Group Accidental Death & Dismemberment

Your lawful spouse,¹ and dependent child(ren) under age 25, are also eligible to enroll. Child(ren) coverage varies by state. Please see your Certificate of Insurance for details.

Family coverage features a spouse benefit of 40% of the insurance amount (total benefit) you have selected for yourself and 5% for each child. If there are no children, the insurance amount for your spouse will be 50% of your insurance amount. If children, but no spouse, the insurance amount for each child will be 10% of your insurance amount.

Minimum Spouse Benefit Amount: $10,000
Maximum Spouse Benefit Amount: $125,000

Minimum Child(ren) Benefit Amount: $1,250
Maximum Child(ren) Benefit Amount: $25,000

¹Wherever the term “spouse” appears, unless otherwise specified, also includes your domestic partner.

If an injury is directly and independently caused by a covered accident that occurs while coverage is in force for you, your spouse or dependent child, and it results in any of the following losses within 365 days of that accident, the following will be payable (subject to exclusions). All amounts listed are stated as percentages of the full amount of coverage:

Loss of life	100%
Loss of any combination of hand, foot, or sight of one eye, as defined above	100%
Loss of speech and loss of hearing	100%
Paralysis of both arms and both legs	100%
Brain damage	100%
Loss of an arm permanently severed at or above the elbow	75%
Loss of a leg permanently severed at or above the knee	75%
Loss of a hand permanently severed at or above the wrist but below the elbow	50%
Loss of a foot permanently severed at or above the ankle but below the knee	50%
Loss of sight in one eye	50%
Loss of speech or loss of hearing	50%
Paralysis of both legs	50%
Paralysis of the arm and leg on either side of the body	50%
Loss of the thumb and index finger of same hand	25%
Paralysis of one arm or leg	25%
Coma: 1% monthly beginning on the 7th day of the coma for the duration of the coma to a maximum of 60 months

Loss of sight means permanent and uncorrectable loss of sight in the eye. Visual acuity must be 20/200 or worse in the eye or the field of vision must be less than 20 degrees. Loss of thumb and index finger of same hand means that the thumb and index finger are permanently severed through or above the third joint from the tip of the index finger and the second joint from the tip of the thumb. Loss of speech means the entire and irrecoverable loss of speech that continues for six consecutive months following the accidental injury. Loss of hearing means the entire and irrecoverable loss of hearing in both ears that continues for six consecutive months following the accidental injury. Paralysis means loss of use of a limb, without severance. A Physician must determine the paralysis to be permanent, complete and irreversible. Brain damage means permanent and irreversible physical damage to the brain causing the complete inability to perform all the substantial and material functions and activities normal to everyday life. Such damage must manifest itself within 30 days of the accidental injury, require a hospitalization of at least five days and persists for 12 consecutive months after the date of the accidental injury. Coma means a state of deep and total unconsciousness from which the comatose person cannot be aroused. Such state must begin within 30 days of the accidental injury and continue for seven consecutive days.

Monthly Rates per $1,000 of Coverage
Member Only	$0.04
Family (Spouse & Children)	$0.06
Rates shown are unisex.

For loss of your life, we will pay benefits to your beneficiary. For any other loss sustained by you, or for any loss sustained by a dependent, we will pay benefits to you.

If you or a dependent sustain more than one covered loss due to an accidental injury, the amount we will pay, on behalf of any such injured person, will not exceed the full amount of coverage.

If you and any dependent die within a 24-hour period, we will pay the benefit to your beneficiary or we may pay your estate. If a beneficiary is a minor, or is incompetent to receive payment, we will pay that person’s guardian.

If you and your spouse are injured in the same accident and die within 365 days as a result of injuries in such accident, the amount we will pay for your spouse’s loss of life will be increased to equal the full amount payable for your loss of life.

SEAT BELT USE BENEFIT

If you or a dependent die as a result of an accidental injury, we will pay this additional Seat Belt Use Benefit if: we pay a benefit for loss of life; this benefit is in effect on the date of the injury; and we receive proof that the deceased person was in an accident while driving or riding as a passenger in a passenger car; was wearing a seat belt which was properly fastened at the time of the accident; and died as a result of injuries sustained in the accident.

Benefit Amount
The Seat Belt Use Benefit is an additional benefit equal to 10% of the full amount of coverage. However, the amount we will pay for this benefit will not be less than $1,000 or more than $25,000.

AIR BAG USE BENEFIT

If you or a dependent die as a result of an accidental injury, we will pay this additional benefit if: we pay a benefit for loss of life; this benefit is in effect on the date of the injury; and we receive proof that the deceased person was in an accident while driving or riding as a passenger in a passenger car equipped with an air bag(s); was riding in a seat protected by an air bag; was wearing a seat belt which was properly fastened at the time of the accident; and died as a result of injuries sustained in the accident.

Benefit Amount
The Air Bag Use Benefit is an additional benefit equal to 5% of the full amount of coverage. However, the amount we will pay for this benefit will not be less than $1,000 or more than $10,000.

COMMON CARRIER BENEFIT

If you or a dependent die as a result of an accidental injury, we will pay this additional benefit if: we pay a benefit for loss of life; this benefit is in effect on the date of the injury; and we receive proof that the injury resulting in the deceased’s death occurred while traveling in a common carrier.

Common carrier means a government regulated entity that is in the business of transporting fare paying passengers and does include chartered or other privately arranged transportation, taxis or limousines.

Benefit Amount
The Common Carrier Benefit is the amount equal to the full amount.

If you complete the enrollment process, the insurance will take effect on the date you become eligible.

Your insurance will end on the earliest of: the date the Group Policy ends; the date insurance ends for your class; the date you cease to be in an eligible class; the end of the period for which the last premium has been paid for you; the date you cease to be a member; or the premium due date coinciding with or next following the date you attain age 70.

Massachusetts Residents: If your AD&D Insurance ends for any reason, such insurance will continue for 31 days after the date it ends.

A dependent’s insurance will end on the earliest of: the date all of your AD&D Insurance under the Group Policy ends; the date you die; the date the group policy ends; the date you cease to be in an eligible class; the date insurance for your dependents ends under the Group Policy; the date insurance for your dependents ends for your class; for a spouse, the date the spouse attains age 70; the date the person ceases to be a dependent; for Utah residents, the last day of the calendar month the child ceases to be a dependent; or the end of the period for which the last premium has been paid for the dependent.

In certain cases, insurance may be continued as stated in the Certificate of Insurance.

We will not pay benefits under this section for any loss caused by: physical or mental illness or infirmity, or the diagnosis or treatment of such illness or infirmity; infection, other than infection occurring in an external accidental wound or from food poisoning; suicide or attempted suicide, (if you reside in Missouri the exclusion for “suicide or attempted suicide” is as follows: “suicide or attempted suicide while sane”); intentionally self-inflicted injury; service in the armed forces of any country or international authority. However, service in reserve forces does not constitute service in the armed forces, unless in connection with such reserve service an individual is on active military duty as determined by the applicable military authority other than weekend or summer training. For purposes of this provision reserve forces are defined as reserve forces of any branch of the military of the United States or of any other country or international authority, including but not limited to the National Guard of the United States or the national guard of any other country; any incident related to travel in an aircraft as a pilot, crew member, flight student or while acting in any capacity other than as a passenger; travel in an aircraft for the purpose of parachuting or otherwise exiting from such aircraft while it is in flight; parachuting or otherwise exiting from an aircraft while such aircraft is in flight, except for self-preservation; travel in an aircraft or device used for testing or experimental purposes; by or for any military authority; or for travel or designed for travel beyond the earth’s atmosphere; committing or attempting to commit a felony; the voluntary intake or use by any means of any drug, medication or sedative, unless it is taken or used as prescribed by a physician; or an “over-the-counter” drug, medication or sedative taken as directed; alcohol in combination with any drug, medication, or sedative; or poison, gas, or fumes; war, whether declared or undeclared; or act of war, insurrection, rebellion or active participation in a riot.

We will not pay benefits under this section for any loss if the injured party is intoxicated at the time of the incident and is the operator of a vehicle or other device involved in the incident.

You may designate a beneficiary in your application or enrollment form. You may change your beneficiary at any time. To do so, you must send a signed and dated, written request to the policyholder using a form satisfactory to us. Your written request to change the beneficiary must be sent to the policyholder within 30 days of the date you sign such request.

You do not need the beneficiary’s consent to make a change. When we receive the change, it will take effect as of the date you signed it. The change will not apply to any payment made in good faith by us before the change request was recorded.

If two or more beneficiaries are designated and their shares are not specified, they will share the insurance equally.

If there is no beneficiary designated or no surviving designated beneficiary at your death, we may determine the beneficiary to be one or more of the following who survive you: your spouse, your child(ren), your parent(s), or your sibling(s).

Instead of making payment to any of the above, we may pay your estate. Any payment made in good faith will discharge our liability to the extent of such payment. If a beneficiary or a payee is a minor or incompetent to receive payment, we will pay that person’s guardian.

Any statement made by you will be considered a representation and not a warranty. We will not use such statement to avoid insurance, reduce benefits or defend a claim unless the following requirements are met: the statement is in a written application or enrollment form, you have signed the application or enrollment form, and a copy of the application or enrollment form has been given to you or your beneficiary.

We will not use your statements that relate to insurability to contest AD&D Insurance after it has been in force for two years during your life, unless the statement is fraudulent. In addition, we will not use such statements to contest an increase or benefit addition to such insurance after the increase or benefit has been in force for two years during your life, unless the statement is fraudulent.

You must be completely satisfied with your coverage. Once your application is approved and coverage issued, you’ll receive a Certificate of Insurance. Take up to 30 days² to review it. If you are not completely satisfied, tell us within 30 days. Any premiums paid during this period will be refunded and the coverage will be invalidated, provided there have been no claims.

²20 days North Dakota; 10 days West Virginia