Rehabilitation During a Period of Disability - If the insurance company determines that you are a suitable
candidate for rehabilitation, the insurance company may require you to participate in an assessment and
rehabilitation plan, not to exceed 18 months. A rehabilitation plan may consist of educational, vocational or
physical rehabilitation or may include modified work or work on a part-time basis. If you refuse such assistance
without good cause (a medical reason preventing participation, in whole or in part, in the rehabilitation plan),
insurance under this plan will end.
When Your Coverage Begins and Ends
Coverage becomes effective on the later of the program’s effective date, the date you become eligible, the date
we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. Your
coverage will not begin unless you are actively at work on the effective date. Dependent coverage will not begin
for any dependent who on the effective date is hospital or home confined; receiving chemotherapy or radiation
treatment; or disabled and under the care of a physician. Coverage will continue while you and your dependents
remain eligible, the group policy is in force, and required premium paid.
Conversion - If group life coverage ends (except due to nonpayment of premium), your employment is
terminated, membership in an eligible class is terminated, or insurance coverage is reduced based on attained
age, you can convert to an individual non-term policy. To convert, you must apply for the conversion policy and
pay the first premium payment within 31 days after your group coverage ends. Dependents may convert their
coverage as well. Premiums may change at this time, and terms of coverage will be subject to change.
Portability - If your employment is terminated and you are under age 70, you can continue your [employee-paid]
life insurance on a direct-bill basis. Coverage may also be continued for your spouse/children. Premiums will
increase at this time. Coverage can be continued to age 70, unless the insurance company terminates portability
for all insured persons. Refer to your certificate for details.
Exclusions: Voluntary life insurance will not be paid if you commit suicide, while sane or insane, within the first two
years of coverage
Other Voluntary Accidental Death & Dismemberment (AD&D) Insurance Coverage Features
A Valuable Combination of Benefits
Survivors of severe accidents will be paid an additional benefit according to the chart below.
If, within 365 days of a covered accident, bodily injuries result in:
We will pay this % of the benefit amount:
Total paralysis of upper and lower limbs, or Loss of any combination of two:
hands, feet or eyesight, or Loss of speech and hearing in both ears
Total paralysis of both lower or upper limbs
Total paralysis of upper and lower limbs on one side of the body, or
Loss of hand, foot or sight in one eye, or Loss of speech or loss of
hearing in both ears, or Severance and Reattachment of one hand or foot
Total paralysis of one upper or lower limb, or Loss of all four fingers of the
same hand, or Loss of thumb and index finger of the same hand
Loss of all toes of the same foot
Only one benefit (the largest) will be paid for losses from the same accident.
Additional Benefits of Voluntary Accidental Death & Dismemberment Insurance
For Wearing a Seatbelt & Protection by an Airbag - Additional 10% benefit but not more than $25,000 if the
covered person dies in an automobile accident while wearing a seatbelt or approved child restraint. We will
increase the benefit by an additional 5% but not more than $12,500 if the insured person was also positioned in
a seat protected by a properly-functioning and properly deployed Supplemental Restraint System (Airbag).
For Comas - You will receive 1% of the full benefit amount each month, for up to a maximum of 11 months, if you
or an insured family member are in a coma for 30 days or more as a result of a Covered Accident. If the covered
person is still in a coma after 11 months, or dies, the full benefit amount will be paid
For Exposure & Disappearance - Benefits are payable if you or an insured family member suffer a covered loss
due to unavoidable exposure to the elements as a result of a Covered Accident. If your or an insured family
Rev. 6/2015
