Life and AD&D

Basic Accidental Death and Dismemberment Insurance 

Eligible employees of Tufts Health Plan who are regularly scheduled to work for at least 20 hours per week are provided with Basic Accidental Death and Dismemberment (AD&D) Insurance. The Company pays the full cost of this coverage. 

Certain losses are not covered by Basic or Voluntary AD&D Insurance. This is explained in the Exclusions and Limitations section. 

AMOUNT OF COVERAGE
The maximum amount payable under your Basic AD&D Insurance is one times your annual earnings, rounded to the next higher $1,000. This amount is also referred to as your principal sum

For plan purposes, your “annual earnings” is your base salary only. It does not include: 

  • bonuses;
  • commissions;
  • overtime pay;
  • earnings for more than 40 hours per week; or
  • other additional forms of compensation.          
The amount of your Basic AD&D Insurance coverage will automatically adjust to match changes in your annual earnings. The maximum Basic AD&D Insurance benefit is $500,000.

IF YOU WORK AFTER AGE 65
If you remain in active employment with the Company after age 65, your Basic AD&D Insurance coverage will be reduced as follows: 

Active Employee Age* Basic AD&D Insurance Coverage
Age 65 65% of principal sum
Age 70 50% of principal sum

*reductions shown go into effect as of your 65th or 70th birthday 

COVERED LOSS
Your Basic AD&D Insurance will pay benefits for a covered loss only. In order to qualify for benefits, a covered loss must be: 

  • the result, directly and independently of all other causes, from a covered accident;
  • the type of loss specified in the Amount of Benefit section (below); and
  • suffered by the covered person within 365 days of a covered accident.          

For Basic AD&D Insurance, a "covered accident” is defined as:
A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a covered loss and meets all of the following conditions: 

  • occurs while the covered person is insured under this plan;
  • is not contributed to by disease, sickness, mental, or bodily infirmity; and
  • is not one of the excluded accidents or losses specified in the Exclusions and Limitations section. 

Certain losses are not covered by Basic AD&D Insurance. This is explained in the Exclusions and Limitations section.

AMOUNT OF BENEFIT
Your Basic AD&D Insurance benefit is figured as a percentage of your principal sum (as described above). As the following chart shows, the amount of this benefit depends on the type of loss suffered: 

Type of Loss Benefit Payable
Loss of life 100% of Principal Sum
Two or more hands or feet 100% of Principal Sum
Entire sight of both eyes 100% of Principal Sum
One hand or one foot and sight in one eye 100% of Principal Sum
Speech and hearing (in both ears) 50% of Principal Sum
One hand or foot 50% of Principal Sum
Speech 50% of Principal Sum
Hearing in both ears 50% of Principal Sum
Entire sight of one eye 50% of Principal Sum
Thumb and index finger of same hand 25% of Principal Sum
All four fingers of the same hand 25% of Principal Sum
All toes of the same foot 25% of Principal Sum
Quadriplegia 100% of Principal Sum
Paraplegia 75% of Principal Sum
Hemiplegia 50% of Principal Sum
Uniplegia 25% of Principal Sum
Coma (payable at beginning of 12th month)

Monthly Benefit (maximum: 11 months): 1% of Principal Sum

Lump Sum Benefit: 100% of Principal Sum

MAXIMUM BENEFIT
In the event of a covered person’s death due to a covered accident, the maximum benefit payable is for loss of life (reduced by payment for other covered loss, if any). If a covered person suffers more than one covered loss due to a covered accident, benefits will be paid for the covered loss for which the largest available benefit is payable. 

SEATBELT AND AIRBAG BENEFIT
Your Basic AD&D Insurance will pay the following additional amounts in the event that a covered person dies in a covered accident while riding in an automobile (either as the driver or as a passenger): 

  • 10% of the principal sum (up to a maximum of $25,000) if the person was wearing a seatbelt; and
  • 5% of the principal sum (up to a maximum of $25,000) if the car was equipped with a properly functioning and deployed airbag.          
You should contact the Insurance Company and read your insurance certificate for the full facts and details concerning the terms and conditions for receiving these benefits, including benefit eligibility, coverage, and amount.