Life and AD&D

Exclusions and Limitations

OPTIONAL LIFE INSURANCE EXCLUSIONS
If an Insured commits suicide, while sane or insane, within 2 years from the date his or her insurance under the Policy becomes effective, Optional Employee Term Life Insurance Benefits will be limited to a refund of the premiums paid on the Insured’s behalf. The suicide exclusion applies from the effective date of any additional benefits or increases in Life Insurance Benefits. 

Except for any amount of benefits in excess of the Prior Plan’s* benefits, this exclusion will not apply to any person covered under the Prior Plan for more than two years. If a person was not insured for two years under the Prior Plan, credit will be given for the time he or she was insured.

If a Dependent Child commits suicide and is survived by other Dependent Children covered under the same certificate, no refund of premiums will be paid. 

*This refers to the plan that was insured by the Prudential Insurance Company prior to January 1, 2010. 

BASIC AND VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) EXCLUSIONS
In addition to any benefit-specific exclusions, benefits will not be paid for any Covered Injury or Covered Loss which, directly or indirectly, in whole or in part, is caused by or results from any of the following unless coverage is specifically provided for by name in the Group Accident Insurance Policy: 

  1. intentionally self-inflicted injury, suicide or any attempt thereat while sane or insane;
  2. commission or attempt to commit a felony or an assault;
  3. commission of or active participation in a riot or insurrection;
  4. bungee jumping; parachuting: skydiving; parasailing; hang-gliding;
  5. declared or undeclared war or act of war;
  6. flight in, boarding or alighting from an Aircraft or any craft designed to fly above the Earth’s surface:
    1. except as a passenger on a regularly scheduled commercial airline;
    2. being flown by the Covered Person or in which the Covered Person is a member of the crew;
    3. being used for:
      1. crop dusting, spraying or seeding, giving and receiving flying instruction, fire fighting, sky writing, skydiving or hang-gliding, pipeline or power line inspection, aerial photography or exploration, racing, endurance tests, stunt or acrobatic flying; or
      2. any operation that requires a special permit from the FAA, even if it is granted (this does not apply if the permit is required only because of the territory flown over or landed on);
    4. designed for flight above or beyond the earth’s atmosphere;
    5. an ultra-light or glider;
    6. being used for the purpose of parachuting or skydiving;
    7. being used by any military authority, except an Aircraft used by the Air Mobility Command or its foreign equivalent;
  7. sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food;
  8. travel in any Aircraft owned, leased or controlled by the Subscriber, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be “controlled” by the Subscriber if the Aircraft may be used as the Subscriber wishes for more than 10 straight days, or more than 15 days in any year;
  9. a Covered Accident that occurs while engaged in the activities of active duty service in the military, navy or air force of any country or international organization. Covered Accidents that occur while engaged in Reserve or National Guard training are not excluded until training extends beyond 31 days;
  10. operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the Covered Person has been provided a written warning against operating a vehicle while taking it. Under the influence of alcohol, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Accident occurred;
  11. voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;
  12. in addition, benefits will not be paid for services or treatment rendered by a Physician, Nurse or any other person who is:
    1. employed or retained by the Subscriber;
    2. providing homeopathic, aroma-therapeutic or herbal therapeutic services;
    3. living in the Covered Person’s household;
    4. a parent, sibling, spouse or child of the Covered Person. 
The Administrative Information section of your Summary Plan Description (SPD) is incorporated into this section by reference. The Administrative Information section contains additional important information about your Life and AD&D Insurance benefits, including your rights as a plan participant under the Employee Retirement Income Security Act of 1974 (ERISA).