| ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PLAN This accidental death and dismemberment insurance plan provides financial protection for your beneficiary(ies) by paying a benefit in the event of your death or for you in the event of any other covered loss. The amount you or your beneficiary(ies) receive(s) is based on the amount of coverage in effect just prior to the date of your death or any other covered loss according to the terms and provisions of the plan. EMPLOYER'S ORIGINAL PLAN
EFFECTIVE DATE: January 1, 2009 POLICY NUMBER: 139604 001 ELIGIBLE GROUP(S): Group 1
Assessors in active employment in the United States with the Employer Group 2
Chief Deputy Assessors in active employment in the United States with the Employer Group 3
All Employees not eligible in another group earning greater than $30,000 annually in active employment in the United States with the Employer Group 4
All Employees earning $20,000 to $30,000 annually in active employment in the United States with the Employer Group 5
All Employees not eligible in another group earning less than $20,000 annually in active employment in the United States with the Employer
MINIMUM HOURS REQUIREMENT: Employees must be working at least 35 hours per week.
WAITING PERIOD: For employees in an eligible group on or before January 1, 2009: 30 days of continuous active employment For employees entering an eligible group after January 1, 2009: 30 days of continuous active employment
REHIRE: If your employment ends and you are rehired within 1 year, your previous work while in an eligible group will apply toward the waiting period. All other policy provisions apply.
WHO PAYS FOR THE COVERAGE: Your Employer pays the cost of your coverage.
ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT: AMOUNT OF ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE FOR YOU (FULL AMOUNT) Group 1
$200,000 Group 2
$150,000 Group 3
$75,000 Group 4
$50,000 Group 5
$20,000
AMOUNT OF ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE AVAILABLE IF YOU BECOME INSURED AT CERTAIN AGES OR HAVE REACHED CERTAIN AGES WHILE INSURED If you have reached age 70, your amount of AD&D insurance will be:
- 50% of the amount of AD&D insurance you had prior to age 70; or
- 50% of the amount of AD&D insurance shown above if you become insured on or after age 70. There will be no further increases in your amount of AD&D insurance. REPATRIATION BENEFIT FOR YOU Maximum Benefit Amount: Up to $5,000 The Repatriation Benefit is separate from any accidental death and dismemberment benefit which may be payable. To receive the Repatriation Benefit, your accidental death benefit must be paid first. SEATBELT(S) AND AIR BAG BENEFIT FOR YOU Benefit Amount: Seatbelt(s): 10% of the Full Amount of your accidental death and dismemberment insurance benefit. Air Bag: 5% of the Full Amount of your accidental death and dismemberment insurance benefit. Maximum Benefit Payment: Seatbelt(s): $25,000
Air bag: $5,000 The Seatbelt(s) and Air Bag Benefit is separate from any accidental death and dismemberment benefit which may be payable. To receive the Seatbelt(s) and Air Bag Benefit, your accidental death benefit must be paid first. EDUCATION BENEFIT Each Qualified Child Benefit Amount per Academic Year for which a Qualified Child is enrolled: 6% of the Full Amount of the employee's accidental death and dismemberment insurance to a maximum of $6,000. Maximum Benefit Payments: 4 per lifetime Maximum Benefit Amount: $24,000 Maximum Benefit Period: 6 years from the date the first benefit payment has been made. The Education Benefit is separate from any accidental death and dismemberment benefit which may be payable. In order for your Qualified Child to receive the Education Benefit, your accidental death benefit must be paid first. EXPOSURE AND DISAPPEARANCE BENEFIT FOR YOU Maximum Benefit Amount: The Full Amount
SOME LOSSES MAY NOT BE COVERED UNDER THIS PLAN. OTHER FEATURES: Portability
The above items are only highlights of this plan. For a full description of your coverage, continue reading your certificate of coverage section. |
