print) ___________________________________________________________________________________________

Signature ____________________________________________________________________________________________________

Title (print) ___________________________________________________________________________________________________

Date _______________________________________________________________________________________________________

Send completed form to PABrochureIntake@aig.com. Contact your local representative with questions.

©2018. All rights reserved. SM-37929-17 R05/18

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SUBMIT FORM

Policy Exclusions (may vary by state)

No coverage shall be provided under the Policy and no payment shall be made for any loss resulting in whole or in part from, or contributed to by, or as a natural and probable consequence of any of the following excluded risks even if the proximate or precipitating cause of the loss is an accidental bodily Injury.

1. suicide or any attempt at suicide or intentionally self-inflicted Injury or any attempt at intentionally self-inflicted Injury or auto-eroticism.

2. sickness, disease, mental incapacity or bodily infirmity whether the loss results directly or indirectly from any of these.

3. the Insured’s commission of or attempt to commit a crime.

4. infections of any kind regardless of how contracted, except bacterial infections that are directly caused by botulism, ptomaine poisoning or an accidental cut or wound independent and in the absence of any underlying sickness, disease or condition including but not limited to diabetes.

5. declared or undeclared war, or any act of declared or undeclared war, except if specifically provided by this Policy.

6. participation in any team sport or any other athletic activity, except participation in a Covered Activity.

7. full-time active duty in the armed forces, National Guard or organized reserve corps of any country or international authority. (Unearned premium for any period for which the Insured is not covered due to his or her active duty status will be refunded.) (Loss caused while on short-term National Guard or reserve duty for regularly scheduled training purposes is not excluded.)

8. travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if the Insured is:

a. riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; or

b. performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft; or

c. riding as a passenger in an aircraft owned, leased or operated by the Policyholder or the Insured’s employer.

9. the Insured being under the influence of intoxicants;

10. the Insured being under the influence of drugs unless taken under the advice of and as specified by a Physician.

11. the medical or surgical treatment of sickness, disease, mental incapacity or bodily infirmity whether the loss results directly or indirectly from the treatment.

12. stroke or cerebrovascular accident or event; cardiovascular accident or event; myocardial infarction or heart attack; coronary thrombosis; aneurysm.

13. any condition for which the Insured is entitled to benefits under any Workers’ compensation Act or similar law.

14. the Insured riding in or driving any type of motor vehicle as part of a speed contest or scheduled race, including testing such vehicle on a track, speedway or proving ground.

15. any loss incurred while outside the United States, its Territories or Canada.

Accident Medical Expense Benefit Exclusions

In addition to the above Exclusions, Accident Medical Expense benefits are not payable for, and usual and customary charges for Covered Accident Medical Services do not include, any expense for or resulting from any of the following:

1. repair or replacement of existing artificial limbs, artificial eyes or other prosthetic appliances or rental of existing Durable Medical Equipment unless for the purpose of modifying the item because Injury has caused further impairment in the underlying bodily condition;

2. new, or repair or replacement of, dentures, bridges, dental implants, dental bands or braces or other dental appliances, crowns, caps, inlays or onlays, fillings or any other treatment of the teeth or gums, except for repair or replacement of sound natural teeth damaged or lost as a result of Injury up to the Dental Maximum shown in the Benefit Schedule;

3. new eye glasses or contact lenses or eye examinations related to the correction of vision or related to the fitting of glasses or contact lenses, unless Injury has caused impairment of sight; or repair or replacement of existing eyeglasses or contact lenses unless for the purpose of modifying the item because Injury has caused further impairment of sight;

4. new hearing aids or hearing examinations unless Injury has caused impairment of hearing; or repair or replacement of existing hearing aids unless for the purpose of modifying the item because Injury has caused further impairment of hearing;

5. rental of Durable Medical Equipment where the total rental expense exceeds the usual purchase expense for similar equipment in the locality where the expense is incurred (but if, in the Company’s sole judgment, Accident Medical Expense benefits for rental of Durable Medical Equipment are expected to exceed the usual purchase expense for similar equipment in the locality where the expense is incurred, the Company may, but is not required to, choose to consider such purchase expense as a Usual and Customary Covered Accident Medical Expense in lieu of such rental expense);

6. any charge for medical care for which the Insured is not legally obligated to pay;

7. care, treatment or services provided by an Insured or by an Immediate Family Member;

8. routine physical exam and related medical services;

9. personal comfort or convenience items, such as but not limited to, Hospital telephone charges, television rental, or guest meals while confined in a Hospital or for items taken away or home from the Hospital, except Durable Medical Equipment.

10. pre-existing Conditions;

11. an Emergency Evacuation for which any benefits are payable under the Policy’s Emergency Evacuation Benefit;

12. elective treatment or surgery;

13. experimental or Investigative treatment or procedures;

14. treatment for temporomandibular dysfunction;

15. care, treatment or services provided by persons retained or employed by the Policyholder; or for supplies, prescriptions or medicines paid for or reimbursable by the Policyholder, or for which a charge is not made;

16. mental Illness, psychological or psychiatric counseling of any kind, mental and nervous disease or disorders and rest cures;

17. educational or vocational testing or training;

18. treatment of Osgood-Schlatter’s disease;

19. detached retina unless due to an Injury;

20. diagnostic tests or treatment, except due to infection which occurs directly from an accidental cut or wound or ingestion of contaminated food;

21. plastic or cosmetic surgery;

22. charges that are payable under motor vehicle medical benefits;

23. hernia, except as a result of participation in a Covered Activity;

24. any condition for which the Insured is entitled to benefits under any Workers’ Compensation Act or similar law.

Definitions

Covered Emergency Evacuation Expense(s) means an expense that: (1) is charged for a Medically Necessary Emergency Evacuation Service; (2) does not exceed the usual level of charges for similar Transportation, treatment, services or supplies in the locality where the expense is incurred; and (3) does not include charges that would not have been made if no insurance existed.

Emergency Sickness means an illness or disease, diagnosed by a Physician, which meets all of the following criteria: (1) there is present a severe or acute symptom requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of the Insured’s condition or place his or her life in jeopardy; (2) the severe or acute symptom occurs suddenly and unexpectedly; and (3) the severe or acute symptom occurs while the Policy is in force as to the Insured suffering the symptom and while the Insured is participating in a Covered Activity.

Injury means bodily injury: (1) which is sustained as a direct result of an unintended, unanticipated accident that occurs while the injured person’s coverage under the Policy is in force; (2) which occurs while such person is participating in a Covered Activity; and (3) which directly (independent of sickness, disease or any other cause) causes a covered loss.

Insured means a person: (1) who is a member of an eligible class of persons as described in the Classification of Eligible Persons section of the Master Application; (2) for whom premium has been paid; and (3) while covered under the Policy.

Loss means with reference to hand or foot, complete severance through or above the wrist or ankle joint; with reference to sight in an eye, total and irrecoverable loss of sight; with reference to hearing in an ear, total and irrevocable loss of ability to hear in that ear; with reference to speech, total and irrevocable loss of ability to speak; with reference to thumb and index finger, complete severance through or above the metacarpophalangeal joint of both digits. In the event an Insured suffers more than one Loss as a result of the same accident, only one amount, the largest, shall be paid, subject to the Maximum Amount under the Plan you select.

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For more information, contact your AIG Accident and Health representative or please visit our website at www.aig.com/us/accident.

IMPORTANT: This program provides accident insurance only. It does not provide basic hospital, basic medical, or comprehensive/majormedical coverage, and does not satisfy the “minimum essential coverage” requirements of the Patient Protection and Affordable Care Act.

This brochure provides only brief descriptions of the coverages available under Policy Series C11695DBG. The issued Policy will contain reductions, limitations, exclusions, definitions and termination provisions. Full details of the coverage will be contained in the issued Policy. If there are any conflicts between this brochure and the issued Policy, the Policy shall govern in all cases. Insurance is underwritten by National Union Fire Insurance Company of Pittsburgh, Pa., a Pennsylvania insurance company, with its principal place of business at 175 Water Street, 18th Floor, New York, NY 10038. It is currently authorized to transact business in all states and the District of Columbia. NAIC No. 19445. Certain coverages may not be available in some states. Copyright © 2018. All rights reserved. SM-37929-17 R05/18