Accidental Death and Dismemberment (AD&D)

You may buy coverage under the Accidental Death and Dismemberment (AD&D) Insurance Plan. This coverage provides a benefit to help you and your family financially if you should die in an accident or become dismembered.

Coverage Options
You can buy one of five coverage options under the Accidental Death and Dismemberment (AD&D) Insurance Plan:

$ 50,000
$100,000
$150,000
$200,000
$250,000
No Coverage

If you lose . . .	This percentage of the coverage amount is paid...
Your life	100%
Two hands, two feet, or your eyesight	100%
Hearing and speech	100%
All feeling in both upper and lower limbs (that is, you become quadriplegic)	100%
One hand, one foot, or your sight in one eye	50%
Hearing or speech	50%
All feeling in both legs (that is, you become paraplegic)	50%
All feelings in upper and lower limbs on one side of your body (that is, you become hemiplegic)	50%
Your thumb and index finger of the same hand	25%

Who Can Be Covered
You can choose coverage on:

Associate only: Yourself
Associate Plus Family: Yourself, your legally married spouse or domestic partner; your and your legally married spouse’s unmarried children from age 14 days up to the end of the calendar year in which they attain age 19, the end of the month in which they attain age 25 if they are enrolled as full-time students; or the end of the month in which they are no longer enrolled as full-time students. Coverage may be kept in force for any child who reaches the age limit and meets the handicapped requirements established by the insurance plan. Application and documentation of handicapped status must be provided prior to the cancellation date that normally occurs for dependent children. Continuation of coverage is not activated until approval is made by the benefit plan or it's designee. For definition of domestic partner see Your Eligibility for Health Alliance Benefits.

The amount of coverage on your spouse or domestic partner and eligible dependents is shown below:

If you have a spouse or domestic partner and eligible dependents
- You: 100%.
- Your spouse or domestic partner: 40% of your coverage amount.
- Each eligible dependent: 10% of your coverage amount.
If you have eligible dependents but no spouse or domestic partner
- You: 100%.
- Each eligible dependent: 15% of your coverage amount.
If you have a spouse or domestic partner but no eligible dependents
- You: 100%.
- Your spouse or domestic partner: 50% of your coverage amount.

Beneficiary
You are the beneficiary for benefits paid for dismemberment of yourself or a family member or the covered death of a family member. You can choose anyone to be the beneficiary on your accidental death coverage. That beneficiary will receive your plan benefit if you die through covered accidental causes while you are covered by the plan.

You will need to fill out the appropriate beneficiary section on your benefits enrollment form or complete a Change in Beneficiary Designation form when you wish to make a change. You can change your beneficiary at any time.

Cost of Coverage
You pay the full cost of AD&D coverage. The cost of coverage for a legally married spouse and dependent children is deducted on a before-tax basis from every bi-weekly paycheck during the covered period. If the coverage includes a domestic partner, a notarized Declaration of Domestic Partnership form must be submitted and the cost will be deducted on an after-tax basis. Refer to the cost of coverage for the premium amounts.

Note: This benefit is available to you and your eligible dependents through age 69