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$15,000
ACCIDENTAL DEATH AND DISMEMBERMENT COVERAGE FACT
SHEET
This
is a description of the coverage and plan features
associated with this benefit. This coverage does
not require any contribution.
EFFECTIVE
DATE OF COVERAGE:
All PEF Members are automatically covered. New
employees must be in a PEF represented position
for 6 months and a dues paying member to be eligible
for coverage. If you happen to be both disabled
and away from work on the date your coverage would
take effect, the coverage will not take effect
until you return to full-time work for one full
day.
COVERAGE:
A benefit is payable if, while insured you suffer
a bodily injury in an accident and if within 90
days after the accident, you lose as a direct
result of the injury:
-
Your life
-
A hand, at or above the wrist joint.
-
A foot, at or above the ankle joint.
-
An eye, involving irrecoverable and complete
loss of sight in the eye.
BENEFITS:
Your full Principal Sum is payable for loss of
life.
Half your Principal Sum is payable for: loss of
a hand, loss of a foot or loss of an eye.
No more than your full Principal Sum is payable
for all losses which result from one accident.
LIMITATIONS:
Benefits are paid for losses caused by accident
only. No benefits are payable for a loss caused
or contributed to by:
-
Bodily or mental infirmity.
-
Disease, ptomaines
or bacterial infections. *
-
Medical or surgical treatment. *
-
Suicide or attempted suicide.
-
Intentionally self-inflicted injury.
-
War or any act or war (declared or undeclared).
*
These do not apply if the loss is caused by:
· An infection which results directly from the
injury.
· Surgery needed because of the injury.
TERMINATION
OF COVERAGE:
Coverage will terminate at the first to occur
of:
Continuation During Leave of Absence
or Layoff:
-
Members on leave of absence will have their
coverage continued for up to 6 months. The member
must be able to document state approval for the
leave of absence and maintain their PEF membership
while on leave.
-
Members subject to layoff on a preferred list
will have their coverage continued for up to six
months per layoff. The extension will be in force
once the affected members have furnished evidence
of being laid off to the Membership Benefits Program's
office within 60 days of the last day worked for
the State.
BENEFICIARIES:
In the event of the death of an insured person
occurring under the terms of this policy the death
benefits shall be paid in the following order:
1. To spouse, if living
2. If no spouse, in equal shares to the children
3. If no children, in equal shares to the parents.
4. If no parents, in equal shares to siblings.
5. If no siblings, to the estate.
If
the beneficiaries are minors, or cannot give a
valid release, payment will be provided to the
duly appointed guardian or committee.
You
may name or change your beneficiary by filing
a written request at the Membership Benefits Program's
Office. The naming or any change will take effect
as of the date you execute the request.
REPORTING
OF CLAIMS:
A claim must be submitted to Hartford in writing
through the Membership Benefits Program. It must
give proof of the nature and extent of the loss.
The Membership Benefits Program has the proper
claim forms.
All
claims should be reported promptly. The deadline
for filing a claim for any benefits is 90 days
after the date of loss causing the claim. If,
through no fault of your own, you are unable to
meet the deadline for filing claim, your claim
will still be accepted if you file as soon as
possible. Otherwise late claims will not be covered.
REDUCTION
RULE FOR ACTIVE MEMBERS:
Your Accidental Death and Dismemberment Coverage
will be reduced to 60% upon attainment of age
70.
REDUCTION
RULE FOR RETIRED MEMBERS:
Your Accidental Death and Dismemberment Coverage
will terminate at retirement.
IMPORTANT
While every precaution was taken to accurately
report your benefits, discrepancies or errors
are possible. In case of a discrepancy between
this report and the actual plan document, the
actual plan document will prevail.
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