Accident

What is it? Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident. Accident Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Who can be covered? You have the option to enroll yourself as well as your spouse* and children* in Accident Insurance coverage to meet your needs. *Employees must be enrolled in order to elect coverage for eligible spouse and eligible dependent children as defined in the Certificate of Coverage and Riders. Why should I consider it? Benefits will be paid directly to you to use for any purpose, such as paying out-of-pocket medical expenses, copays, deductibles, groceries, gas, utilities and more its up to you. Coverage is always guaranteed issue. You can choose to take this coverage with you if you leave your employer or retire, and youll be billed at the same rates via direct billing. ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya family of companies Wellness Benefit Your coverage includes a Wellness Benefit, which will pay you and covered family members an annual benefit if they complete an eligible health screening test. These screenings may include a mental health screening, flu immunization, a mammogram and a routine eye or dental exam. $75 for employees, $75 for spouses, $75 per child, per calendar year How much does it cost? The tables below show your rates for Accident Insurance. The cost provided below includes Accident Insurance premium and a fee for Voya Travel Assistance. Accident Insurance Help minimize the financial impact that can come with an accidental injury Group Name: Ball State University Group Number: 752151 Class: All Eligible Employees Bi-Weekly Rates Bi-Weekly Rates Low Plan High Plan Employee Employee and Spouse Employee and Children Family Employee Employee and Spouse Employee and Children Family $2.05 $4.97 $4.97 $7.89 $3.61 $8.73 $8.86 $13.98 18- Pay Period 18- Pay Period Low Plan High Plan Employee Employee and Spouse Employee and Children Family Employee Employee and Spouse Employee and Children Family $2.96 $7.18 $7.17 $11.39 $5.22 $12.61 $12.80 $20.19

What kinds of injuries and treatments does it cover? Your Accident Insurance coverage is always guaranteed issue, and it provides a benefit payment after a covered accident that results in specific injuries and treatments. The following list presents the benefits provided by Accident Insurance. State variations may apply. For a complete description of your available benefits, see your certificate of insurance and any riders. Accident Hospital Care Benefit Low Plan Benefit High Plan Surgery (open abdominal, thoracic) $2,000 $3,000 Surgery (exploratory or without repair) $250 $500 Blood, Plasma, Platelets $600 $900 Hospital Admission $1,250 $2,000 Hospital Confinement (per day, up to 365 days) $250 $400 Critical Care Unit (CCU) Admission $2,000 $3,000 Critical Care Unit Confinement (per day up to 30 days) $400 $800 Rehabilitation Facility Confinement (per day up to 90 days) $175 $300 Induced Coma (up to 14 days) $125 $200 Non-Induced Coma (duration of 14 or more days) $20,000 $30,000 Transportation (per trip up to 3 per accident) $650 $800 Lodging (per day up to 30 days) $200 $300 Family care (per child/adult up to 45 days) $25 $35 Accident Care Benefit Low Plan Benefit High Plan Initial Doctor Visit $100 $200 Urgent Care Facility Treatment $200 $250 Emergency Room Treatment $200 $325 Ground Ambulance $300 $550 Air ambulance $1,250 $2,000 Follow-up Doctor Treatment $100 $150 Home Health Care $50 $75 Chiropractic Treatment (up to 6 per accident) $60 $90 Prescription Medicine $10 $20 Medical Equipment $250 $400 Physical or Occupational Therapy (per treatment up to 10) $60 $90 Prosthetic Device (one) $1,000 $1,500 Prosthetic Device (two or more) $2,000 $3,000 Major Diagnostic Exams $200 $300 CT (computerized tomography) or CAT scan (computerized axial tomography) MRI (magnetic resonance imaging) EEG (electroencephalogram) PET (positron emission tomography) scan Ultrasound Outpatient Surgery $200 $250 X-ray $200 $400

Common Injuries Benefit Low Plan Benefit High Plan Burns (2 nd degree, at least 36% of body) $1,125 $1,500 Burns (3 rd degree, at least 2% but less than 4% of the total body surface area) $6,000 $8,500 Burns (3 rd degree, 4% or more of the total body surface area) $12,500 $20,000 Skin Grafts (percentage of burn benefit) 50% 50% Emergency Dental Work (Crown) $300 $450 Emergency Dental Work (Extraction) $100 $150 Eye Injury (removal of foreign object) $200 $300 Eye Injury (surgery) $275 $400 Torn Hip, Knee or Shoulder Cartilage (surgery with no repair or if cartilage is shaved) $250 $500 Torn Hip, Knee or Shoulder Cartilage (surgical repair) $1,000 $2,000 Laceration 1 (treated - no sutures) $25 $50 Laceration 1 (sutures up to 2) $50 $90 Laceration 1 (sutures 2 to 6) $200 $350 Laceration 1 (sutures over 6) $400 $750 Puncture Wound 1 $25 $50 Ruptured Disk (surgical repair) $1,000 $1,500 Tendon, Ligament, Rotator Cuff (exploratory arthroscopic surgery with no repair) $350 $600 Tendon, Ligament, Rotator Cuff (1, surgical repair) $675 $925 Tendon, Ligament, Rotator Cuff (2 or more, surgical repair) $1,000 $1,500 Concussion $200 $350 Traumatic Brain Injury $1,500 $2,000 Paralysis (monoplegia) $7,500 $12,500 Paralysis (hemiplegia) $12,500 $17,500 Paralysis (paraplegia) $15,000 $25,000 Paralysis (quadriplegia) $30,000 $50,000 Dislocations Complete 2 /Complete Requiring Surgical Repair 3 Benefit Low Plan Benefit High Plan Hip Joint $2,550/$5,100 $4,000/$8,000 Knee $1,600/$3,200 $2,500/$5,000 Ankle or foot bone(s) (other than toes) $1,300/$2,600 $1,500/$3,000 Shoulder $1,000/$2,000 $1,600/$3,200 Elbow $750/$1,500 $1,100/$2,200 Wrist $750/$1,500 $1,100/$2,200 Finger/toe $175/$350 $275/$550 Hand bone(s) (other than fingers) $750/$1,500 $1,100/$2,200 Lower jaw $750/$1,500 $1,100/$2,200 Collarbone $750/$1,500 $1,100/$2,200 Incomplete dislocations: percentage of the complete amount 25% 25%

Fractures Non-Surgical Repair Fracture 4 /Fracture Requiring Surgical Repair 5 Benefit Low Plan Benefit High Plan Hip $2,000/$4,000 $5,000/10,000 Leg $1,500/$3,000 $2,700/$5,400 Ankle $1,200/$2,400 $2,250/$4,500 Heel $1,200/$2,400 $2,250/$4,500 Kneecap $1,200/$2,400 $2,250/$4,500 Foot (excluding toes, heel) $1,200/$2,400 $2,250/$4,500 Upper arm $1,400/$2,800 $2,400/$4,800 Forearm, hand, wrist (except fingers) $1,200/$2,400 $2,250/$4,500 Finger, Toe $160/$320 $300/$600 Vertebral body $2,240/$4,480 $4,000/$8,000 Vertebral processes $960/$1,920 $1,750/$3,500 Pelvis (except coccyx) $2,250/$4,500 $4,000/$8,000 Coccyx $200/$400 $450/$900 Bones of the face (except nose) $800/$1,600 $1,300/$2,600 Nose $500/$1,000 $750/$1,500 Upper jaw $1,000/$2,000 $1,600/$3,200 Lower jaw $960/$1,920 $1,750/$3,500 Collarbone $1,100/$2,200 $2,200/$4,400 Rib $300/$600 $450/$900 Skull Simple (except bones of the face) $1,000/$2,000 $2,000/$4,000 Skull Depressed (except bones of face) $2,000/$4,000 $4,000/$8,000 Sternum $1,100/$2,200 $1,100/$2,200 Shoulder blade $1,200/$2,400 $2,250/$4,500 Chip Fractures: percentage of the Non-Surgical Repair 25% 25% 1 Laceration benefits are a total of all lacerations per accident. Payable once per covered accident. If your injury qualifies as both a laceration and puncture wound, only one benefit in the higher amount will be payable. 2 Complete separated joint that does not require a surgical repair. If you receive more than one dislocation in the same covered accident, a benefit is payable for all dislocations. However, the benefit amount will be no more than two times the benefit amount for the joint involved which pays the highest benefit amount. Other limitations and maximums may apply. 3 Completely separated joint that requires surgical repair. If you receive more than one dislocation in the same covered accident, a benefit is payable for all dislocations. However, the benefit amount will be no more than two times the benefit amount for the joint involved which pays the highest benefit amount. Other limitations and maximums may apply. 4 Fracture that does not require a surgical repair. If you receive more than one fracture in a covered accident, a benefit is payable for all fractures. However, the benefit will be no more than two times the benefit amount listed for the bone which pays the highest benefit amount. 5 Fracture that does require surgical repair. If the doctor diagnoses the fracture as a chip fracture, the benefit will be reduced to a percentage of what would have been paid for a Non-Surgical Repair Fracture of the same bone. If you receive more than one fracture in a covered accident, a benefit is payable for all fractures. However, the benefit will be no more than two times the benefit amount listed for the bone which pays the highest benefit amount.

Accidental Death Benefits Benefit Low Plan Benefit High Plan Common Carrier* Employee $100,000 $200,000 Spouse $50,000 $100,000 Child $25,000 $50,000 Accidental Death Employee $50,000 $100,000 Spouse $25,000 $50,000 Child $10,000 $20,000 * A common carrier is commercial transportation that operates on a regular schedule, between predetermined points or cities (such as a bus or airline route). Accidental Dismemberment Benefits Benefit Low Plan Benefit High Plan Loss of both hand or both feet or sight in both eyes $28,000 $40,000 Loss of one hand or one foot AND sight of one eye $22,000 $30,000 Loss of one hand AND one foot $22,000 $30,000 Loss of one hand OR one foot $12,500 $15,000 Loss of two or more fingers or toes $1,800 $2,500 Loss of one finger or toe $1,250 $1,500 Accidental Death and Dismemberment (AD&D) If you are severely injured or die as a result of a covered accident, an AD&D benefit may be payable to you or your beneficiary. If there is no beneficiary named, benefits will be paid according to the Benefit Payments provision in the Certificate. Note: No Accidental death benefit is payable if the Covered Person is eligible for the common carrier benefit What else is included? The benefits below are also included with your coverage. For a complete description of your benefits, along with applicable provisions, conditions on benefit determination, exclusions and limitations, see your certificate of insurance and any riders. Sports Accident Benefit increases the benefit amounts listed in the accident hospital care, accident care or common injuries sections by 25% and to a maximum additional benefit amount of $1,000 if your accident occurs while participating in an organized sporting activity (as defined in the certificate of coverage). Portability allows you to continue your coverage under the same group policy by paying your premiums directly to the insurance company when your eligibility for benefits changes such as due to termination or reduced hours. Continuation of Insurance allows you to maintain your current Accident Insurance coverage for yourself, your spouse and children during an employer-approved leave of absence. Additional Non-Insurance Services Voya Travel Assistance offers you and your dependents services when traveling 100 miles or more from home, including: medical assistance services, emergency medical transport services, pre-trip and cultural information, security services and accessible technology. Voya Travel Assistance services are provided by International Medical Group, Inc., Indianapolis, IN. Provisions and availability may vary by state.

This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Accident Insurance is underwritten by ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya family of companies. Policy Form #RL-ACC3-POL-16; Certificate Form #RL-ACC3-CERT-2-23; and Rider Forms: Spouse Accident Rider Form #RL-ACC3-SPR2-23, Children's Accident Rider Form #RL-ACC3-CHR2-23, Wellness Benefit Rider Form #RL-ACC3-WELL2-23, Accidental Death & Dismemberment (AD&D) Rider Form #RL- ACC3-ADR2-23, Catastrophic Accident Rider Form #RL-ACC3-CAR2-23, Off Job Accident Disability Income Rider form #RL-ACC3-DIR-16, Sickness Hospital Confinement Rider Form #RL-ACC3-HCR-16, Waiver of Premium Rider form #RL-ACC3-WOP-16, Absence from Employment Premium Waiver Rider form #RL-ACC3-AEPW-23; Continuation of Insurance Rider form #RL-ACC3-CNT2-23. Form numbers, provisions and availability may vary by state and employers plan. Accident 2.3 only Date Prepared: 09/29/2025 2024 Voya Services Company. All rights reserved. CN3836004_0926 3467966_091524 Questions? Enrollment instructions will be provided by your employer. If you have additional questions before you enroll, please call: Voya Employee Benefits Customer Service at (877) 236-7564 Scan the QR code to visit your Employee Benefits Resource Center to learn more about this benefit and review instructions on how to file a claim after your effective date. https://presents.voya.com/EBRC/ballstateuniversity *Definition and limitations/exclusions may vary by state. Exclusions and limitations Standard exclusions for the Certificate, Spouse Accident Insurance, and Childrens Accident Insurance and AD&D are listed below. (These may vary by state.) For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders. Your Benefits are not payable for any loss caused in whole or directly by any of the following*: Any sickness or declining process caused by sickness. Participation or attempt to participate in a felony or illegal activity. An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered persons blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred. Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane. War or any act of war, whether declared or undeclared, other than acts of terrorism. Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion. Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test. Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities. Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.