As an APWU member, you are eligible to enroll for Accidental Death & Dismemberment insurance in amounts of $30,000 to $300,000 in increments of $30,000.
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| Special Features |
Speech and/or Hearing
In addition to protection for accidental loss of life and limbs, you are also covered for loss of speech and/or hearing. You receive the full Benefit Amount for the loss of both, and half the Benefit Amount for the loss of one or the other.
Seat Belt Benefit
We will pay an additional accidental death benefit per covered person of up to 10% of the covered person's full benefit amount subject to a maximum of $30,000 if you and/or an insured family member dies within 365 days as a result of a covered accident while driving or riding in a private passenger car equipped with seat belts and the seat belt was in actual use and properly fastened at the time of the accident, as certified in the police accident report.
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| Member Only Plan |
You select your Benefit Amount from the "Benefit Selection and Cost" table. You are eligible regardless of your health history.
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| Family Plan |
If you wish to insure your eligible spouse (under age 80) and/or dependent child/ren under the Family Plan, the amount of insurance applicable to members of the family is based on the composition of the family at the time of loss and is expressed as a percentage of your Benefit Amount as follows:
- At time of loss the family consists of Member & Spouse AND Dependent Child/ren
- Member...100%
- Spouse...40%
- Each Child...10%
- At time of loss the family consists of Member and Spouse but NO Dependent Child/ren
- Member...100%
- Spouse...50%
- At time of loss the family consists of Member and Dependent Child/ren but NO Spouse
- Member...100%
- Each Child...15%
Example: The Member selects $150,000 coverage under the Family Plan. The family consists of the Member, Spouse and Children
Member...$150,000
Spouse...$60,000
Each Child...$15,000
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| The Coverage |
The Plan offers full 24-hour insurance protection against covered accidents anywhere in the world, on or off the job, on business-vacation-at home. While covered, bodily injuries suffered by the insured must be as a direct result and from no other cause than from the covered accidents that results in loss of life. Please be sure to review the enclosed materials for more information on what is and is not covered.
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| The Benefit |
If injuries result in death or dismemberment, within 365 days from the date of a covered accident, which occurs while you are insured, the plan will pay as follows:
Loss of Life..........................................................100%
Loss of two or more hands or feet.....................100%
Loss of sight of both eyes...................................100%
Loss of speech and hearing (in both ears)........100%
Quadriplegia.........................................................100%
Paraplegia.............................................................75%
Hemiplegia.............................................................50%
Uniplegia................................................................25%
Loss of one hand or foot.......................................50%
Loss of sight in one eye........................................50%
Loss of speech......................................................50%
Loss of hearing (in both ears)...............................50%
Loss of thumb and index finger of the same hand..25%
"Loss" means with regard to hand or foot complete severance through or above the wrist or ankle joint; loss of an arm or leg means complete severance through or above the elbow or knee 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 means irrecoverable 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.
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| Benefit Selection And Cost |
| BENEFIT SELECTION AND COST |
| BI-WEEKLY COST |
| FOR MEMBERS UNDER AGE 80* |
Benefit
Amount |
Member
Only |
Family
Plan |
| $30,000 |
$.52 |
$.75 |
| 60,000 |
1.04 |
1.50 |
| 90,000 |
1.56 |
2.25 |
| 120,000 |
2.08 |
3.00 |
| 150,000 |
2.60 |
3.75 |
| 180,000 |
3.12 |
4.50 |
| 210,000 |
3.64 |
5.25 |
| 240,000 |
4.16 |
6.00 |
| 270,000 |
4.68 |
6.75 |
| 300,000 |
5.20 |
7.50 |
*Coverage terminates at age 80
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| Coverage |
The plan offers full 24-hour protection against accidents anywhere in the world, on or off the job, on business-vacation-at home.
While covered, bodily injuries suffered by the insured must be as a direct result and from no other cause than from the covered accident that results in loss of life. Please be sure to review all materials for more information on what is and is not covered.
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| Exclusions |
- No benefits are paid for loss resulting from intentionally self inflicted injury; sickness, disease, or bodily infirmity; commission of a felony; war or act of war, whether declared or not declared; while insured is serving on full time active duty for more than 30 days in any Armed Forces; and air travel by, in or on any device or vehicle except as a passenger in any licensed civilian aircraft or transport aircraft operated by the U.S. Military Airlift Command (MAC) or similar foreign service.
- A complete description of all the exclusions is detailed in the Certificate of Insurance. When you receive your Certificate, please read it carefully for further details on plan exclusions.
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| Who May Apply For Insurance? |
You are eligible if
- You are an active APWU Member in good standing under age 80
- You are in ACTIVE Service with your employer on a full time basis
You may also apply to insure your eligible lawful Spouse (under age 80) and dependent Children.
"Dependent Child" is defined as your unmarried child typically from birth to age 19, (25 years if a full-time student at an accredited school or college) who lives with you and primarily relies upon you for support. (Subject to any state variations).
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| State Availability |
Coverage is not available to residents of the following territories VI, GU & AS.
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| When Coverage Begins |
Your coverage will become effective on the first payday the following written notification the premium is deducted from your paycheck during your lifetime. You must be actively at work on that day, otherwise coverage is effective the day you return to work.
Applicable benefits for your eligible Spouse and Children will also become effective on that pay day.
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| Termination Of Insurance |
The insurance on a Covered Person will end on the earliest date below:
1. the date this Policy or insurance for a Covered Class is terminated;
2. the date this Policy ends;
3. the next premium due date after the date the Covered Person is no longer in a Covered Class or satisfies eligibility requirements under this Policy;
4. the last day of the last period for which a premium is paid;
5. the next premium due date after the Covered Person attains the maximum Age (80) for insurance under this Policy;
6. the next premium due date after the Member ceases to be a Member in good standing;
7. with respect to a Spouse or Dependent Child, the date of the death of the covered Member or the date of divorce from the Covered Member.
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| It's Easy To Enroll |
- Simply complete the enrollment form for the desired benefit amount. Click here for an Insurance form. Please make sure you complete all the information requested. An incomplete enrollment form will be returned, resulting in a delay in processing your enrollment form. You may apply for this benefit over the phone!
- Send no money.
- Return your enrollment form to: The Voluntary Benefits Plan, P.O. Box 1471, Waterbury, CT 06721 or fax to 1-203-754-7847.
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| Any Questions? |
Call the following toll-free number 1-800-422-4492
• TDD 1-203-754-4410
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| Administered By |
The Voluntary Benefits Plan
P.O. Box 1471
Waterbury, CT 06721
Phone: 1-800-422-4492
Fax: 1-203-754-7847
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