Designation of Beneficiary
When you enroll for coverage through ProvConnect you will see a space for naming a beneficiary(ies) for your Basic Employee Life and AD&D Insurance coverage. You may change your beneficiary(ies) at any time by updating ProvConnect. The beneficiary may be one person or several people or your estate. If you are married, a spousal consent form may be required as part of your beneficiary designation.
Before deciding on beneficiaries, you may wish to contact your attorney for advice. If you do not name a beneficiary, any Basic Employee Life and AD&D benefit payable would be made in accordance with a line of succession specified in the insurance contract.
You may contact the HR Service Center for an
Benefits
Your Basic Employee Life and AD&D Insurance death benefit will be payable to your designated beneficiary upon satisfactory proof that your death occurred while you were insured. (Payment for AD&D benefits if you are injured are payable to you.) Your beneficiary will receive details about payment options when you die.
If death or dismemberment due to a covered accident (see page 10-1 for exclusions) occurs within 365 days of an accident to an insured individual, the Plan pays benefits as follows:
Loss Benefit Payable
Life 100% of Coverage Amount
Loss of speech and hearing 100% of Coverage Amount
Brain damage 100% of Coverage Amount
Loss of any combination of hand, foot, or sight of one eye
100% of Coverage Amount
●Loss of hand
●Loss of foot
●Loss of sight in one eye
50% of Coverage Amount
●Loss of an arm
●Loss of a leg
75% of Coverage Amount
Paralysis of both upper and lower
limbs (quadriplegia)
100% of Coverage Amount
Paralaysis of both lower limbs
(paraplegia)
50% of Coverage Amount
Paralysis of both upper & lower
limbs on one side (hemiplegia)
50% of Coverage Amount
Paralysis of one arm or leg 25% of Coverage Amount
Loss of speech or loss of hearing 50% of Coverage Amount
Loss of thumb & index finger of same hand
25% of Coverage Amount
Coma 1% of Coverage Amount
per month to a maximum of 60 months
No more than the elected amount will be paid for all losses sustained by an insured individual while the group policy is in effect.
Coverage If Totally Disabled
If you become totally and permanently disabled while insured before age 60, the amount of your Basic Employee Life Insurance in force at that time will be continued by your employer until age 65. When you turn 65, you may convert your coverage. Filing Claims
To file a claim, your beneficiary should contact the HR Service Center.
Termination of Insurance
Your Insurance will cease at the end of the month in which you are no longer benefits-eligible, terminate employment or are no longer a member of eligible group, serve more than 30 days full-time active duty in any armed forces, the premium is not paid when due, or the group policy is terminated. Conversion
If your group coverage stops for any reason other than non-payment of the premiums when due, you have 31 days to convert your group coverage to an individual policy. This conversion benefit allows you to convert coverage to an individual policy (any permanent life insurance policy that the insurance company is then offering) up to the current certificate amount without having to give evidence of insurability. The permanent policy you receive will not include waiver of premium benefits or other supplementary benefits available under the group policy. If the Master Group policy or the employer’s participation terminates, only a limited conversion benefit will be available.
coverage, loss means:
● with regard to hand or foot, complete
severance through or above the wrist or ankle joint;
● loss of an eye means total and irrecoverable loss of sight;
● loss of speech means complete inability to communicate audibly in any degree;
● loss of hearing which cannot be corrected by any hearing aid or device;
● loss of thumb and index finger means
severance of each through or above the joint closest to the wrist.
Paralysis
Paralysis means loss of use, without severance of a limb. This loss must be determined by a physician to be complete and not reversible.
Paraplegia
Paralysis of the lower half of the body. Plan Year
The 12-month period beginning January 1 and ending December 31.
Quadriplegia
Paralysis of all four limbs. Severance
Severance means complete separation and dismemberment of the limb from the body.
Chapters
Accident
An unforeseen and unavoidable event resulting in an injury which is not due to any fault of the covered person.
Adult Benefit Recipient See page 1-1
Beneficiary
The person(s) or other entity you designate to receive your life insurance, accidental death & dismemberment insurance, and Business Travel Accident insurance benefits if you die.
Dependent
See page 1-1 and page 9-1 Hemiplegia
Total or partial paralysis of one side of the body. Imputed Income
The assessed value of your Basic Life Insurance which is subject to tax, based on your age and amount of coverage, is called imputed income. Your employer is required to calculate your imputed income for Basic employee coverage over $50,000 using an IRS table. (The value of Supplemental Life Insurance price tags is not considered imputed income because premiums are paid on an after-tax basis.) Taxable amounts will be shown annually on your W-2 statement.
Limb