This plan does not cover: (a) suicide or any attempt thereat while sane or insane; (b) loss caused by an act of declared or undeclared war; (c) injuries received while participating in training exercises or maneuvers of an armed service while a member of an armed service; (d) injuries received while traveling by air (except as provided under the Coverage section); (e) injuries received because the Insured person was under the influence of any controlled substance unless administered on the advice of a physician; (f) injuries received because the Insured person was intoxicated while driving a motor vehicle.
Benefit Amount - Choose the Protection Your Family Needs
The amount of insurance you select is called the "Principal Sum." You may select a Principal Sum amount from a minimum of $50,000 to a maximum of $750,000* in $10,000 increments.
*Principal Sum amounts over $200,000 are subject to ten (10) times your annual salary.
If you select a Family Plan, your spouse's benefit will be 60% of your Principal Sum and the benefit for each child (no matter how many) will be 20% of your Principal Sum.
NOTE: Coverage for your Spouse and/or children cannot be purchased on a "stand alone" basis. Employee participation in the program is required in order to purchase coverage for your eligible dependents.
Accidental Death and Specific Loss*
When you or a dependent suffers any of the following specific losses because of injuries within 12 months from the date of the accident, we will pay for loss of:
|Both Hands or Both Feet or Both Eyes||Principal Sum|
|One Hand and One Foot||Principal Sum|
|One Hand and One Eye or One Foot and One Eye||Principal Sum|
|Speech and Hearing||Principal Sum|
|One Hand or One Foot or One Eye||One-half Principal Sum|
|Speech or Hearing||One-half Principal Sum|
|Thumb and Index Finger of the Same Hand||One-fourth Principal Sum|
If you or your covered dependent suffers multiple losses due to the same accident, only one benefit amount - the largest to which you are entitled - is payable. Loss of hand, hands, foot or feet means actual severance at or above the wrist or ankle joint. Loss of eye or eyes, speech or hearing means total, uncorrectable and irrecoverable loss of the entire sight, speech or hearing.
*Accidental Death and Specific Loss Benefits for Insureds age 70 and over shall be payable according to the following schedule:
- Insureds ages 70 through 74 receive 82.5% of their original Principal Sum amount.
- Insureds ages 75 through 79 receive 57.5% of their original Principal Sum amount.
- Insureds ages 80 through 84 receive 37.5% of their original Principal Sum amount.
- Insureds ages 85 and over receive 20.0% of their original Principal Sum amount.
Permanent Total Disability Benefits
If injuries result in your total disability within 365 days from the date of the accident and continues for 12 consecutive months, and it is then documented with medical evidence to be permanent, we will pay an amount equal to your Principal Sum less any amount paid or payable under the Benefits for Specific Loss section for a loss resulting from the same accident.
Benefits will end on whichever of the following dates occurs first: (a) your 70th birthday; (b) the date you cease to be engaged on a full-time basis in a gainful work or service; or (c) the date your coverage terminates for any reason.
Seat Belt Usage
When you or a covered dependent receives injuries covered by the policy which result in loss of life, we will pay an additional $25,000 if, at the time of the accident, you were the operator of or a passenger in a private passenger automobile and utilizing a seat belt. Seat belt usage must be verified by a doctor, coroner, traffic officer or other person of competent authority.
If a dependent child is enrolled in and attending either the 12th grade or an accredited college or university on the date of a covered accident which results in your death, we will pay 5% of your Principal Sum not to exceed a maximum of $10,000 per child per year, for each year of full-time uninterrupted college or university attendance completed during the four consecutive years following the child's graduation from the 12th grade. If, on the date of such covered accident, Dependent Children are insured under the Policy or Certificate but none qualify for Education Benefits, a benefit of $5,000 is payable to your designated beneficiary.
Surviving Spouse Training Benefit
If you have family coverage and suffer loss of life in a covered accident, we will pay your surviving spouse within 54 months from the date of the accident, the expense incurred while enrolled in any college, university, licensed professional or trade school training program not to exceed 5% of your Principal Sum. This benefit is payable provided the spouse has: (a) enrolled for the purpose of obtaining an independent source of support or maintenance; (b) successfully completed the program; and (c) received a certificate or degree upon completion.
Common Accident Benefit
In the event both you and your dependent spouse die due to injuries resulting from the same accident or within 24 hours of each other if different accidents, your spouse's Principal Sum will be 100% of your Principal Sum.
If you, due to a covered injury, suffer loss of life, coverage for any insured dependents will continue without premium payment until whichever of the following occurs first: (a) the date your spouse remarries; (b) the date the insurance terminates; (c) the date an unmarried dependent child ceases to be eligible due to age or marriage; or (d) the date the 12-month Benefit Period ends.
HIV Occupational Accident Benefit
If the Insured suffers injuries due to a covered accident while performing his or her duties causing him or her to acquire and test positive for Human Immunodeficiency Virus (HIV) and/or AIDS Related Complex (ARC), within one year of the covered accident, We will pay 1% of the Insured's Principal Sum subject to a maximum of $5,000 in equal monthly installments for 24 months. Benefits will terminate at the end of the month in which the Insured dies or the date on which We have paid the Benefit Amount, whichever occurs first.
Continuation of Medical Coverage
If the Insured's surviving dependent spouse and/or child elect to continue medical coverage under the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) or any applicable state continuation law, We will pay an annual benefit amount of 3% of the Insured's Principal Sum up to $3,000 for a three year period.
Exposure and Disappearance
An Insured will be presumed to have suffered a covered loss due to covered injuries, if while insurance is in effect he or she suffers exposure to the elements. An Insured will be presumed to have died if, while insurance is in effect and after the forced landing, stranding, sinking or wrecking of a covered vehicle: (a) he or she disappears; (b) his or her body is not found within 52 weeks of the accident; and (c) a valid death certificate is issued by a court of appropriate jurisdiction.
New Benefits Effective January 1, 2010
HEMIPLEGIA, PARAPLEGIA AND QUADRIPLEGIA - Included for all Insured Persons (including dependents). Hemi/Para/Quadriplegia (beginning within 60 days of covered accident, continuing for one year) pays 50%, 75% and 100% of Principal Sum, respectively. (Only one of the amounts, the largest applicable, listed here or in the Benefits for Specific Loss provision of the certificate or if insured under the Permanent total Disability Benefits Rider, will be paid for injuries resulting from one accident.)
AIR BAG BENEFIT RIDER - Included for all Insured Persons (including dependents). Pays $10,000 for loss of life in covered auto accident, if, at the time of the accident, an Air Bag restraint system was in place and operable
ACCIDENT ONLY COMA BENEFIT RIDER - When covered injuries result in treatment by a legally qualified physician beginning within 7 days of injury, this benefit will pay 5% of the applicable Principal Sum monthly after 31 days for up to 20 months if insured person lapses into an irreversible coma from a covered injury. Remainder of any Principal Sum paid upon death.
CHILDREN'S DISMEMBERMENT BENEFIT - Included on Family Plans only. Non-loss-of life plegia and dismemberment benefits increased to 100% of Child's applicable principal sum.
DAY CARE BENEFIT RIDER - Included only if Children also covered. Pays 5% of Insured's principal sum to $5,000 maximum for each dependent Child enrolled in day care facility at time of loss (or within 90 days of loss) if Insured dies from a covered accident. $1,000 alternate benefit to Employee's beneficiary if no eligible Children.
REHABILITATIVE SERVICES BENEFIT - Included for all Insured Persons. Pays 5% to $5,000 maximum after a $250 deductible, for losses incurred for rehabilitative services (when the Insured is totally disabled) within 52 weeks of the date of the covered accident.
- "Injuries" means accidental bodily injuries received while coverage is in force and resulting independently of sickness and all other causes.
- "Seat Belt" means any factory-installed passive restraint device or any child passive restraint device which meets published federal safety standards.
- "Total Disability" means that period during which you receive medical treatment and are unable to engage in any gainful work or service which you are reasonably qualified by education, training or experience.