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This is a
group accident policy between Zurich American Insurance
Company and the University of Wisconsin Board of Regents
for University of Wisconsin System employees. The plan
is self-administered by the University.
• Zurich Travel Assist offers comprehensive, world travel service, when you travel 100 miles or more from home. View the benefit summary or the complete Zurich Travel Assist brochure.
• Zurich Travel Assist 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.
• Your family members are eligible, too, provided you carry AD&D Family Plan coverage.
Eligibility
- University
employees eligible for the State of Wisconsin Group
Health Insurance Plan are eligible for AD&D.
Enrollment
-
Coverage is effective on the first of the month following the date you submit your application to your campus 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. By electing the Family Plan, you are covering
your spouse or domestic partner and dependent children.
- 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 or $250,000.
- Coverage
in excess of $200,000 may not exceed 10 times your
annual salary.
- Under
the Family Plan, dependent 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.
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.
Program
Features
- Education
and training benefits for your spouse
and dependent children if you are enrolled in the
Family Plan at the time of your death.
- If you
and your spouse suffer loss of life as result of a
common accident while enrolled in the Family Plan,
your spouse's coverage is equal to yours, to a combined
maximum of $250,000
- A monthly payment for your spouse, in addition to the Principal
Sum for the year following your death, if you select
the Family Plan.
- If you
become permanently and totally disabled within 180
days of an injury and conditions are met, you may
be eligible for a Principal Sum payment.
- Special
Air Ambulance coverage extension is available at additional
cost for employees who ride on or operate the university
air ambulance.
-
A person covered
in the plan may apply for pilot coverage.
- Continuation
of insurance in the group plan is available at a reduced
level of coverage 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.
- Zurich Travel Assist puts you in touch with a global network of providers that can address medical, legal, in formational and personal assistance needs when traveling 100 or more miles away from home.
FAMILY PLAN
If the Family
Plan is elected, dependent family members will be covered
by the following amounts:
Spouse:
The spouse's coverage would be 50% of the Principal
Sum, provided there are no covered children at the time.
If there were covered children, the spouse's coverage
would be 45% of the Principal Sum.
Children:
Each dependent child would be covered for 10% of the
Principal Sum if there were a covered spouse, subject
to a maximum of $25,000. If there were no covered spouse,
each child's coverage would be 20% of the Principal
Sum, subject to a maximum of $37,500.
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:
| Age
70-74 |
65% |
| Age
75-79 |
45% |
| Age
80-84 |
30% |
| Age
85 and over |
15% |
SCHEDULE
OF COVERAGE
|
FOR
LOSS OF
|
AMOUNT
|
| Life |
The
Principal Sum |
| Both
hands or feet, sight of both eyes |
The
Principal Sum |
| One
hand or foot and sight of one eye |
The
Principal Sum |
| One
hand and one foot |
The
Principal Sum |
| Speech
and hearing |
The
Principal Sum |
| One
hand or foot or sight of one eye |
One-half
Principal Sum |
| Speech
or hearing |
One-half
Principal Sum |
| Thumb
and index finger of same hand |
One-quarter
Principal Sum |
The covered loss must occur within 365 days of the accident.
In the event
the covered employee, their spouse 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.
For more information, see the insurance fact sheet and the certificate.
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This document was last
revised on January 2, 2008
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