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Employee Accidental Death and Dismemberment Benefit

How does my Accidental Death and Dismemberment (AD&D) Benefit work?

If you die or lose a hand, a foot or your sight, the insurance carrier will pay a benefit based on the Table of Losses shown below. The loss or death must be the direct result of an Accidental Injury that occurs while you are insured by the Group Policy. Also, the loss must occur within 90 days of the accident date and submitted within 180 days of the accident.

TABLE OF LOSSES

The full sum is paid for loss of:

The full sum is paid for loss of:

• Life
• Both hands
• Both feet
• Sight of both eyes
• One hand and one foot
• One hand and sight of one eye
• One foot and sight of one eye

• One hand
• One foot
• Sight of one eye

• Thumb and index finger of either hand
• Loss of hand or foot means actual severance at or above wrist or ankle joints
• With respect to eyes, permanent and total loss of sight
• With respect to thumbs and index finger, complete severance of entire digit at or above joints.

No more than 100% of the Maximum Benefit will be paid for any one accident, no matter how many of the above listed losses occur as a result of that accident.

Your beneficiary designation for Employee Life Insurance will apply to benefits for loss of life under the AD&D benefit.

Loss of hand or foot means the irrecoverable loss of the hand or foot as a result of an Accidental Injury. Loss of sight means total sight loss that cannot be restored

Additional Benefits

AD&D Seat Belt Benefit
Amount is the lessor of $25,000, or

1. The amount of the AD&D benefit that is paid because of Accident, or
2. $1000 if an official police report certifying that the seat belt is properly fastened cannot be submitted with the claim.

Repatriation Benefit

• The Company will pay up to $5000 for the preparation and transportation of the Insured’s body to a mortuary if: The Insured dies as a result of an accident for which AD&D benefit is payable and
• The Insured’s death occurs at least 75 miles away from the Insured’s principal place of residence.

Education Benefit
"Student” means a Dependent who, on the date of the Insured’s death, is:

1. A full time post –high school in a school of higher education, or
2. A student in the 12th grade but who becomes a full time post high school student in a school of high education within 365 days after the Insured's death.

a) Bachelor’s degree or not less than a two year program with full credit towards a Bachelor’s degree, or

b) Gainful employment so long as such program is at least one year of training and is accredited by an agency or association recognized by the US Department of Education under the Higher Education Assistance Act as may be amended from time to time.

Amount of Benefit
The Dependent Education Benefit for each Dependent Student shall equal the lessor of the Maximum amount of the Insured’s AD&D or $12,000 payable over 4 years.

Special Child Education Benefit
If the Insured’s Dependent does not qualify as a Student, but is enrolled in an elementary or high school, the Company will pay a Child Education Benefit in the amount of $1000.00. This benefit is payable once upon proof that the Insured has died as a result of an accident for which the Accidental Death & Dismemberment benefit is payable and that, within 12 months after the Insured’s death, the Insured’s Dependent is a full time student in an elementary or high school.

Under what circumstances will a loss not be covered by this AD&D Benefit?

1. We will not pay for any loss that results in any way from Any disease of infirmity of mind or body, and any medical or surgical treatment thereof; or
2. Suicide or attempted suicide, while sane or insane,or
3. Any intentionally self–inflicted injury; or
4. War, declared or undeclared, whether or not the Insured is a member of any armed forces; or
5. Commission of, participation in, or an attempt to commit an assault or felony; or
6. Being under the influence of any narcotic, hallucinogen, barbiturate or amphetamine, gas or fumes, poison or any other controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter, amended, unless as prescribed by the Insured’s licensed physician. Conviction is not necessary for a determination of being under the influence; or
7. Intoxication as defined by laws of the jurisdiction in which the accident occurred. Conviction is not necessary for a determination of being intoxicated; or
8. Active participation in a riot. “Riot” means all forms of public violence, disorder, or disturbance of the public peace, by three or more persons assembled together, whether with or without a common intent and whether or not damage to person or property or unlawful act is the intent or the consequence of such disorder.

Will this AD&D Benefit continue if I become disabled?
If you are Totally Disabled and Your Life Insurance Benefit is being continued under the waiver of premium provision, this Accidental Death and Dismemberment Benefit will end.