Life and AD&D

Voluntary Accidental Death and Dismemberment Insurance 

Eligible employees of the Tufts Health Plan who are regularly scheduled to work for at least 20 hours per week may elect Voluntary Accidental Death and Dismemberment (AD&D) Insurance: 

  • for themselves only; or
  • for themselves and their eligible dependents.          

To qualify for Voluntary AD&D Insurance, you must enroll and agree to make the required payroll deduction contributions towards the cost of your coverage. 

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

COVERAGE FOR YOURSELF ONLY
The amount of Voluntary AD&D coverage that you elect for yourself is called your principal sum. You can elect from $10,000 to $1,000,000 as your principal sum. This election: 

  • must be made in $10,000 increments; and
  • cannot exceed 10x your annual earnings (as defined in the Basic AD&D Insurance section).          

COVERAGE FOR YOUR ELIGIBLE DEPENDENTS
Coverage for your eligible dependents (as defined under Eligibility and Plan Participation) is figured as a percentage of your principal sum: 

Eligible Dependent Percentage of Principal Sum

Spouse or domestic partner

  • 60% of principal sum if there are no insured dependent children at the time of the accident
  • 50% of principal sum if there are insured dependent children at the time of the accident
 Maximum Benefit: $300,000

Each dependent child

  • 20% of principal sum if there is no insured spouse at the time of the accident
  • 15% of principal sum if there is an insured spouse at the time of the accident
 Maximum Benefit: $25,000

Here is an Example: Assume that you elect Voluntary AD&D coverage, and: 

  • your principal sum (coverage on your life) is $60,000; and
  • your family consists of you, your spouse, and one eligible dependent child. 

In the event of your death as the direct result of a covered accident, your beneficiary would receive $60,000 (100% of the principal sum). In the event of your spouse’s death, you would receive $30,000 (50% of the principal sum). In the event of your child’s death, you would receive $9,000 (15% of the principal sum).

IF YOU WORK AFTER AGE 65
If you remain in active employment with the Company after age 65, your Voluntary AD&D Insurance coverage (and your spouse’s coverage, if applicable) will be reduced as follows: 

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

*reductions shown go into effect as of the date of the applicable birthday 

COVERED LOSS
Your Voluntary 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 Voluntary 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.          

AMOUNT OF BENEFIT
Your Voluntary 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) 100% 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 20% 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

It is important to remember that your Voluntary AD&D Insurance benefit is payable in addition to the amount payable by Basic AD&D Insurance.

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. 

ADDITIONAL BENEFITS
Your Voluntary AD&D Insurance includes the following additional benefits: 

  • seatbelt and airbag benefit
  • common accident benefit
  • child care center benefit
  • special education benefit
  • rehabilitation benefit 
This section provides brief summaries of the plan’s additional benefits. 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.

Seatbelt and Airbag Benefit
Your Voluntary 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.          

Common Accident Benefit
This benefit increases your covered spouse or domestic partner’s principal sum to 100% of your principal sum (up to a maximum of $1,000,000) if: 

  • both you and your spouse/domestic partner die as the result of injuries sustained in the same accident; or
  • both you and your spouse/domestic partner die as the result of injuries sustained in separate accidents that occur within the same 24-hour period; and
  • you and your spouse/domestic partner are survived by one or more dependent children.          

Child Care Center Benefit
This benefit provides an annual child care center care expense payment (up to a maximum of $5,000) for each of your dependent children following your death or your covered spouse’s death as the direct result of injuries sustained in an accident. 

To qualify for this benefit, a dependent child must be under age 13 and: 

  • enrolled in a child care center on the date of the accident; or
  • enrolled in a child care center within 90 days of the covered accident.

The day care benefit will end as of the date that a dependent child reaches age 13 (or the date that five annual day care benefit payments have been made, if earlier). 

Special Education Benefit
This benefit provides an annual payment for each of your dependent children to enable them to continue their education following your death or your covered dependent spouse’s death as the direct result of an accident. 

To qualify for this benefit, a dependent child must be: 

  • insured under this plan for dependent child coverage on the date of your death; and
  • enrolled as a full-time student at an accredited institution of higher learning on or after the date of your death. 

Benefit Amount and Duration: The special annual education benefit is 5% of your principal sum (or $5,000, if less). This benefit is subject to a maximum of four annual payments for each insured dependent child. 

Rehabilitation Benefit
This benefit provides a lump sum payment for rehabilitation needed as the direct result of a covered person’s Covered Loss.

To qualify, the rehabilitation must: 

  • be essential for the covered person’s physical rehabilitation;
  • meet generally accepted standards of medical practice;
  • be performed under the care, supervision, or order of a physician
  • prepare the covered person to return to his or her regular occupation, or any other occupation. 

Benefit Amount: The rehabilitation benefit is 10% of the covered person’s principal sum, up to a maximum of $10,000.