Prudential – Basic Coverage – 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.

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

THIS INSURANCE PRODUCT IS
NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY	NOT A DEPOSIT
NOT FDIC-INSURED	NOT BANK GUARANTEED