Group Retiree Accidental Death & Dismemberment Insurance Plan

What Would Happen If You Had A Serious Accident?

Accidents can happen and they may occur suddenly and unexpectedly. If you should suffer an accident resulting in the loss of life, speech, hearing or dismemberment, would your family have the financial help it needs? Help protect yourself and your family against the unexpected with this economical Accidental Death and Dismemberment coverage, underwritten by New York Life Insurance Company.

Who May Apply?

You are a dues-paying APWU member between the age of 18 and 80. You may also apply to insure your eligible lawful spouse (under age 80) and unmarried dependent children under age 26. Associates are also eligible to apply.

Important Features

Member Only Plan

As a dues-paying APWU member between the age of 18 and 80, you are eligible to enroll for Accidental Death & Dismemberment insurance in amounts of $30,000 to $300,000 in increments of $30,000. PSEs may also apply.

Family Plan

If you wish to insure your eligible spouse and/or Domestic Partner (under age 80) and/or dependent child/ren (under age 26) 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 the covered Member's principal sum amount as follows*:

*See Schedule of Covered Losses for specific details.

  1. At time of loss the family consists of Member & Spouse AND Dependent Child/ren
    • Member...100%
    • Spouse...40%
    • Each Child...10%
  2. At time of loss the family consists of Member and Spouse but NO Dependent Child/ren
    • Member...100%
    • Spouse...50%
  3. 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 $120,000 coverage under the Family Plan. The covered family consists of the Member, Spouse and Children.  If the Member, Spouse or Child suffers a covered loss of life, the following benefits would be paid to that Member, Spouse or Child:

  • Member...$120,000
  • Spouse...$48,000
  • Each Child...$12,000

The Coverage

The Plan offers 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 accidental loss. Please be sure to review the Exclusions Section enclosed materials for more information on what is and is not covered.

Schedule of Covered Losses

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 of sight, speech or hearing means total and permanent loss.
  • Loss of limb means severance through or above wrist or ankle.
  • Loss of thumb and index finger mean severance through or proximal to the metacarpophalangeal joints.
  • Loss of movement of limbs means total and permanent paralysis of such limbs.
  • No more than one benefit, the largest benefit is payable for all losses to the same limb due to or relative to any one accident.
  • No more than the Principal Sum is payable for all losses due to or related to any accident.

 

Coverage Selection And Cost

Current 2020 Rates

For Members Under Age 70 Monthly Cost*

Coverage
Amount
Member
Only
Family
Plan
$30,000 $1.25 $1.80
60,000 2.50 3.60
90,000 3.75 2.25
120,000 5.00 7.20
150,000 6.25 9.00
180,000 7.50 10.80
210,000 8.75 12.60
240,000 10.00 14.40
270,000 11.25 16.20
300,000 12.50 18.00

For Members Age 70 or Over Monthly Cost

Coverage
Amount
Member
Only
Family
Plan
$30,000 $1.50 $2.17
60,000 3.00 4.34
90,000 4.50 6.51
120,000 6.00 8.68
150,000 7.50 10.85
180,000 9.00 13.02
210,000 10.50 15.19
240,000 12.00 17.36
270,000 13.50 19.53
300,000 15.00 21.70
*Coverage terminates at age 80

Definitions

Covered Accident: A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a Covered Injury or Covered Loss and meets all of the following conditions:
      1. occurs while the covered person is insured under this Policy;
      2. is not contributed to by disease, Sickness, mental or bodily infirmary;
      3. is not otherwise excluded under the terms of this Policy.

Additional Benefits at No Additional Cost:

Escalator Benefit - Insured Member Only:

  • Periodic Increase: 2% of the Principal Sum
  • Frequency of Increases: Biennially
  • Maximum Total Increase: 10% of the Principal Sum

Child Education Benefit - Insured Child(ren) Only:

  • 2% of the Principal Sum subject to a Maximum Benefit of $6,000
  • Maximum Number of Annual Payments: 4

Seat Belt Benefit - All Covered Persons:

  • 10% of the Principal Sum subject to a Maximum Benefit of $30,000

Spouse Retraining Benefit - Insured Spouse Only:

  • 1% of the principal sum subject to an annual
  • Maximum Benefit of $3,000
  • Maximum Number of Annual Payments: 2

State Availability

This plan is currently not available in NH, OH, TX, UT, WA, and is not available in any U.S. Territories, the Virgin Islands, Puerto Rico and Guam.

When Coverage Begins

Your coverage will become effective on the first payday your insurance premiums are deducted from your paycheck.

Applicable benefits for your eligible Spouse and Children will also become effective on that pay day.

 

Termination Of Insurance

The insurance on a Covered Person will end on the earliest date below:

  1. Attainment of age 80.
  2. The date this Policy or insurance for a Covered Class is terminated or 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. With respect to a covered dependent, the date the Insured Member's insurance ends, except a dependent may continue coverage in the event of the member's death.

Exclusions

Benefits Will Not Be Paid For A Loss Caused By The Following:

Air Travel - A loss that occurs during or is a direct result of the Covered Person’s travel in,
travel on, fall from or descent from any aircraft while such aircraft is in flight, unless the
Covered Person is traveling solely as a passenger.
Crime/Illegal Occupation/Illegal Activity - A loss that: (a) occurs during; (b) is due to; or
(c) is related to; the Covered Person’s active participation in or incarceration resulting from
any of the following in a role other than as a victim: (a) the commission of a felony; (b) an
illegal occupation or activity; (c) an insurrection; or (d) a riot.
Disease/Infirmity - A loss that is due to or related to: (a) disease or bodily infirmity of mind
or body; (b) medical or surgical treatment of such disease or bodily infirmity; or (c) bacterial
infections, except infections which occur as the result of an: (1) accidental cut or wound; or
(2) accidental ingestion of contaminated material.
Drugs - A loss that: (a) occurs during; (b) is due to; or (c) is related to; the Covered
Person’s: (1) use of drugs, intoxicants, narcotics, barbiturates or hallucinogenic agents,
unless such use is as prescribed by a doctor or if the loss results from purely accidental and
unforeseen circumstances; or (2) legal intoxication.
Hazardous Activities - A loss that occurs during: (a) bungee jumping; (b) parachuting; (c)
skydiving; (d) parasailing; or (e) hang-gliding.
Military Service - A loss that: (a) occurs during; (b) is due to; or (c) is related to; the
Covered Person’s duty in the military, naval or air services of any country.
Self-Inflicted Injury/Suicide - A loss that: (a) is due to or is related to: (1) suicide; (2) an
attempt at suicide; or (3) an intentionally self-inflicted injury; (b) occurs during an attempt at
suicide; or (c) occurs while intentionally injuring oneself; while the Covered Person is sane
or insane.
Treatment - A loss that: (a) occurs during; (b) is due to; or (c) is related to; any medical,
dental or surgical treatment unrelated to the accident which would otherwise entitle the
Covered Person to benefits.
War Conditions - A loss that: (a) occurs during; (b) is due to; or (c) is related to; the
Covered Person’s engagement in any of the following in a role other than as a victim: (a) in
war, (b) an act of war, or (c) an armed conflict which involves the armed forces of one or
more countries.

 

It's Easy To Enroll

  1. Simply complete the enrollment form for the desired benefit amount.

    Click here to download an Application

  2. 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 enroll for this benefit over the phone!
  3. Send no money now...we will send you a direct bill for coverage.
  4. Return your enrollment form to: The Voluntary Benefits Plan, P.O. Box 12009, Cheshire, CT 06410 or fax to 1-203-754-7847.

Any Questions? Call 1-800-422-4492

Please Note

You must notify The Voluntary Benefits Plan of any address change for you, your dependents and/or beneficiaries, and any change in employment and union membership status change, life status change (i.e., marriage, divorce, beneficiary or name change), or benefit changes requested. Notice must be in writing.

This is only a brief summary of benefits and is subject to the terms, conditions, exclusions and limitations of group policy number G-39315-0. Complete terms and conditions are found in the group master policy and are summarized in your certificate.

Administered by:

The Voluntary Benefits Plan
P.O. Box 12009
Cheshire, CT 06410
Phone: 1-800-422-4492
Fax: 1-203-754-7847
Licensed Agent: David Generali
Connecticut State License #2322879
Agency Insurance License Numbers: AR: 245147, CA: 0791700

UNDERWRITTEN BY:
New York Life Insurance Company
51 Madison Avenue
New York, NY 10010
Policy Form GMR

 

AD&D Important Notice Disclosure:

THE INSURANCE ADVERTISED IS A GROUP ACCIDENT ONLY POLICY. IT DOES NOT PAY BENEFITS 

FOR LOSS CAUSED BY SICKNESS. THIS IS A LIMITED POLICY.

New York Life has received the highest financial strength ratings currently awarded to any U.S. life insurer by Standard & Poor's (AA+); A.M. Best (A++); Moody's (Aaa); and Fitch (AAA). Source:  Individual Third-Party Ratings Reports as of 9/12/19.
New York Life Insurance Company is licensed/authorized to transact business in all of the 50 United States, the District of Columbia, Puerto Rico and Canada. However, not all group plans it underwrites are available in all jurisdictions. New York Life Insurance Company’s state of domicile is New York, and NAIC ID# is 66915.

 

To find out more about your member benefits today, Click Here

Offered through: Alliant Services Houston

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