Sample Basic – Group Accidental Death and Dismemberment Insurance

$3,000 (100% of Additional Coverage Amount for customer ) loss of: Life, two limbs, sight of both eyes, speech and hearing, one limb and sight of one eye, quadriplegia.
$2,250 (75% of Additional Coverage Amount for customer) loss of one arm or one leg, triplegia or paraplegia.
$1,500 (50% of Additional Coverage Amount for customer) sight of one eye, one limb, speech or hearing in both ears, hemiplegia.
$750 (25% of Additional Coverage Amount for customer) loss of hearing in one ear, thumb and index finger of the same hand, four fingers of the same hand, all toes on one foot, uniplegia.
$390 (13% of Additional Coverage Amount for member) loss of big toe.

The customer may designate a beneficiary by completing, signing and submitting the enrollment form.

ABC Insurance will make available to each customer a Certificate of Insurance which will reflect the coverages under the Policy.

All coverage amounts reduce by 50% when insured reaches age 70 and to 25% at age 75.