1 Basic Accidental Death & Dismemberment Insurance November 2009 Introduction This information booklet insert has been prepared to give you an informal summary of the main features of your accidental death & dismemberment insurance program. This insert is not an insurance policy and does not grant or confer any contractual rights. All rights under this program shall be governed by the provisions of the master policy and by applicable law. Eligibility All full-time, regular part-time employees must be covered for accidental death & dismemberment insurance which provides coverage 24 hours per day while actively employed by the University worldwide travelling or at home on or off the job in an amount equal to 3 times annual earnings rounded to the next higher $1,000, if not already a multiple thereof (principal sum), to a maximum of $300,000. Commencing at age 61 this maximum decreases $20,000 per year to age 65 and $30,000 per year thereafter to a minimum of $50,000 at age 70. This same level of coverage is available for employees of Associated Employers / Grantholders. However, agreement to pay 100% of the cost must be provided before coverage is extended. Other Part-Time Employees and Employees of Associated Employers of Grant Holders Other part-time employees grant paid, temporary and casual employees including students, are enrolled in the accidental death & dismemberment insurance program which provides coverage in the amount of $25,000 (principal sum) 24 hours per day while actively employed by the University worldwide travelling or at home on or off the job. Beneficiary Your Loss of Life benefit shall be payable to the beneficiary or beneficiaries designated under your Basic Group Life Insurance Program, or if there is no such beneficiary designation, the benefit shall be payable to your Estate. All other indemnities payable will payable to you, with the exception of indemnities payable under the following sections: Repatriation Education Day-Care Occupational Training Family Transportation Identification.
2 Definitions Wherever used in this booklet: "Policy" means the Group Policy # which is on file with the Policyholder. "You" and "Your", means the Eligible Employee who is employed with the Policyholder. We, Us, The Insurer and AXA Assurances means AXA Assurances Inc. "Injury" means bodily injury caused by an accident occurring while your coverage is in force under the Policy, and resulting directly and independently of all other causes in Loss covered by the Policy, 24 hours a day, anywhere in the world. "Policyholder" means Dalhousie University, a member of Interuniversity Services Inc. "Insured Person" means an Employee insured under the Policy. "Declared War" means a hostile contention by means of armed forces carried on between nations, states or rulers or between citizens in the same nation or state. "Undeclared War" means a hostile contention by means of armed forces carried on between nations, states or rulers or between citizens in the same nation or state, the activities of which were made without public or solemn declaration. An undeclared war should not be confused with a riot as a riot does not take into account the lawfulness of its purpose and the manner it was performed. Whereas, a war (declared or undeclared) can not exist between political units unless one of them has its own government that will take responsibility for the actions taken with respect to the rules of war as governed by any acts, treaties, laws or any similar legislation designed for the purpose. "Terrorism" means the systematic use of terror committed by a person or group of persons in order to intimidate a population or government into granting his / their demands. "Spouse" means an individual under the age of 70; a) to whom you are legally married, b) with whom you have continuously cohabited and who has been publicly represented as your spouse for a minimum of one year immediately before a Loss is incurred under the Policy. Only one individual will qualify as a spouse. If you are legally married but also cohabiting with an individual as described under section (b) above, the Spouse will be the individual to whom you are legally married. "Member of the Immediate Family", means a person at least 18 years of age, who is your spouse, son, daughter, father, mother, brother, sister, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, sister-inlaw, (all of the above include natural, adopted or step relationship), grandson, granddaughter, grandfather or grandmother. "Hospital" means an institution licensed as a hospital, which is open at all times for the care and treatment of sick and injured persons, has a staff of one (1) or more Physicians available at all times and which continuously
3 provides twenty-four (24) hour nursing service by graduate registered nurses. It provides organized facilities for diagnostics and surgery, is an active treatment hospital and not primarily a clinic, rest home, nursing home, convalescent hospital or similar establishment. For the purposes of this definition, hospital will include a facility or part of a facility used for rehabilitative care. "Regular Care and attendance" means observation and treatment to the extent necessary under existing standards of medical practice for the condition causing the confinement. "Physician" means a doctor of medicine (other than the Insured Person or a Member of the Immediate Family) who is licensed to practise medicine by: 1) a recognized medical licensing organization in the locale where the treatment is rendered, provided he is a member in good standing of such licensing body, or 2) a governmental agency having jurisdiction over such licensing in the locale where the treatment is rendered. "Accommodation" means lodging in the vicinity of the Hospital where the Insured Person is confined. The male pronoun will be construed as the feminine when the person is a female. Benefits Specific Loss Accident Indemnity When Injury results in any of the following losses within three hundred and sixty-five (365) days after the date of the accident, the Insurer will pay: For Loss Of: Life Entire sight in one eye Speech Hearing in on ear All toes of one foot For Loss or Loss of Use of: One arm One leg One hand One foot Thumb and index finger or at least four fingers For total Paralysis of: Both upper and lower limbs (Quadriplegia) Both lower limbs (Paraplegia) Upper and lower limbs of one side (Hemiplegic) Amount Payable ½ x ¼ x 1/3 x 2 x 2 x 2 x "Loss" as used above with reference to: hand or foot: means the complete severance through or above the wrist or ankle joint, but below the elbow or knee joint; arm or leg: means the complete severance through or above the elbow or knee joint; thumb: means the complete severance of one entire phalanx of the thumb; finger: means the complete severance of two entire phalanges of the finger;
4 toe: means the complete severance of one entire phalanx of the big toe and all phalanges of the other toes; eye: means the irrecoverable loss of the entire sight thereof; speech: means the complete and irrecoverable loss of the ability to utter intelligible sounds; hearing: means the complete and irrecoverable loss of hearing; quadriplegia, paraplegia, and hemiplegic: means the complete and irreversible paralysis of such limbs; loss of use: means the total and irrecoverable loss of use, provided the loss is continuous for 12 consecutive months and such loss of use is determined to be permanent at the end of such period. Indemnity provided under this section for all Losses sustained by any one Insured Person as the result of any one accident will not exceed the following: a) with the exception of quadriplegia, paraplegia and hemiplegic, the Principal Sum. b) with respect to quadriplegia, paraplegia and hemiplegic, Two Times the Principal Sum, or the Principal Sum if Loss of Life occurs within 90 days after the date of the accident. In no event will indemnity provided under this section exceed Two Times the Principal Sum for all Losses sustained by an Insured Person as the result of the same accident. Repatriation* If you sustain accidental Loss of Life not less than 50 kilometers from your normal place of residence and indemnity for such Loss becomes payable under this program, we will pay the reasonable and customary expenses actually incurred for the transportation of your body to the first resting place (including but not limited to a funeral home or the place of interment) in proximity to your normal place of residence. The repatriation benefit up to $10,000 will be paid for expenses incurred for the return home of your body (including charges for the preparation of the body for such transportation). Education** If you sustain accidental loss of life and indemnity for such loss becomes payable in accordance with the terms of this Program, we will pay the Education Benefit stated below for each of your Dependent Children for education expenses provided the child is: 1) already enrolled full-time in a post-secondary institution as defined in the province, territory or country of residence; or 2) at a secondary school level but will enroll, as a full-time student in a post-secondary education program within 365 days of your accidental death. This benefit is equal to the reasonable and necessary expenses actually incurred for each Dependent Child, subject to a maximum of 5% of your Principal Sum or $5,000, whichever is less, for up to 4 consecutive years. This benefit will be paid each year immediately upon receipt of satisfactory proof that your child is enrolled as a full-time student in an institution for higher learning, but payment will not be made for expenses incurred prior to your death, nor for room, board or other ordinary living, travelling or clothing expenses. If your Dependent Child satisfies the above requirements, any benefits payable will be paid to such child. "Institution for higher learning" includes any university, college, CEGEP or trade school. "Dependent Children" mean persons who are either your legitimate or illegitimate children, adopted children, step-children or children who are in a parent-child relationship with the Insured Person. The children are unmarried, under 25 years of age and dependent upon the Insured Person for maintenance and support.
5 Day Care* If you sustain Accidental Loss of Life and indemnity for such Loss becomes payable in accordance with the terms of this Program, we will pay the Day-Care Benefit stated below for each of your Dependent Children who: (1) are enrolled in a Day-Care Centre on the date of such Loss; or (2) will enroll in a Day-Care Centre within three hundred and sixty-five (365) days after the date of your death. This benefit is equal to the reasonable and necessary expenses actually incurred, subject to a maximum of 5% of your Principal Sum or $5,000, whichever is less, for each year your Dependent Child is enrolled in a Day-Care Centre, but not to exceed 4 years, which must run consecutively, with respect to any one Dependent Child. This benefit will be paid each year immediately upon receipt of satisfactory proof that your child is enrolled in a Day-Care Centre, but payment will not be made for expenses incurred prior to your death, nor for room, board or other ordinary living, travelling or clothing expenses. In the event that your Dependent Child does satisfy the requirements indicated above, the Day-Care Benefit will be payable to your surviving Spouse if your Spouse has custody of the child. If there is no surviving Spouse or your child does not reside with your Spouse, benefits payable under this provision will then be paid to your child's guardian who has been legally appointed to manage the person of the child. If none of your Dependent Children satisfy the requirements as shown under either the section entitled Education Benefit or this section, we will pay an amount equal to 5% of your Principal Sum or $2,500, whichever is less, under one of the policies issued to the your Employer by AXA Assurances to your beneficiary. The following definitions are applicable only to this benefit: "Day-Care Centre" means a facility which is operated according to law, including laws and regulations applicable to day-care facilities and which provides care and supervision for children in a group setting on a regular basis. Day-Care Centre will neither include a hospital, the child's home or care provided during normal school hours while a child is attending grades one (1) through twelve (12). "Dependent Children" mean persons that are either legitimate or illegitimate children, adopted children, stepchildren or children who are in a parent-child relationship with you. The children are under 13 years of age and dependent upon you for maintenance and support. Rehabilitation* If you sustain an injury which results in a Loss payable under the section entitled Specific Loss Accident Indemnity under this program and such injury requires that you participate in a rehabilitation program in order to be qualified to engage in an occupation in which you would not have engaged except for such injury, the Insurer will pay the reasonable and necessary expenses actually incurred within 3 years from the date of the accident to a maximum of $10,000. No payment will be made for room, board or other ordinary living, travelling or clothing expenses. Occupational Training* If you sustain accidental loss of Life and indemnity for such loss becomes payable in accordance with the terms of this program, we will pay the reasonable and necessary expenses actually incurred, within 3 years from the date of your accidental death, by your spouse who engages in a formal occupational training program in order to become specifically qualified for active employment in an occupation for which your spouse, would not otherwise have sufficient qualifications, up to a maximum of $10,000 for all such expenses. No payment will be made for room, board or other ordinary living, travelling or clothing expenses. If your spouse satisfies the requirements stated above, it is presumed that your spouse is the beneficiary.
6 Permanent Total Disability The Principal Sum is payable in a lump sum, less any other amounts paid or payable under the Specific Loss Accident Indemnity as a result of the same accident, if you become totally disabled and the following conditions are met: 1) The disability results from an Injury occurring prior to age 65. 2) The disability commences within 365 days of the accident. 3) The disability prevents you from engaging in each and every occupation or employment for compensation or profit for which you are reasonably qualified by education, training or experience. 4) The disability has continued for 12 consecutive months, remains total and is deemed to be permanent at the end of such period. Family Transportation* If any Specific Loss covered under the Specific Loss Accident Indemnity confines you as an inpatient in a hospital or if any other Injury confines you to a hospital for 4 days and such hospital is located at least 150 kilometers from your residence, this benefit will refund expenses incurred by any Member(s) of your Immediate Family for hotel accommodation and transportation (via the most direct route) to your bedside, to a maximum of $1,000. Private transportation expenses are limited to $0.20 per kilometer travelled. Payment is not made for board or other ordinary living, travelling or clothing expenses. Identification* If you sustain accidental Loss of Life, and the police require the identification of the body by a Member of the Immediate Family, and indemnity for Loss of Life subsequently becomes payable under the Policy, we will refund expenses incurred by such family member for: 1. lodging and board (up to a maximum of 3 consecutive nights) while en route and/or during the stay in the city or town where the body is located, and 2. transportation via the most direct route to this location, provided this location is not less than 150 km from the family member's usual residence. Private transportation expenses are limited to $0.20 per km travelled and the total maximum refundable for all expenses is limited to $5,000. Payment will not be made for ordinary living, travelling or clothing expenses other than stated above. Seat belt** If, at the time of the accident, you are wearing a properly fastened seat belt and driving or riding in a vehicle driven by a driver who has a valid driver s license and who was neither intoxicated nor under the influence of drugs (unless taken as prescribed by a physician), and a loss becomes payable under the Specific Loss accident indemnity, the applicable amount of principal sum will be increased by 10% for those wearing a seat belt. Due proof of Seat Belt use must be provided as part of the written proof of loss. "Intoxicated" and "being under the influence of drugs" is as defined by the jurisdiction in which the accident occurs.
7 "Seat Belt" means those belts that form a restraint system and includes infant and child restraint systems when properly used with a Seat Belt. "Vehicle" means a passenger car, station wagon, van, jeep-type automobile or truck. Home Alteration and/or Vehicle Modification* If you sustain the Loss of or Loss of Use of Both Feet or Legs or become Quadriplegic, Paraplegic or Hemiplegic, for which indemnity becomes payable under the Policy, and you subsequently require the use of a wheelchair to be ambulatory, we will refund the reasonable and necessary expenses actually incurred during the 3 year period following the accident, to a maximum of $10,000 per accident; (a) for the cost of alterations to your principal residence for the purpose of making it accessible and/or; (b) the cost of modifications to one motor vehicle utilized by yourself, when such modifications are approved by licensing authorities where required, for the purpose of making it wheel chair accessible. The amount payable under this section will be coordinated with any amount paid or payable under any other insurance plan providing the same or similar benefit. Hospital Indemnity** If any Loss covered under the "Specific Loss Schedule" section of the Policy confines you to a Hospital and you are under the Regular Care and Attendance of a Physician, you will receive a daily benefit of 1/30th of 1% of your Principal Sum from the 1st day of hospitalization, up to a maximum of $2,500 per month and for a maximum duration of 365 days per accident. Hospitalization required for treatment of any Injury other than for a Specific Loss is also covered in accordance with the above terms, provided such hospitalization begins within 365 days of the date of the accident which caused the Injury and insurance is in force. The daily benefit is payable from the 1st day of hospitalization if the Insured Person is hospitalized for at least 4 days. Hospitalization is either a single uninterrupted confinement in a Hospital or several successive confinements in a Hospital as a result of the same accident, provided each such confinement is separated by a period of less than 183 days. All confinements must occur within 365 days of the date of the accident. Only one hospitalization, as defined above, will be payable for all Injuries sustained by the Insured Person as the result of the same accident. Cosmetic Disfigurement If you or an Insured Dependent suffer cosmetic disfigurement due to a burn, the Insurer will pay the Cosmetic Disfigurement benefit provided that such burn is classified as a third degree burn. The amount of benefit payable under this section is based on the percentage of the Principal Sum, as shown in the Cosmetic Burn Schedule below, which is determined by the Area Classification factor times the percentage of body surface actually burned. Maximum allowable percentage for body surface burned, as shown in the following Cosmetic Burn Schedule, is based on 100% of the specific body part being burned. The attending physician will determine the actual percentage applicable to each burn. If you suffer burns to more than one body part as a result of any one accident, benefits payable for all such burns will not exceed 100% of the Principal Sum.
8 Cosmetic Burn Schedule: Maximum Allowable Maximum % of Area Classification % of Body Surface Body Part Factor Burned Payable Face, Neck, Head % 99.9% Hand & Forearm (Right) 5 4.5% 22.5% Hand & Forearm (Left) 5 4.5% 22.5% Upper Arm (Right) 3 4.5% 13.5% Upper Arm (Left) 3 4.5% 13.5% Torso (Front) % 36.0% Torso (Back) % 36.0% Thigh (Right) 1 9.0% 9.0% Thigh (Left) 1 9.0% 9.0% Lower Leg below knee (Right) 3 9.0% 27.0% Lower Leg below knee (Left) 3 9.0% 27.0% In the event benefits are payable under this section and the sections entitled Specific Loss Accident Indemnity or Permanent Total Disability, the total benefits payable will not exceed 100% of the Principal Sum (or 200% for Paralysis). NOTE: Benefits marked with an asterisk (*) are only payable under one of the policies issued to the Employer by AXA Assurances. Benefits marked with 2 asterisks (**) are payable under all other policies with similar benefits issued to the Employer by AXA Assurances subject to the maximum amount stated in the policies. Occupation Coverage All active faculty and staff members, research assistants, teaching assistants, temporary and casual employees, employees of Grantholders are insured for the following benefits if any injury is sustained while performing the normal and regular duties which pertain to their occupation. Occupation means each and every occupation or employment assigned by the Policyholder that you are engaged in for wage or profit on the date of the accident. If injury results in any of the following losses within 365 days after the date of the accident, the plan provides the following benefits: Amputations Proximal third of humerous or disarticulation of shoulder 70% Middle third of humerus 65% Distal third of humerus of biceps Insertion 60% Biceps insertion to wrist 60% Immobility of Joints Shoulder, without either articular or scapula movement 35% Shoulder joint (gleno humeral) ankylosed but with full scapular movement 15% Shoulder, abduction limited to 90 degrees but with good rotation and pivotal movement 5% Elbow 25% Wrist 15% Pronation and supination complete in mid-position 10% Pronation alone lost 3% Supination alone lost 5%
9 Denervation Median, complete at elbow 40% Median, complete at wrist 20% Ulnar, complete at elbow 10% Ulnar, complete at wrist 8% Radial, complete at elbow 25% Chart 1 - Thumb or Single Finger See schedule for two fingers Chart 2 - Two Fingers (one and one half times the sum of the single values) Index & Middle as Distal 5.4% Index & Ring at Distal 4.8% Index & Little at Distal 4.2% Middle & Ring at Distal 4.2% Ring & Little at Distal 3.0% Index & Middle at PIP 10.8% Index & Ring at PIP 9.6% Index & Little at PIP 8.4% Middle & Ring at PIP 8.4% Middle & Little at PIP 7.2% Ring & Little at PIP 6.0% Index & Ring at Metacarpal 13.5% Index & Ring at Metacarpal 12.0% Index & Little at Metacarpal 10.5% Middle & Ring at Metacarpal 10.5% Middle & Little at Metacarpal 9.0% Ring & Little at Metacarpal 7.5% Chart 3 Three Fingers (Twice the Sum of the Single Values) Index & Middle with Ring at Distal 9.6% Index & Middle with Little at Distal 8.8% Index & Ring with Little at Distal 8.0% Index & Middle with ring at PIP 7.2% Index & Ring at PIP 19.2% Index & Little at PIP 17.6% Ring & Little at PIP 16.0% Index & Middle at Metacarpal 14.4% Index & Ring at Metacarpal 24.4% Middle & Ring at Metacarpal 22.0% Middle & Little at Metacarpal 20.0% Ring & Little at Metacarpal 18.0% Chart 4 - Four Fingers Index & Middle with Ring at Distal 14.0% Index & Middle with Little at Distal 28.0% Index & Ring with Little at Distal 35.0%
10 Amputations Hip disarticular or short stump requiring an ischial bearing prosthesis 65.0% Thigh, site of election 50.0% End bearing knee or short below knee stump not suitable for a conventional below knee prosthesis 45% Leg, suitable for below knee prosthesis 35.0% Leg, at ankle, end bearing 25.0% Through foot 10 to 25% All toes 6.5% Toe, great 2.5% Toe, great at distal 1.0% Toe, other than great, each 1.0% Immobility of Joints Hip 30.0% Knee 25.0% Knee, flexion limited to 90 degrees 5.0% Ankle 12.0% Great toe, both joints 2.5% Great toe, distal joint 0.5% Shortening of Leg Up to 2 cm 1.5% Up to 5 cm 6.0% Up to 8 cm 15.0% Denervation Peroneal, complete 12.0% Foot drop, complete 12.0% Indemnity provided under this section will not be paid under any circumstances for more than one (1) of the Losses, the greatest, sustained for multiple injuries to the same limb by any one (1) person as the result of any one (1) accident in combination with the section entitled Specific Loss Accident Indemnity. Aircraft Coverage You are covered while riding as a passenger, but not as a pilot, operator or member of the crew, in any aircraft provided the aircraft has a current and valid certificate of airworthiness and is flown by a licensed pilot. You are also covered while flying as a passenger in any military aircraft and when boarding or alighting from or struck by any aircraft. Exposure and Disappearance If, by reason of an accident covered by this program, you are unavoidably exposed to the elements and such exposure results in a covered Loss, such Loss will be covered. If you are not found within one year of the disappearance, sinking or wrecking of a conveyance in which you were riding at the time of the accident, it will be presumed you have suffered Loss of Life resulting from bodily Injury caused by an accident. When does insurance coverage stop? Your insurance coverage will stop on the earliest of the following dates:
11 1) on the date the Policy is terminated. 2) on the premium due date if the Policyholder fails to pay your premiums to The Insurer, except as the result of an inadvertent error. 3) on June 30 th following attainment of age 65; 4) on the date you cease to be associated with the Policyholder in a capacity making you eligible for insurance hereunder; 5) on the date you cease to be an active employee, on account of leave of absence, lay-off, maternity leave, disability, resignation, dismissal, pension or retirement, except as provided under the following sections: Waiver of Premium Continuation of Coverage During Approved Leaves If your insurance should stop, you can still file a claim under the policy for losses arising from an accident, which occurred prior to the termination date, subject to the terms and provisions of the policy. Waiver of premium Provided you have been approved for Waiver of Premium and remain eligible for such under the terms and conditions of your Employer's Group Long Term Disability Insurance policy, you need not pay any further premiums under this program, while you remain disabled, until the earliest of the following dates: (1) you reach age 65; (2) you cease to be totally disabled. All terms and provisions of the Policy apply during the period premiums are waived, including provisions relating to reductions in amounts of insurance. Notwithstanding anything contained to the contrary in the Policy, benefits payable for any Loss which occurs while this clause is in effect cannot exceed the amount of insurance payable on the commencement date of your disability. Continuation of coverage If, under your Basic Group Life Insurance program, your life insurance is continued during any approved leave of absence, temporary lay-off, maternity leave, or disability leave, coverage under this program will also be continued, provided payment of premium is continued. All terms and provisions of the Policy apply during the period of the leave, including provisions relating to reductions in amounts of insurance. Notwithstanding anything contained to the contrary in the Policy, benefits payable for any Loss which occurs while this clause is in effect cannot exceed the amount of insurance payable on the commencement date of your leave. Retirement If you retire prior to age 65, coverage may be continued for you, until you reach age 65, provided payment of premium is continued. Subject to payment of premiums, coverage may be continued after you reach your 65th birthday, subject to the following:
12 (1) Your Principal Sum will be limited to a maximum of $100,000; (2) Paralysis benefits will not exceed 100% of the Principal Sum; and (3) Your coverage will terminate when you reach your 70th birthday. Note: Your insurance cannot be increased after the date you retire. On or after the date of retirement, your amount of insurance may not be increased and Permanent Total Disability is not applicable. This Retirement provision is contingent upon your Basic Group Life Insurance remaining in force after the date of retirement. Exclusions The program does not cover any Loss, fatal or non-fatal, caused or contributed to by: 1) intentionally self-inflicted injury while sane or self-inflicted injury while insane; 2) declared or undeclared war or any act thereof within Canada, the United States of America and countries designated as Zones: A1, A2, A3 and B in the war zone listing provided by the Insurer; War zone coverage for Zones A1, A2, A3 and B is available upon request prior to each departure date. The following information must be provided to the Insurer in order to obtain the additional cost: a) Name of Employee b) Amount of Principal Sum c) Country of destination d) Duration of trip 3) active full-time service in the armed forces of any country; 4) riding as a passenger or otherwise in any vehicle or device for aerial navigation, other than as provided in the section entitled "Aircraft Coverage". In the event of claim You or your beneficiary must notify the Policyholder. In the case of claim, written notice of Injury must be given to AXA Assurances within 30 days after the date of the accident and written proof of Loss must be furnished to them within 90 days after the date of such Loss. Failure to furnish such notice or proof within such time shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such notice or proof and that such notice or proof was furnished as soon as was reasonably possible, but in no event later than one year after the date of the accident. This booklet is your outline of the coverage held under the Basic program of Accidental Death and Dismemberment Insurance and should be retained for reference. The group master Policy # sets forth in detail the terms and conditions of the program and all rights and obligations are determined in accordance with the Master Policy, not this booklet. For exact provisions of coverage, please contact your Human Resources Department. S:\Human_Resources\EB\EB Share\EB_SHARE\BENEFITS\Benefit Documents\New Benefit package\basic AD&D.doc
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Student Accident Insurance for Ontario Pharmacists Association JMT/CGD 1. PLAN DESIGN Coverage Coverage is applicable to any injury sustained while participating in the work experience program sponsored
YOUR GROUP LIFE INSURANCE PLAN For Employees of University System of New Hampshire 6CC000 Class I B-12270 11-12 E-Book CONTENTS CERTIFICATION PAGE............................................. 1 SCHEDULE
Voluntary Term Life, Voluntary Personal Accident Insurance Overview Prepared for the employees of Westminster College Voluntary Term Life Insurance Coverage paid by you What would happen to your family
Manitoba Public School Employees Group Life Insurance Plan Financial protection for every member of your family What could be more important? WELCOME Welcome to the Manitoba Public School Employees Group
Visa Inc. MetLife Life and AD&D Insurance Plan Summary of Benefits for Employees Effective January 1, 2013 MetLife Life and AD&D Insurance Plan 1 Table of Contents BENEFITS UNDER THE LIFE AND AD&D PLAN...
Voluntary Term Life Insurance Overview Prepared for the employees of The Columbus Organization Voluntary Term Life Insurance Coverage paid by you What would happen to your family if you and your income
YOUR GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS Tooele City Corporation All Eligible Full-Time Regular Active Employees IMPORTANT INFORMATION THIS IS A NONPARTICIPATING POLICY PLEASE READ
YOUR GROUP PERSONAL ACCIDENT INSURANCE PLAN For Employees of Etiwanda School District 6CC000 CSEBA Account 33 B-14973 6-14 Elec CONTENTS OUTLINE OF COVERAGE........................................... 1
QMA LIFE INSURANCE Program Apply Now! Complete the application provided, and mail to: Québec Medical Association 380 1000 Saint-Antoine de la Gauchetière West West Suite 3200 660 Montréal Montreal (Québec)
TRAVEL ACCIDENT INSURANCE SUMMARY PLAN DESCRIPTION February 2014 Travel Accident Insurance Summary Plan Description for Oak Ridge Associated Universities Principle Address: P.O. Box 117 Oak Ridge, TN 37831-0117
Basic & Voluntary Term Life, Basic & Voluntary Personal Accident Insurance Overview Prepared for the employees of Hardy Diagnostics Basic Term Life Insurance Coverage paid by your employer What would happen
YOUR GROUP LIFE INSURANCE PLAN For Employees of North Dakota Public Employees Retirement System 6CC000 B-13092 (01-14) CONTENTS CERTIFICATION PAGE............................................. 1 SCHEDULE
HEAD OFFICE : TORONTO BRANCHES: MONTREAL, VANCOUVER ACCIDENT INSURANCE PLAN AIG Insurance Company of Canada having issued POLICY NO. SRG 902 9942-A General The Accidental Death and Dismemberment Plan provides
HCC LIFE INSURANCE COMPANY 225 TownPark Drive, Suite 145 Kennesaw, GA 30144-5509 GROUP TERM LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT POLICY Non-Participating This is a legal contract between the Policyholder
PERSONAL ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PROGRAM For Employees of Member Colleges of Accidents are the 5 th leading cause of death among people of all ages. In the United States alone, each
YOUR GROUP LIFE INSURANCE PLAN For Employees of Five Colleges 6CC000 B-13192 05-12 CONTENTS CERTIFICATION PAGE............................................. 1 SCHEDULE OF BENEFITS...........................................
Term Life and AD&D Insurance Employee Benefit Booklet JEFFERSON COUNTY COMMISSION F019105-0001 Class 1-01 and 1-02 Products and services marketed under the Dearborn National brand and the star logo are
24/7 PERSONAL ACCIDENT COVERAGE CYCLING BC PROGRAM INFORMATION!! 24 /7 PERSONAL ACCIDENT COVERAGE Page! 2 24 /7 Personal Accident Insurance (Worldwide Coverage) 24/7 Personal Accident Insurance coverage
Stand Alone Accidental Death and Dismemberment Program Description of Benefits When to Use this Product When you need ultimate flexibility to choose desired AD&D coverage benefits When customization of
Basic & Voluntary Term Life, Basic & Voluntary Personal Accident Insurance Overview Prepared for the employees of Lane Community College Basic Term Life Insurance Coverage What would happen to your family
Optional Accidental Death And Dismemberment Insurance For Employees Participating In OEBB Plans Standard Insurance Company Optional Accidental Death And Dismemberment Insurance About This Brochure This
Public Employees Benefits Agency Public Employees Group Life Insurance Plan Table of Contents INTRODUCTION...2 ELIGIBILITY...3 Employer Responsibility Enrolment Spouse Dependent Child BENEFITS...5 Basic
Personal Accident Insurance Plan ACCIDENTAL DEATH and DISMEMBERMENT COMA BENEFITS COMMON DISASTER CONVERSION PRIVILEGE DAY CARE BENEFIT EDUCATION BENEFITS PERMANENT TOTAL DISABILITY REHABILITATION BENEFIT
BASIC LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT UNDERWRITTEN BY LIFEWISE ASSURANCE COMPANY This summary of benefits explains the key features of your Group Life and AD&D benef its. The contrac t between
YOUR GROUP LIFE INSURANCE PLAN For Employees of Harford County Public Schools ReliaStar Life Insurance Company P.O. Box 20 Minneapolis, MN 55440-0020 LC00GP B-11595 03-09 (3,000) TABLE OF CONTENTS CERTIFICATION
YOUR GROUP LIFE INSURANCE PLAN For Employees of Baldwin County Commission 6CC000 B-13072 (8-11) CONTENTS CERTIFICATION PAGE............................................. 1 SCHEDULE OF BENEFITS...........................................
YOUR GROUP LIFE INSURANCE PLAN 6CC000 B-14307 12-13 (E-Book) CONTENTS CERTIFICATION PAGE............................................. 1 SCHEDULE OF BENEFITS........................................... 2
Accidental Death & Dismemberment (AD&D) Lowe's Accidental Death & Dismemberment (AD&D) provides life insurance coverage for accidental death anywhere in the world, on or off-the-job, on business, on vacation,
Policyholder: Linfield College Voluntary Term Life Benefit Summary Effective Date: 04/01/2015 This chart provides you a brief summary of the key benefits of the life coverage available from Principal Life
YOUR GROUP LIFE INSURANCE PLAN For Employees of Hendricks Community Hospital 6CC000 B-11654 (50) 10-08 CONTENTS CERTIFICATION PAGE............................................. 1 SCHEDULE OF BENEFITS...........................................
STANDARD INSURANCE COMPANY A Stock Life Insurance Company 900 SW Fifth Avenue Portland, Oregon 97204-1282 (503) 321-7000 CERTIFICATE GROUP LIFE INSURANCE Policyholder: Colorado Employer Benefit Trust (CEBT)
YOUR GROUP LIFE INSURANCE PLAN For Employees of Lincolnshire Prairie View School District 103 Class IV - Full-time Staff 6CC000 NIHIP Account 31 B-12602 11-14 Elec CONTENTS CERTIFICATION PAGE.............................................
Personal Accident Insurance Developed for the Employees of Texas Association of Business Member Firms 817762 a 06/12 Who Needs Personal Accident Insurance? You do. Accident insurance can help you pay expenses
Adobe Systems Incorporated Liberty Life Assurance Company of Boston Life and Accidental Death and Dismemberment Certificate of Coverage Class 2 Effective January 1, 2013 This summary is part of, and is
Term Life and Accident Insurance Developed for the Employees of ABC Company Protecting Your Family Securing Your Future "As long as you've got your health..." If you're physically healthy, you can work,
Business Travel Accident Insurance Business Travel Accident at a Glance 1) The Teradyne Business Travel Accident (BTA) Insurance Plan covers you when you are travelling on company business. Any benefits
State of Louisiana Employee Term Life Coverage Accidental Death and Dismemberment Coverage Dependents Term Life Coverage Foreword We are pleased to present you with this Booklet. It describes the Program
Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122 CERTIFICATE OF COVERAGE Policyholder...Georgia Bankers Association Policy Number...GSR 11061 Division, Subsidiary or Affiliate
Voluntary Accidental Death and Dismemberment (AD&D) Insurance For Employees of The California State University Standard Insurance Company Voluntary AD&D Insurance About This Brochure This booklet is designed
Employee Group Benefits UNDERWRITTEN BY SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK Marist College GROUP POLICY NUMBER - 810015 POLICY EFFECTIVE DATE - 93C-LH-NY Welcome to Sun Life Insurance and
LIFE & ACCIDENT INSURANCE CERTIFICATE BOOKLET GROUP INSURANCE FOR MONROE CO COMMUNITY COLLEGE SCHOOL NUMBER 704 TEACHERS The benefits for which you are insured are set forth in the pages of this booklet.
December 31, 2011 to April 1, 2012 1 1 December 31, 2011 to April 1, 2012 2 2 Canadian Cycling Association Insurance Program January 1, 2011 to January 1, 2012 Medical Payments: Non Members Exclusion Endorsement:
Voluntary Group Accidental Death & Dismemberment Insurance 0159298 American Foreign Service Protective Association Voluntary Group Accidental Death & Dismemberment Insurance Plan Protect the Ones You Love
NRECA Group Term Life and AD&D Insurance Plan SUMMARY PLAN DESCRIPTION For: BIG COUNTRY ELECTRIC COOPERATIVE 01-44163-001 EFFECTIVE DATE: January 1, 2013 Introduction This document is a Summary Plan Description
Life and Accident Coverage Your Life and Accident Insurance benefits are designed to provide financial security for your survivors in the event of your death, and for you, in case of accidental dismemberment,