T is covered by an accidental death and dismemberment policy

1 Financial Impact of Premature Death, MetLife 2020 

Accidental Death & Dismemberment insurance does not include payment for any loss which is caused by or contributed to by: physical or mental illness, diagnosis of or treatment of the illness; an infection, unless caused by an external wound accidentally sustained; suicide or attempted suicide; injuring oneself on purpose; the voluntary intake or use by any means of any drug, medication or sedative, unless taken as prescribed by a doctor or an over-the-counter drug taken as directed; voluntary intake of alcohol in combination with any drug, medication or sedative; war, whether declared or undeclared, or act of war, insurrection, rebellion or riot; committing or trying to commit a felony; any poison, fumes or gas, voluntarily taken, administered or absorbed; service in the armed forces of any country or international authority, except the United States National Guard; operating, learning to operate, or serving as a member of a crew of an aircraft; while in any aircraft for the purpose of descent from such aircraft while in flight (except for self preservation); or operating a vehicle or device while intoxicated as defined by the laws of the jurisdiction in which the accident occurs.

MetLife AD&D and BTA is issued by Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 under Policy Forms GPN99/G2130-S and GBPNP-04.

Nothing in these materials is intended to be advice for a particular situation or individual. Please consult with your own advisors for such advice. Like most group insurance policies, insurance policies offered by MetLife contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact your benefits administrator or MetLife for costs and complete details. 

Who's Eligible: Employees eligible for full, mid-level or core benefits and retirees

Who’s covered: You and your family members

Who pays the premium: You

UC offers the Accidental Death and Dismemberment (AD&D) plan to help protect you and your family from the unforeseen financial hardship of a serious accident that causes death or dismemberment.

What the Plan Covers

The plan provides $10,000 to $500,000 coverage for accidental death, dismemberment or loss of sight, speech or hearing caused by an accident. It offers three levels of coverage:

• Individual coverage for you only
• Family coverage for you, your spouse or eligible domestic partner and your child(ren). This plan covers your spouse or domestic partner for 60% of your coverage amount. If eligible children are covered, then your spouse or domestic partner is covered for 50% of your amount and each child for 20%.
• Modified family coverage for you and your child(ren). Each eligible child is covered for 20% of your amount.

If you are on leave for health reasons on the day you become eligible for coverage, your coverage starts the day after your first full day at work.

Plan Benefits

The plan provides benefits if the accident results in:

• Death or dismemberment or loss of sight, speech, or hearing caused by an accident
• Paraplegia, quadriplegia, or hemiplegia
• Coma lasting more than 30 days
• Permanent and total disability caused by an accident

In addition to receipt of the principal sum, your family members may also receive the following if you die:

• Special educational benefits for your spouse or eligible domestic partner and/or children
• Your child's higher education costs provided the child is enrolled in an institution of higher education on the day of the accident, or, if the child is a high school student, the child must enroll in an institution of higher education within one year of high school graduation

Day care expenses for covered children under age 13 for up to four years if you die in an accident.

Enrollment

You may enroll in AD&D insurance at any time. Prudential Insurance is the administrator of the AD&D plan.

• Employees: You can enroll on UCPath at any time. After your Period of Initial Eligibility (PIE), you can increase, decrease, cancel, or enroll in coverage by completing the UCPath Benefits eForm: Submit New Form. In the Reason For Request, select Change AD&D.
• Retirees: Use the enrollment form available from Prudential to enroll in coverage. The level of coverage for which you are eligible depends on your level of coverage as an employee. See the plan costs chart for more information.

Plan Costs

See the chart for employee and retiree costs.

To File a Claim

If you need assistance completing the claim form, call UCPath at (855) 982-7284 to work with a beneficiary care coordinator. For reference, UC's policy number is 97000.

Naming Your Beneficiaries

You should designate a beneficiary immediately upon enrolling in AD&D insurance. You may name the same or different beneficiary for your UC Retirement Plan.

You may name more than one beneficiary and specify the percentage that each beneficiary is to receive online or by submitting form UBEN 116. A beneficiary may be a person, trustee or organization.

You can change your beneficiaries at any time. If no beneficiary is named or if your beneficiary is no longer living, any benefits will be paid to your survivors in the following order:

• Surviving legal spouse or surviving domestic partner; or, if none,
• Surviving children, on an equal-share basis; or, if none,
• Surviving parents on an equal-share basis; or, if none,
• Surviving siblings; or, if none,
• The member's estate.

If a family member is covered by AD&D, you are automatically named the beneficiary. You can change this online or by submitting form UBEN 119 (Designation of Alternate Beneficiary).

What does accidental death and dismemberment policy cover?

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