| Accidental Death & Dismemberment Ins. |
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| Plan Description and Documents |
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| Notice |
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This Web page presents summary information only. Any error or omission here is unintentional and will be resolved in favor of plan documents or applicable federal or state law or rule. See plan documents for details.
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| Eligibility |
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All PEBB-eligible employees may purchase accidental death and dismemberment (AD&D) insurance coverage for themselves and their eligible dependents.
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| Premium Rates |
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2009 Accidental Death and Dismemberment Premium Rates
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Amount
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Employee
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Employee & Dependents
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$50,000
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$1.00
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$1.70
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$100,000
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$2.00
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$3.40
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$150,000
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$3.00
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$5.10
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$200,000
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$4.00
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$6.80
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$250,000
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$5.00
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$8.50
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$300,000
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$6.00
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$10.20
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$350,000
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$7.00
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$11.90
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$400,000
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$8.00
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$13.60
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$450,000
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$9.00
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$15.30
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$500,000
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$10.00
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$17.00
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| Description of Benefits |
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The AD&D plan provides 24-hour coverage for accidental loss of life, limb, hand, foot, hearing, speech, sight or thumb and index finger (of the same hand). You may select a coverage amount from $50,000 to $500,000, in increments of $50,000.
Employee coverage
The amount of coverage you select for yourself (the principal sum) is payable as follows:
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100 percent of the principal sum is paid for the following accidental losses:
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Life
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Both hands or both feet or sight of both eyes
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Or any two or more of the following accidental losses:
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One hand or one foot
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One hand or one foot and sight of one eye
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Speech and hearing.
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50 percent of the principal sum is paid for the following accidental losses:
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Sight of one eye
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One hand or one foot
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Speech or hearing
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25 percent of the principal sum is paid for accidental loss of thumb and index finger of either hand.
When a claim is filed on a dependent, the payable benefit is equal to a percentage of your employee AD&D insurance as follows:
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Spouse or domestic partner only — 50 percent
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Children only — 15 percent for each child
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Spouse or domestic partner and children — 40 percent for spouse or partner, 15 percent for each child.
The maximum benefit payable for all losses caused by the same accident will not be more than the principal sum.
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| Tax Treatment |
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For the AD&D insurance program, payroll deducts the monthly premium after taxes. However, any benefit dollars you receive through this benefit are not taxed.
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| Contact the plan |
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Contact The Standard Insurance at: (800) 628-8600, or visit their web site.
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