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Accidental Death & Dismemberment Ins.

Summary Information Only

 
This Web page presents summary information only. Any error or omission here is unintentional and will be resolved in favor of plan documents or applicable federal or state law or rule.


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Eligibility & Effective Dates

 
Eligibility
 
All PEBB-eligible employees may enroll in this benefit.
 
Effective Dates
 
If you enroll during Open Enrollment, your coverage becomes effective January 1 of the new plan year.
 
If you enroll outside of Open Enrollment, your coverage becomes effective the first of the following month.


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Description of Benefits

 
The AD&D plan provides 24-hour coverage for accidental loss of life, limb, hand, foot, hearing, speech, sight or thumb and index finger (of the same hand). You may select a coverage amount from $50,000 to $500,000, in increments of $50,000.
 
Employee coverage
 
The amount of coverage you select for yourself (the principal sum) is payable as follows:
  • 100 percent of the principal sum is paid for the following accidental losses:
    • Life
    • Both hands or both feet or sight of both eyes
    • Or any two or more of the following accidental losses:
      • One hand or one foot
      • One hand or one foot and sight of one eye
      • Speech and hearing.
  • 50 percent of the principal sum is paid for the following accidental losses:
    • Sight of one eye
    • One hand or one foot
    • Speech or hearing
  • 25 percent of the principal sum is paid for accidental loss of thumb and index finger of either hand. 
 
When a claim is filed on a dependent, the payable benefit is equal to a percentage of your employee AD&D insurance as follows:
  • Spouse or domestic partner only — 50 percent 
  • Children only — 15 percent for each child 
  • Spouse or domestic partner and children — 40 percent for spouse or partner, 15 percent for each child. 
 
The maximum benefit payable for all losses caused by the same accident will not be more than the principal sum.


 ● Accidental Death & Dismemberment Insurance Certificate 
 ● More Information on Accidental Death & Dismemberment Insurance (in the Summary Plan Description)
 ● The Standard Insurance Company Website 


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Premium Rates

Accidental Death and Dismemberment Premium Rates 
Amount
Employee
Employee & Dependents
$50,000
$1.00
$1.70
$100,000
$2.00
$3.40
$150,000
$3.00
$5.10
$200,000
$4.00
$6.80
$250,000
$5.00
$8.50
$300,000
$6.00
$10.20
$350,000
$7.00
$11.90
$400,000
$8.00
$13.60
$450,000
$9.00
$15.30
$500,000
$10.00
$17.00
 
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Tax Treatment

 
For the AD&D insurance program, payroll deducts the monthly premium after taxes. However, any benefit dollars you receive through this benefit are not taxed.


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Contact the Standard


Contact The Standard Insurance at: (800) 368-2859, or visit their website.

Click here to return to the Open Enrollment Portal Page

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