Group Accidental Death & Dismemberment (AD&D) Insurance

AD&D insurance provides a benefit in the event that you die or become dismembered as a result of a covered accident. Dismemberment can involve anything from a loss of limb to the loss of a capacity, such as speech or sight. The amount of money received due to dismemberment depends on the type of loss. Visit the enrollment site to learn more or call us at (833) 241-4372.

All active members who are 18 and older, their lawful spouses age 18 and older and the members' unmarried dependent children are eligible for coverage. Dependent children are defined (subject to state variations) as those up to age 21 or 25 if full-time students and primarily dependent upon the member for support. On joint accounts, the Primary Member must be the one to enroll.

Every eligible member will be accepted for this coverage regardless of health or occupation. No physical examination is necessary and there are no health questions to answer.

You must complete and submit the Activation Form to be eligible for the $3,000 of Basic Coverage which is provided for you at no cost. Indicate the amount of Additional Coverage you are enrolling for on the Activation Form. If you select Additional Coverage, you have the option of covering your family as well as yourself (basic coverage is not applicable to dependents). This program can help provide the accident protection that you and your family need.

If you already have this coverage, you may increase your existing voluntary coverage or add dependent coverage by completing a New York Life Change Form found on www.nbfsa.com or calling the Plan Administrator toll-free at (833) 241-4372, weekdays between 8 a.m. and 7 p.m. Central Time.

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Additional Coverage up to $300,000 is available at affordable rates. Choose the plan that is closest to your family's needs, keeping in mind that a reasonable minimum should be 1-1/2 times your annual salary; more if your obligations are greater. Premiums will be deducted from your checking or savings account each month.

* All coverage reduces 50% at age 70 and to 25% at age 75. If you are age 70 or older, your coverage amount will be 50% of the amounts shown; if age 75 or older, the coverage amount is 25% of the amount shown. Premiums remain the same. Premiums are current and may be changed on any due date and any date which benefits are changed. However, your rates may only be changed if they are changed for all others in the same class of insureds. For example, a class of insureds would be a group of people with the same benefit type.

Benefits: The following benefits are payable in the event of a covered loss occurring as a direct result of an accidental bodily injury while insured under this plan, provided that the loss occurs within one year of the date of the accident.

• Basic $3,000 plus the additional Principal Sum of Additional Coverage will be paid for loss of: Life, Two limbs, Sight of both eyes, Speech and Hearing, One limb and sight of one eye, Loss of movement of both upper and lower limbs.
• Basic $2,250 plus three-quarters of the additional Principal Sum of Additional Coverage selected will be paid for loss of movement of both lower limbs.
• Basic $1,500 plus one-half of the additional Principal Sum of Additional Coverage will be paid for loss of: Sight of one eye, one limb, Speech or Hearing in both ears, Loss of movement in both upper and lower limbs on one side of the body.
• Basic $750 plus 25% of the additional Principal Sum of Additional Coverage selected will be paid for loss of: Thumb and index finger of the same hand.
• If an insured sustains Quadriplegia, Paraplegia or Hemiplegia within 365 days of a covered accident, the following will be paid: Quadriplegia - full amount of Additional Coverage; Paraplegia - three quarters of Additional Coverage; Hemiplegia - one half of Additional Coverage. Maximum benefit shall not exceed the total amount of Additional Coverage. Not applicable to Basic Coverage.

Escalator Benefit - The loss of life benefit will increase at the rate of 2% of the Covered Person's principal sum of additional insurance for each year of continuous coverage under the Policy for the first five years up to a maximum of 110% of the original amount of insurance. The first increase will be effective on the Policy Anniversary on or after the Covered Person's anniversary of continuous coverage under the Policy. Further increases will take effect on the same day each year thereafter.

Seat Belt Benefit - If a Covered Person suffers loss of life from injuries sustained within 365 days of an accident occurring while traveling in a Private Passenger Car, the beneficiary will be paid an additional benefit equal to the lesser of (a) 10% of the Principal Sum of the Additional AD&D benefit or (b) $10,000.

Rehabilitation Physical Therapy Benefit - If a Covered Person suffers an injury which results in a covered loss as described under the policy, The Prudential Insurance Company of America will pay an amount equal to the lesser of (a) 10% of the Covered Person's Principal Sum of Additional AD&D Insurance (b) $10,000 (c) the Expense incurred for the rehabilitation program or (d) 100% of the Covered Person's Additional AD&D Insurance minus any amounts paid for all loss due to or related to the accident which caused the loss.

Common Carrier Benefit - The plan will automatically double the Covered Person's Principal Sum of Additional Insurance if death is a result of an accident while the insured was a fare-paying passenger in a public conveyance operated by a licensed Common Carrier.

Air Bag Benefit - If the Seat Belt Benefit is payable, an additional benefit of $5,000 will be paid if the Covered Person was positioned in a seat protected by a properly functioning, original, factory installed system that inflates on impact when the accident occurs.

Education Benefit - If the Family Plan is selected and the Insured Member or Insured Member's spouse suffers a covered loss of life, an education benefit will be paid equal to the lesser of (a) 5% of the insured's principal sum of additional insurance AD&D benefit, (b) $5,000 or (c) the actual amount of tuition charge for one school year, to any covered dependent who is eligible for this benefit. This benefit is payable up to four consecutive years.

Your spouse is automatically insured for 50% of your Additional Coverage (increases to 60% if no dependent children).

Your children are automatically insured for 20% of your Additional Coverage (increases to 25% if no spouse).

EXAMPLE:

• Member Coverage = $50,000 + $3,000 basic coverage
• Spouse Coverage = $25,000 ($30,000 if no children)
• Child Coverage = $10,000 per child ($12,500 per child if no spouse)

Each member enrolling in the plan will receive a Certificate of Insurance which will be mailed to you within a short time of the effective date of your coverage.

Your insurance will become effective on the first regular billing date following receipt and acceptance of your Activation Form by the Plan Administrator, provided your first month's premium for any Additional Coverage has been paid.

Any person or persons you choose may be the beneficiary of your benefits. You may change your beneficiary at any time by written request to the Plan Administrator. If no beneficiary is on record, benefits will be paid per the Beneficiary of the Insured provision as outlined in your Certificate of Insurance.

Your coverage will end on the earliest of 1) the next premium due date if you are no longer an eligible member of the credit union participating in the plan; 2) the premium due date, if required premium is not paid by the end of the 31 day grace period; 3) the date the Insured Person enters full-time active duty in the Armed Forces; 4) the date group policy is terminated or modified to end coverage for the class of eligible persons to which the Insured Person belongs; or 5) the date that the plan of benefits under which the Insured Person is covered is terminated. Termination will not affect a claim for a covered loss due to an accident that occurred while coverage was in effect. Coverage for your insured spouse or child will end when your coverage ends or when the dependent eligibility requirements are no longer being met.

When you receive your Certificate of Insurance, read it carefully. If you are not completely satisfied with the terms of your new insurance, simply return your Certificate, without claim, within 30 days and your premium will be promptly refunded. Your insurance will then be invalidated.

This is a brief description of the features of the plan. It is not a contract. Complete terms and conditions of coverage are set forth in the Group Policy G-29282-0/FACE issued by The Prudential Insurance Company of America to the American Advantage Association.

The Association and/or Organizational Member incurs costs in connection with providing oversight and administrative support for the sponsored plan. To provide and maintain this valuable membership benefit, they are reimbursed for these costs. The Association and/or Organizational Member may also receive a fee in connection with the plan.