1 What s not covered? This policy does not cover loss caused by or resulting from: 1. Suicide, a suicide attempt, self-destruction or an attempt to self-destroy while sane or insane. 2. Declared or undeclared war or an act of either. 3. Sickness or disease, except pyogenic infections that occur through an accidental cut or wound (the sickness or disease exclusion does not apply to the Emergency Medical Evacuation Benefits of the Repatriation of Remains Benefits). 4. Service in the armed forces of any country (orders to active military service for 2 months or less shall not constitute service in the armed forces). 5. Air Travel except as described under air travel coverage. 6. Riding in or boarding or alighting from any aircraft owned, operated, chartered or leased by or on behalf of the Holder unless a specific written agreement has been obtained from Us to provide such coverage. 7. Riding in or boarding or alighting from any vehicle or device for aerial navigation as a pilot or crew member. 8. Intentionally self-inflicted Injury while sane or insane. 9. Participation in an illegal occupation or attempt to commit a felony. 10. Any heart, coronary or circulatory malfunction. Beneficiary Assist Offered Through ComPsych At no additional cost, you, your beneficiary or family members have access to professional counseling up to 5 working sessions or equivalent professional time with a grief counselor, financial or legal advisor. Beneficiary Assist is available for up to one year after a loss. Enrolling is easy. Simply indicate your option on your flex form enrollment sheet. You may enroll as a new hire when you become eligible or only during an annual enrollment period. Proof of coverage will be forwarded to you along with other necessary documents. You may change coverage from employee to family when first acquiring a dependent (spouse or child); otherwise, you may change coverage only during an annual enrollment period. Voluntary Accidental Death & Dismemberment Insurance (VAD&D) for Faculty and Staff of Nevada System of Higher Education 1 The Hartford is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company, Hartford Life and Accident Insurance Company, and Hartford Life Group Insurance Company. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the issuing companies listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.
2 A fatal injury occurs every five minutes and a disabling injury every 1.6 seconds (National Safety Council Report on Injuries in America 2003). Nevada System of Higher Education is committed to providing you and your family with valuable voluntary accidental death and dismemberment (VAD&D) insurance at affordable rates through The Hartford. 1 Only your policy can give you the actual terms of your coverage, but we ve summarized the basic elements of your employer s plan. Please read this information to help in choosing the coverage amounts that fit your needs. Who is eligible for coverage? All regular members of the faculty and staff employed half time or more. Your lawful spouse or domestic partner and your unmarried Dependent Child who is 18 years of age or younger and who is dependent upon You for support and maintenance. Your AD&D insurance amounts. Regardless of how much other coverage you have, you are free to select your own benefit up to the maximum amount. Amounts over $150,000 may not exceed 10 times your salary. Your benefit amount will be a percentage of your selected benefit depending on your age on the date of loss: Age on Date of Loss Selected Principal Sum Age 69 or younger 100% % % % 85 and older 15% Example: If you enrolled in the plan at age 55 and selected a benefit amount of $100,000, your selected benefit amount would reduce to $65,000, if loss occurred at age 70. Your choice of individual or family coverage. When you enroll, your eligible family members are guaranteed acceptance too. Your spouse and all unmarried, dependent children under age 19 (or 25 if attending school full-time) can be insured for a portion of your benefit amount for a small additional monthly cost. A person may not be insured as both an employee and a dependent. An eligible dependent child may not be insured as a dependent child of more than one employee. Your spouse will be covered for 60% of your benefit amount, or 50% if you have eligible children. Each of your eligible children will be insured for 20% of your benefit amount, if there is no insured spouse or 15% if there is an Insured spouse. Accidental death benefits If you die as a result of a covered accident within 365 days of its occurrence, your Group Accident Coverage will pay your beneficiary your full benefit amount. $100,000 of family coverage for a monthly cost equal to that of one movie ticket! Employee coverage costs $.29 for each $10,000 of Benefit Amount Sum selected by the employee. Family coverage costs $.50 for each $10,000 of Benefit Amount Sum selected by the employee. Some examples of benefit amounts and corresponding monthly costs are shown below: Principal Sum* Employee Coverage Family Coverage $ 10,000 $.29 $.50 20, , , , , , , , , *Amounts over $150,000 may not exceed 10 times your salary. Rates and/or benefits may be changed on a class basis.
3 How are benefits paid? Benefits will be paid for specific losses caused by a covered accident within 365 days of its occurrence, as below: Loss of: % of Principal Sum Payable* Life 100% Two Members 100% One Member 50% Speech 50% Hearing in both ears 50% Thumb & index finger of same hand 25% Member means hand, foot or eye. Loss of hand or foot means complete severance through or above the wrist or ankle joint. Loss of sight means irrecoverable loss of vision. Loss of speech and hearing in both ears must be irrecoverable. Fingers must be completely severed or above the third joint. A benefit is not payable for both loss of thumb and index finger on same hand, and loss of one hand or injury to the same hand as a result of any one accident. In no event will benefits payable under this provision due to the same accident exceed the applicable Principal Sum. The dismemberment amount for children is 50% of the employees amount. Air travel coverage. You are paid for any covered loss you suffer as a passenger (but not as a pilot or crew member) on any aircraft used for the transportation of passengers, including those suffered while boarding of deplaning such aircraft. Coverage while riding in an aircraft owned, operated, or leased by (or on behalf of) your employer must be agreed to in writing by the insurance company. Additional benefits. Here are just a few of the additional benefits this coverage provides: Common Disaster Benefit If while covered under the family plan, you and your insured spouse both suffer loss of life due to covered injuries caused by the same accident or separate accidents which occur with 24 hours of each other, we will increase the Principal Sum for your insured spouse to equal yours, provided you both suffer loss of life within 90 days of the accident. Paralysis Benefit If, because of a covered injury to the spinal cord and beginning within 365 days after the date of the accident, you or an insured family member sustain Hemiplegia, Paralegia or Quadriplegia, we will pay in one sum the stated percentage of your benefit amount shown in the Schedule below. This benefit is payable provided the Paralysis has lasted 12 consecutive months. Schedule Uniplegia.25% Hemiplegia 50% (Total paralysis of upper and lower limbs on one side of the body) Paraplegia.50% (Total paralysis of both lower limbs) Triplegia.75% Quadriplegia 100% (Total paralysis of all four limbs) In no event will the Paralysis Benefit plus any Accidental Death, Dismemberment exceed the insured person s benefit amount because of the same accident. Paralysis must be determined by competent medical authority to be permanent, complete and irreversible. When does coverage end? As long as the plan is in force, you are an eligible employee and you pay your premium, your coverage remains in effect. Your family members will remain insured as long as they are eligible, you are covered and their premium is paid. Handicapped children shall remain insured, regardless of age, as long as they continue to be handicapped and your coverage remains in force.
4 Safe Driving Benefit Your benefit amount will be increased by 10% not to exceed $25,000, if you or an insured family member suffer a covered loss as a result of an accident while: 1. wearing a seat belt; and 2. driving or riding in a vehicle driven by a driver who is not under the influence of drugs or alcohol. Vehicle means a passenger car, station wagon, van or truck. Seat belt means those belts that form a restraint system and include properly used infant and child restraint systems. Covered family member benefit amounts will increase based on the Family Plan benefit formula. Education Benefit If your eligible dependent children are covered under the program on the date of an accident which resulted in your loss of life and for which benefits were payable, an additional 5% of your benefit amount not to exceed $7, will be paid to each child enrolled as a full-time student in a university, college or trade school, or who is in the 12 th grade and enrolls in such an institution within 365 days after your death. This benefit will be paid for each consecutive year an insured child continues his or her education on a full-time basis, up to four years. If none of your children meet the requirements above or if you have no children, your beneficiary will receive in one lump sum, an amount equal to $3, Spouse Retraining Benefit If loss of life benefits are payable as the result of a covered injury to an insured whose eligible family members are covered under the policy on the date of the accident, the following benefit will also be payable. We will pay a Spouse Retraining Benefit for the insured s spouse who, on the date of the accident, was not employed in an income producing occupation and who, as a result of the accident, must seek employment on a full-time basis. This benefit is payable provided the spouse is enrolled as a full-time student for the purpose of preparing for employment, within one-year after the insured s death in: A. A School for Higher Learning; or B. Vocational Training The Spouse Retraining Benefit will be payable one time in an amount equal to 3% of the insured s principal sum or $5,000, whichever is less. It will be paid to the Spouse immediately upon our receipt of satisfactory proof that the above requirements have been met. School for Higher Learning means an educational institution above the 12 th grade level. It includes, but is not limited to, any state university, junior college or trade-vocational school. In-Hospital Accident Indemnity The plan also provides in-hospital accident coverage if you or your dependents (if Family Plan option is selected) are confined to a hospital for more than 3 consecutive days. The monthly benefit is equal to 1% of the Principal Sum of the hospitalized person subject to a minimum benefit of $100 per day up to a maximum of $2,000. This benefit will continue for a period of up to one year as long as you are confined in a hospital. If hospital confinement is less than a full month, the benefit will be prorated on the basis of a thirtyday month. If hospitalization ends and then reoccurs within 60 days it will be considered a continuation. If longer than 60 days, it is a new claim.
5 Day Care Benefit If loss of life benefits are payable as the result of a covered Injury to You or Your insured spouse and Your eligible dependent children are covered under the policy on the date of the accident, one of the following benefits will also be payable. We will pay a Day Care Benefit for each of the insured dependent children who: a. is under age 7; and b. is attending a Day Care Center; or c. will be attending a Day Care Center within one year after You or Your insured spouse s death. The Day Care Benefit will be payable each year for each dependent child who continues to be enrolled in a Day Care Center following You or Your spouse s death. The benefit payable for each such year is the lesser of: $3,000; or 3% of You or Your spouse s Principal Sum, whose death is the basis of the claim. It is payable until the earlier of: 1) the child attains age 7; or 2) a maximum of 4 Day Care Benefit payments have been made. Payments will be made in accordance with the Payment of Claims provision immediately upon Our receipt of satisfactory proof that the above requirements have been met. If there are no dependent children who qualify under 1 above, We will pay in one lumpsum 3% of the applicable Principal Sum, subject to a maximum of $3,000 to Your beneficiary. Day Care Center means a center of child care which: a. holds a license as a day care center, or is operated by a licensed day care provider, if required; or b. if licensing is not required, operates primarily for the care of children on a daily basis of 12 months a year; and c. is operated in a private home, school or other facility; and d. a charge is customarily made for the care provided. Coma Benefit When an employee (or family member) suffers a covered injury resulting in a coma, a monthly benefit will be paid if the coma: occurs within 3 days of the accident and continues for 6 successive months; and is diagnosed by a competent medical authority to be permanent, complete and irreversible. The Coma Benefit is equal to 1% of the employee s Principal Sum, and is payable monthly beginning with the 7 th continuous month that the employee (or family member) remains in a coma, and ceases after being paid for 100 months, or until the amount of the Principal Sum is reached for the employee for family members whose injury is the basis for the claim. If the employee (or family member) dies during the period of time the benefits are payable, and before an amount equal to the applicable Principal Sum has been paid, the remaining unpaid benefit will be paid in one lump sum. Disappearance Your full benefit amount will be paid to your beneficiary if you are not found within one year of the disappearance, sinking, or wrecking of a conveyance in which you were riding when a covered accident occurred. Exposure to the elements If you are exposed to the elements as the result of an accident and suffer any loss otherwise covered under the policy, your benefits will be payable. Extended Dependents Coverage Upon receipt of due written proof of your accidental death while your coverage is in force, we will waive the payment of any premium becoming due for your insured family members until the earliest of the following dates at which time all insurance shall terminate: (1) the remarriage of your spouse; (2) the policy is terminated; (3) the coverage dependent ceases to be a dependent; (4) twelve (12) months after your death.
6 Conversion Privilege You and your insured family members may apply for a conversion policy of accidental death and dismemberment insurance if insurance under the policy terminates for any reason except: (1) non-payment of premium; or (2) when the terminated coverage is replaced within 31 days by similar coverage sponsored or arranged by your employer. Contact your employer for details. Emergency Medical Evacuation Benefit* If medical evacuation is required for you, or an insured family member, due to injury or sickness while traveling outside your country of domicile, then up to $30,000 for reasonable expenses incurred is payable. Reasonable expenses include: (1) immediate transportation to the nearest hospital where appropriate medical treatment can be obtained; (2) after treatment in a local hospital, transportation to your home or a hospital in your home country; and (3) medical services and supplies needed during the evacuation. The evacuation must be ordered by an attending physician who certifies the severity of the condition warrants evacuation. Transportation must be by the most direct and economical route which is medically appropriate. Sickness Exclusion Deletion and Coverage Provision With respect to Travel Care Benefits only, the sickness or disease exclusion does not apply. Benefits are payable for a sickness or disease which first starts and the symptoms of which are first manifested while an insured person s coverage is in force. Insured Person Residing Outside His or Her Country During the 30 days after you, or an insured family member take up residence outside your country of principal domicile, Travel Care Benefits apply regardless of whether or not you are away from the foreign residence. Therefore coverage applies only while on a trip of over 150 miles from the foreign residence. Coordination of Benefits Travel Care Benefits shall be reduced by amounts payable under: (1) other group insurance or an HMO plan; (2) Workers Compensation or occupational disease act or law; and (3) any government health plan. Companion Travel Benefit* If you, or an insured family member, are hospitalized due to injury or sickness while traveling outside your country of domicile, then economy air fare is payable for: (1) returning dependent children under age 16 to your home (if necessary, services of a nonfamily escort is also covered); (2) returning a travel companion home who forfeited their return air fare due to the medical emergency; and (3) one round trip of one family member or one friend to visit the hospitalized person if hospitalization lasts longer than 10 days. Repatriation of Remains Benefit* If you, or an insured family member, die while outside the country of your principal domicile then up to $7,500 for reasonable expenses incurred is payable. Reasonable expenses include (1) documentation and authorization from the authorities; (2) embalming or cremation; (3) an appropriate coffin or urn design for transportation of mortal remains to burial place in your home country. Transportation must be by the most direct and economical route. *Offered through Worldwide Assistance Services, Inc.
7 Continuation of Medical Coverage Funding Benefit Provision If loss of life benefits are payable as the result of a covered injury to you and if your eligible family members are insured persons on the date of the accident, one of the following two benefits will also be payable. 1. Benefit Paid in Three Equal Annual Payments We will pay a benefit for continuation of the Insured Person s medical coverage pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). This benefit will be paid in three equal annual payments. Each payment will equal the lesser of: A. 3% of the Insured s Principal Sum; or B. $3,000. However, before we make the first payment and before we make each of the next two payments, we must receive proof that the payment will be used for continuation of the Insured Person s medical coverage pursuant to COBRA. Payment will be made immediately upon our receipt of such proof. If proof is not provided for a particular payment, we will make neither that annual payment nor the subsequent annual payment(s). Payments will be made to the Insured Person who is your spouse on the date of the accident. If there is no such Insured Person, payments will be made to or on behalf of your dependent children who are Insured Persons on that date. 2. Benefit Paid in a Single Sum If proof for the first payment under 1) above is not provided, we will pay to your beneficiary one payment equal to the lesser of A. or B. defined in 1) above. Payment will be made at the end of the period permitted by COBRA for election of continuation of medical coverage. No other payments will then be made pursuant to this provision