The Accidental Death and Dismemberment Insurance plan (AD&D) offers accidental death and dismemberment insurance as well as the Zurich Travel Assist plan to employees and their spouses or domestic partners and eligible dependent children.

The group policy is between the University of Wisconsin System Board of Regents and Zurich American Insurance Company. The plan is self-administered by the University in accordance with insurance industry standards.

Eligibility

• University employees eligible for the State of Wisconsin Group Health Insurance Plan are eligible for AD&D.

Enrollment

• You may enroll, change or cancel your coverage at anytime by filing an Enrollment and Change Form with your institution's benefits office.

• Coverage is effective on the first of the month following the date you submit your application to your institution's benefits office. If you file on the first day of the month, coverage is effective that day.

• Employee Only or Family Plan coverage is available. If you elect family coverage, your spouse or domestic partner and eligible dependent children will be covered.

• To cover a domestic partner and your domestic partner's eligible children, you must create a domestic partnership for benefits purposes. Please see Domestic Partner Benefits for UW System Employees for detailed information about how to establish a domestic partnership.

• Rehired annuitants who are receiving a Wisconsin Retirement System annuity are excluded from enrollment.

Coverage

• You may select coverage (Principal Sum) of $25,000, $50,000, $100,000, $150,000, $200,000, $250,000, $300,000, $350,000, $400,000, $450,000 or $500,000.

• All employees, regardless of income level, can elect up to $500,000 of coverage.
  
  
• Under the Family Plan, eligible family members are covered at a percentage of your Principal Sum amount.
  
  
• At age 70, your coverage reduces to a percentage of the Principal Sum.
  
  
• This insurance does not cover any loss resulting from intoxication or while under the influence of alcohol or controlled substance unless administered on the advice of a physician and taken in the prescribed dosage.
  
  
• For limitations and exclusions, please refer to the certificate.
  
  
• All employees and covered family members who have coverage under the AD&D plan are also covered by Zurich Travel Assist.
  
  
  • Offers comprehensive, world travel service, when you travel 100 miles or more from home.
    
    
  • Provides a familiar standard of care in an unfamiliar place, putting you in contact with resources to get the medical, personal, informational and legal help needed for vacation or business travel.
    
    
  • View the Zurich Travel Assist benefit summary or the complete Zurich Travel Assist brochure for more information.

Premium

• Premium cost is based on the type of plan and Principal Sum you select.
  
  
• The University does not contribute toward the premium.
  
  
• Premiums are paid one month in advance of the coverage month.

Program Features

See plan summary for details.http://www.uwsa.edu/hr/benefits/ins/uws1246.pdf

• Additional Dismemberment Benefit for Children*
• Carjacking Benefit
• Coma Benefit
• Continuation of Insurance Benefit*
• Day Care Benefit*
• Exposure and Disappearance Coverage
• Hearing Aid or Prosthetic Appliance Benefit
• Higher Education Benefit for Children*
• Home Alteration and Vehicle Modification Benefit
• Loss of Use Benefit
• Natural Disaster Benefit
• Permanent and Total Disability Benefit
• Pilot Coverage
• Reserve Corps/National Guard Unit Coverage
• Retraining Benefit for Spouse or Domestic Partner*
• Safety Device Benefit
• Seat Belt/Air Bag Benefit
• Surviving Spouse or Domestic Partner Benefit*
• Therapeutic Counseling Benefit
• Travel Assist Plan
  

*Must have family coverage in force.

This insurance will pay benefits according to the Schedule of Coverage. Maximum benefit limits may apply.

FAMILY PLAN

When the Family Plan is elected, family members are covered for a portion of the coverage elected by the employee:

• Spouse or domestic partner (sp/dp) coverage is 60% of the employee benefit to a maximum of $300,000 when the employee covers a sp/dp only.
• Spouse or domestic partner coverage is 50% of the employee benefit to a maximum of $300,000 when the employee covers sp/dp and dependent children.
• Children coverage is 20% of employee benefit when there is no sp/dp covered by plan and 15% if there is a covered sp/dp. The maximum benefit is $50,000.

COVERAGE FOR AGE 70 or OLDER

At age 70 the Principal Sum reduces to a percentage of the Principal Sum available prior to age 70. For example:

SCHEDULE OF COVERAGE

The covered loss must occur within 365 days of the accident.

In the event the covered employee, their spouse, domestic partner or child is not found within a year of the accident, provided the occurrence was under circumstances that would otherwise be covered, it will be assumed the lost individual has sustained loss of life.

Continuation of insurance in the group plan is available for those retiring from the University.

Conversion of coverage to an individual plan with the insurance company is available for those under age 70 who terminate employment or end an eligible position.

You are encouraged to complete a beneficiary designation form to ensure benefits are paid to the named beneficiary.

For more information, see the insurance fact sheet and the certificate.

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This document was last revised on December 26, 2012