Accidental Death and Dismemberment insurance is available to benefit-eligible faculty and staff. You may also purchase coverage for your family at a percentage of your own coverage.
Retiree coverage is available to eligible retirees who enrolled in the plan prior to retiring. Coverage amounts are reduced in accordance with the following table, based upon age as of January 1 for the plan year.
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2020 Accidental Death and Dismemberment
|
Accidental Death and Dismemberment- Reduction in amount for retirees |
||
|---|---|---|
| Amount of insurance at retirement | Age as of January 1 | Reduced amount |
| $50,000 | 70-74 | $25,000 |
| 75-80* | $10,000 | |
| $25,000 | 70-74 | $25,000 |
| 75-80* | $10,000 | |
| $10,000 | 70-74 | $10,000 |
| 75-80* | $10,000 | |
Monthly premiums
For active employees, Accidental Death and Dismemberment insurance is 100% employee-paid. Coverage is available in increments of $25,000 up to a maximum of $150,000.
|
Accidental Death and Dismemberment- Monthly premiums for active employees |
||
|---|---|---|
| Coverage amount | Employee cost (per amount listed) | |
| Self coverage | Self and dependents | |
| $25,000 | $0.35 | $0.50 |
| $50,000 | $0.70 | $1.00 |
| $75,000 | $1.05 | $1.50 |
| $100,000 | $1.40 | $2.00 |
| $125,000 | $1.75 | $2.50 |
| $150,000 | $2.10 | $3.00 |
For retirees, Accidental Death and Dismemberment insurance is 100% retiree-paid. Coverage is available in increments of $10,000 up to a maximum of $50,000.
|
Accidental Death and Dismemberment- Monthly premiums for eligible retirees |
||
|---|---|---|
| Coverage amount | Retiree cost (per amount listed) | |
| Self coverage | Self and dependents | |
| $10,000 | $0.35 | $0.47 |
| $25,000 | $0.88 | $1.18 |
| $50,000 | $1.75 | $2.35 |
- Accidental Death and Dismemberment Summary Plan Description (SPD)
- Beneficiary Designation Form - for active faculty and staff; to be used for Basic Life, Supplementary Life, AD&D, and Pre-Retirement Death beneficiary designations.
- Retiree Beneficiary Designation Information, part of the Retiree Benefits Enrollment/Change Form - for retirees; to be used for Basic Life, Additional Life, and AD&D
- Proof of Relationship Requirement form
- View full plan contract information
* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.
Reviewed 2020-05-15
