Group Accidental Death and Dismemberment Insurance

Group Accidental Death and Dismemberment Insurance  

Overview

Accidents happen every day and are a leading cause of death and serious injury. If an accident happened to you, would your family have enough financial resources to maintain their standard of living with or without you?


The Group Accidental Death & Dismemberment (AD&D) Insurance Plan can help provide the added financial security your loved ones may need if an accident happens to you. Plus it features these advantages:

  • Choice of accident benefit amounts from $50,000 up to $500,000.
  • Guaranteed acceptance for eligible members and dependents. No medical exam required.
  • Select between two plans: member only or family coverage.
  • More than 10 additional benefits paid, including seatbelt, education, day care and more.
  • Affordable rates.
Forms

These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.

How It Works

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Plan Details
You may select a Principal Sum ranging from $50,000 to $500,000 (in units of $50,000) for yourself — at competitive group rates. You have a choice of two Plans — the Member Only Plan or the Family Plan. The Member Only Plan pays benefits for covered accidental death or injury for you alone. The Family Plan is designed to cover all of your eligible dependents for benefit amounts based on a percentage of your Principal Sum. 

As a member under age 70, you are eligible to apply for coverage for yourself, your lawful spouse under age 70, and unmarried dependent children under age 19 (26 if a full-time student). To become insured, an application must be submitted and the required premium contribution must be paid.

This coverage is available to residents of the United States (except FL, NC, OR, SD, VT, WA and territories) and Puerto Rico.

An individual may not be insured under one or more AD&D Group Policies underwritten by New York Life for a total amount of AD&D coverage that exceeds current over-insurance standards.

When you reach age 70, coverage converts to Common Carrier Travel Accident Insurance and any Principal Sum in excess of $100,000 reduces to $100,000. Common Carrier coverage protects against accidents that occur while riding on a public conveyance — airplane, bus, train, or taxi.

Schedule of Benefits

Except as stated in the description of the Disappearance benefit below, for an injury directly and independently caused by an accident while coverage is in force for you, your spouse or your child, the benefits specified below will be paid if such resulting loss(es) occur within 365 days of that accident.
 

Benefits are payable for the following losses:

FULL PRINCIPAL SUM for loss of: life; or two limbs; or movement of both upper and lower limbs (quadriplegia); or sight of both eyes; or both speech and hearing; or one limb and sight of one eye.

THREE-QUARTERS OF PRINCIPAL SUM for loss of: movement of both lower limbs (paraplegia).

ONE-HALF OF PRINCIPAL SUM for loss of: one limb; or movement of both upper and lower limbs on one side of the body (hemiplegia); or sight of one eye; or speech; or hearing.

ONE-QUARTER OF PRINCIPAL SUM for loss of the thumb and index finger on one hand.

Loss means: with reference to limbs, actual severance through or above the wrist or ankle joints; with reference to thumb and index finger, actual severance through or above metacarpophalangeal joints; with reference to sight, speech or hearing, entire and irrevocable loss thereof; and with reference to movement, complete and irreversible paralysis of such limbs.

Disappearance – If an insured is riding in a conveyance and such conveyance either disappears or sinks as a result of an accident and the insured's body is not found within one year after that accident, the insured will be presumed dead, as a result of accidental injury, and the benefit in effect will be payable.

The total benefit payable for all losses due to a single accident will not be more than the Principal Sum. Only one of the sums, the largest, will be paid for all injuries to the same limb resulting from one accident.

  • YOUR COST

    As a member, you pay an economical group rate:

     

    CURRENT 2019 ANNUAL MEMBER ONLY PLAN PREMIUM CONTRIBUTIONS

    Member's Principal Sum

    When Member is Under Age 70

    When Member is Age 70 & Over*

    $50,000

    $24.00

    $24.00

    100,000

    48.00

    48.00

    150,000

    72.00

    Not Available

    200,000

    96.00

    Not Available

    250,000

    120.00

    Not Available

    300,000

    144.00

    Not Available

    350,000

    168.00

    Not Available

    400,000

    192.00

    Not Available

    450,000

    216.00

    Not Available

    500,000

    240.00

    Not Available

     

    Family Plan**

    Principal Sums

    Annual Premium Contributions When Member is

    Member

    Spouse

    Each Child

    Under Age 70

    Age 70 & Over*

    $50,000

    $25,000

    $5,000

    $36.00

    $36.00

    100,000

    50,000

    10,000

    72.00

    72.00

    150,000

    75,000

    15,000

    108.00

    N/A

    200,000

    100,000

    20,000

    144.00

    N/A

    250,000

    125,000

    25,000

    180.00

    N/A

    300,000

    150,000

    30,000

    216.00

    N/A

    350,000

    175,000

    35,000

    252.00

    N/A

    400,000

    200,000

    40,000

    288.00

    N/A

    450,000

    225,000

    45,000

    324.00

    N/A

    500,000

    250,000

    50,000

    360.00

    N/A


    *Renewal Only. On the premium due date on or immediately after the date the member reaches age 70, the member may not carry more than $100,000 Principal Sum and all coverage converts to Common Carrier Travel Accident.

    **Under the Family Plan, if on the date of the accident no dependent spouse is covered, dependent child coverage increases to 15% (instead of 10%). Under the Family Plan, if on the date of the accident spouse only is covered, the percentage is 60%. 

    If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option.

     

    The premium contributions shown reflect the current rate and benefit structure. Premium contributions may be changed by New York Life Insurance Company on any premium due date and any date on which benefits are changed. However, your rates may change only if they are changed for all others in the same class of insureds. For example, a class of insureds is a group of people all with the same issue age. Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustee of the Preferred Group Trust.

  • PLAN FEATURES

    The Following Benefits Are Payable In Addition To Any Other Benefits Received Under the Plan Provided the Member is Under Age 70

    Common Carrier Benefit
    If a covered loss occurs as a result of an accident while a passenger on a licensed common carrier (train, bus, etc.), an additional $25,000 benefit will be payable.

    Repatriation Benefit
    If a covered accidental death occurs outside of the insured person’s state of residence, an additional benefit of up to $25,000 of the actual expenses incurred will be paid for the preparation and transportation of the body to the place of burial or cremation.

    Rehabilitation Benefit
    Rehabilitation training can help an insured person return to former productivity following an accident. This benefit may be paid for a covered loss other than loss of life. The amount paid will equal the actual expenses incurred for rehabilitation training up to a maximum of $10,000. The expense must be incurred within two years after the date of the accident.

    Seatbelt Benefit
    If an insured person is involved in an automobile accident in which he/she was properly wearing a seatbelt, and dies within 365 days as a result of that accident, the beneficiary can receive an additional amount which is the lesser of $50,000 or 50% of the Principal Sum payable. Please refer to the Certificate of Insurance for certain limitations and conditions on this benefit.

    Education Benefit
    If the benefit for loss of life is payable with respect to the insured member, and his/her dependents are covered by this Plan on the date of the accident, this Plan will pay an education benefit equal to the lesser of 2% of the member's Principal Sum, $2,500 or the actual cost of tuition for one school year. This benefit will be payable each year for up to four years, for each insured dependent who is enrolled (or enrolls within 365 days of the accident) as a full-time student at an institution of higher learning (college, university or trade school). In addition, if no insured spouse or child qualifies for this benefit following the covered loss of the member's life, a lump sum benefit equal to 2% of the member's principal amount will be payable.

    Spouse Critical Period 
    If either the insured member or insured spouse dies as a result of a covered accident, the survivor will receive additional monthly payments equal to 1% of the member's Principal Sum. These payments will be made until the earlier of six months or the survivor's death.

    Adaptive Home/Auto Benefit 
    If a covered loss (other than loss of life) results in a physical disability, and, because of that disability, an insured person incurs expenses necessary to modify his/her home and/or car, a benefit amount equal to the lesser of 5% of the Principal Sum or $5,000 is payable. Please refer to the Certificate of Insurance for certain limitations and conditions on this benefit.

    Burn Disfigurement 
    If a covered loss causes an insured to suffer a disfigurement due to burns, covering at least 5% of the body, an additional benefit equal to the lesser of 10% of the Principal Sum or $30,000 will be payable.

    Day Care Benefit 
    If the insured Member's death results from a covered loss and his or her children, under age 13, are enrolled in a Day Care program at the time of the loss (proof of enrollment is required; details will be found in your Certificate of Insurance), a benefit equal to the lesser of 5% of the Member's Principal Sum, or $2,500, or the actual Day Care costs for one year, is payable. The benefit is paid each year for each child who qualifies, except that no more than four Day Care Benefits will be paid for each such child. If the insured Member has no child eligible for this benefit at the time of the covered loss, a benefit of $500 will be paid.

    Elder Care 
    If an insured's death is the result of a covered accident and that insured's elderly relative (other than a spouse) was dependent on the insured for support and maintenance, a benefit equal to the lesser of 5% of the Principal Sum or $5,000 will be payable.

    Common Disaster 
    If both the insured member and spouse die within one year of same or separate accidents that occurred within the same 24-hour period, in addition to the benefit payable for loss of life for each, the insured spouse benefit amount for loss of life will be increased to 100% of the member's Principal Sum if the member and spouse are survived by one or more eligible children and the combined member and spouse Principal Sums do not exceed $500,000.

    Only The Following Benefit is Payable At Member Age 70 and After

    Common Carrier Travel Accident Benefit 
    When the insured Member reaches Age 70, coverage is converted to Common Carrier Travel Accident Insurance only. A benefit is payable for a covered loss which is the result of an accident while traveling as a passenger in a common carrier (such as a train, bus, aircraft) properly licensed and operated for that purpose. Any Principal Sum in excess of $100,000 will be reduced to $100,000.



    ADDITIONAL PLAN PROVISIONS

    Exclusions and Limitations 
    No benefit will be payable for any loss that occurs during or is due or related to or resulting from: participation in or incarceration resulting from, in a role other than as victim, commission of a felony, or illegal occupation/activity; voluntary intake of drugs, narcotics or intoxicants, unless prescribed by a physician, illegal use of drugs or intoxicants, or legal intoxication; any declared or undeclared war or act thereof; operating, riding in or descending from any aircraft except when riding as a passenger, Except, for all insured persons covered under the certificate of any insured member in a participating military association/organization and recalled to service or serving in the reserves, this exclusion does not apply to losses that occur during or result while traveling as a passenger on any transport type aircraft operated by the U.S. Military Airlift Command; physical or mental sickness or medical/surgical treatment thereof; suicide or intentionally self-inflicted injury while sane or insane. 

    In addition, when you reach age 70, coverage converts to Common Carrier Travel Accident Insurance, and any Principal Sums in excess of $100,000 reduce to $100,000. This applies to all the coverage you have under Policy G-29319.


    Beneficiary
    You may select any person, persons, trust or other legal entity as your beneficiary. If, at the time of your death, there are no surviving beneficiaries, benefits will be paid to the executor or administrator of your estate, or at the option of New York Life, to the surviving relatives in the following order of survival: spouse; children equally; parents equally; or brothers and sisters equally. The member is the beneficiary for spouse's and children's coverage. If you wish to designate a different beneficiary, simply contact the Plan Administrator for a Beneficiary Form.

    Effective Date 
    Insurance for you and your eligible dependents will become effective on the date specified by New York Life Insurance Company provided the initial contribution has been paid and you and your approved dependents are actively performing the normal activities of a person in good health of like age (For NC residents: a person of like age) on that date. Dependent insurance will not take effect unless your insurance is in effect on a premium paying basis, and any person who is not performing his/her normal activities as required will not become insured until the date he/she is performing such activities, provided such date is within three months of the date insurance would have been effective and the person is still eligible. (Payment of a premium contribution for insurance does not mean there is any coverage in force before the effective date as specified by New York Life Insurance Company.)

    When Coverage Ends
    Insurance will terminate on the occurrence of the earliest of these conditions: if premium contributions due are not paid; if the Group Policy is terminated or modified by the Policyholder or New York Life Insurance Company to end insurance for the group of insureds to which the insured belongs; for any insured person, if the Principal Sum for that insured has been paid; for dependent spouse and/or child coverage, if member coverage ends, except that such dependent coverage may be continued if the member’s Principal Sum has been paid; for a dependent spouse, when he/she is no longer a lawful married spouse; for a dependent child, upon reaching age 19 (26 if a full-time student). A member’s surviving spouse and children may continue coverage if it was in force at the time of the member’s death, as described in the Certificate of Insurance.

    Renewal Payments and Claims 
    Once you are accepted into the Plan, you will have a 31-day grace period for your payment of renewal premium contributions. When you want to submit a claim, call or write the Plan Administrator for claim forms.

    Certificate of Insurance 
    When you become insured you will be sent a Certificate of Insurance summarizing your coverage. This brochure contains only a brief description of some of the Plan's principal provisions and features. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the Trustee of the Preferred Group Trust.

    30-Day Free Look 
    If you are not completely satisfied with the terms of your Certificate of Insurance, you may return it, without claim, within 30 days. Your coverage will be invalidated and you will be sent a full refund - no questions asked!

Contact Us

We're here to help! Please contact us in whatever manner is most convenient for you.

 Address
Mercer Consumer
12421 Meredith Drive
Urbandale, IA 50398
 Hours
 M-F 7:30a-6p CT
 Email
customerservice.service@mercer.com
 Website
https://www.mercer-web.com/products/mercerhealthbenefits.html
 Application Mailing Address
Administrator, ASEE Insurance Program
PO Box 10374
Des Moines, IA 50306-8812
 Payment Billing Address
ASEE Insurance Plans
PO Box 10425
Des Moines, IA 50306-0425
 Insurance Company Address
New York Life Insurance Company
51 Madison Avenue
New York, NY 10010

FAQS

Answers about the plan, including eligibility, options, enrollment, customer service and more.
  • I have life insurance, why would I need this accident coverage?

    If your loved ones were suddenly without your income and support, would the amount of life insurance you have in place be enough to pay all their day-to-day living expenses let alone future costs such as college education, retirement, etc. Accident coverage provides additional financial security if an accident happens to you and is generally easier to get than purchasing additional life insurance.

  • Who is eligible for this coverage?

    As a member under age 70, you are eligible to apply for coverage for yourself, your lawful spouse under age 70, and unmarried dependent children under age 19 (26 if a full-time student). To become insured, an application must be submitted and the required premium contribution must be paid.

    This coverage is available to residents of the United States (except FL, NC, OR, SD, VT, WA and territories) and Puerto Rico. 

Your Association is compensated in connection with this sponsored group plan to provide and maintain this valuable membership benefit.

 

Underwritten by New York Life Insurance Company, under Group Policy No. G-29319-0, on Policy Form GMR-FACE/G-29319-0.

88601

 

About New York Life Insurance Company.

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Details of Mercer disclosure of the compensation.