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Accidental death and dismemberment insurance

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.

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
$50,000	75-80*	$10,000
$25,000	70-74	$25,000
$25,000	75-80*	$10,000
$10,000	70-74	$10,000
$10,000	75-80*	$10,000

*Coverage ends on the December 31 of the plan year in which you turn age 80.

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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	Family coverage
$25,000	$0.53	$0.73
$50,000	$1.05	$1.45
$75,000	$1.58	$2.18
$100,000	$2.10	$2.90
$125,000	$2.63	$3.63
$150,000	$3.15	$4.35

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	Family coverage
$10,000	$0.53	$0.68
$25,000	$1.25	$1.70
$50,000	$2.50	$3.40

Forms and guides

Accidental Death and Dismemberment Summary Plan Description (SPD) (PDF, 393KB)
Benefits Enrollment Form (PDF, 291KB) - For active faculty and staff who are newly eligible for benefits (e.g., newly hired or newly promoted to a benefit-eligible job)
Benefits Change Form (PDF, 553KB) - For active faculty and staff who have a family status change during the specified calendar year.
Beneficiary Designation Form (PDF, 230KB) - 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, Supplemental Life, and AD&D
Proof of Relationship Requirement form (PDF, 53KB)

* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.

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Reviewed August 16, 2019.

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