Accidental Death and Dismemberment
Underwritten by American Home Assurance
SUMMARY OF AVAILABLE COVERAGES
Amount of coverage purchased is the principal amount.
| Plan |
Insured Persons |
| A1 |
B1 |
|
| $250,000 |
$100,000 |
Applicant Employee |
| $10.50/MONTH |
$4.50/MONTH |
|
| Plan |
Insured Persons |
| A2 |
B2 |
|
| $250,000 |
$100,000 |
Applicant Employee |
| $150,000 |
$60,000 |
Spouse Of Applicant Employee |
| $15.50/MONTH |
$6.50/MONTH |
|
| Plan |
Insured Persons |
| A3 |
B3 |
|
| $250,000 |
$100,000 |
Applicant Employee |
| $125,000 |
$50,000 |
Spouse Of Applicant Employee |
| $37,500 |
$15,000 |
Each Dependent Child |
| $15.50/MONTH |
$6.50/MONTH |
|
Dismemberment benefits are outlined in the schedule of benefits.
| Additional Benefits |
Up To |
Included in the following for insured persons if a policy claim** is payable |
| Day Care |
*$ 5,000 |
A3 AND B3 ** (LOSS OF LIFE) |
| Seat Belt |
*$ 25,000 |
ALL PLANS **(SCHEDULE) |
| Education |
$ 5,000 |
A3 AND B3 ** (LOSS OF LIFE) |
| Repatriation |
$ 10,000 |
ALL PLANS ** (LOSS OF LIFE) |
| Rehabilitation |
$ 10,000 |
ALL PLANS **(SCHEDULE) |
| Common Disaster |
$ 125,000 |
A2, A3, B2 AND B3 **(LOSS OF LIFE) |
Transportation
(If Hospitalized) |
$ 10,000 |
ALL PLANS **(SCHEDULE) |
| Home And Vehicle Modification |
$ 10,000 |
ALL PLANS **(SCHEDULE) |
* Benefits are based on a percentage of the principal sum up to the
maximum shown which is attained if $250,000 coverage is purchased.
EXCLUSIONS: The plan does not cover any losses in connection with:
1. Suicide or self-destruction, or attempt thereat. 2. An act of war, whether it is declared or undeclared. 3. Military, Naval or Airforce services of any country. 4. While a pilot or a crew member in any aircraft. 5. Flying in an aircraft owned/leased by an employer.
In the event that there is any differences between this brief summary and the policy, the policy will govern in all cases. The policy contains the actual wordings regarding the terms, Conditions, Limitations and Exclusions, please read the policy.
SCHEDULE OF BENEFITS PROVIDED
The principal amount is the amount of coverage purchased.
The percentage is the amount of payment made for the described type of claim.
| Benefits - For Total Paralysis |
| Quadriplegia (Upper And Lower Limbs) |
200% |
| Hemiplegia (Upper And Lower Limbs On One Side) |
200% |
| Paraplegia (Lower Limbs) |
200% |
| Benefits - For Loss Of: |
| Life |
100% |
| Entire Sight Of Both Eyes |
100% |
| Both Speech And Hearing |
100% |
| Both Hands Or Both Feet |
100% |
| One Hand And One Foot |
100% |
| One Hand And The Entire Sight Of One Eye |
100% |
| One Foot And The Entire Sight Of One Eye |
100% |
| One Arm Or One Leg |
75% |
| One Hand Or One Foot |
66 2/3% |
| The Entire Sight Of One Eye |
66 2/3% |
| Either Speech Or Hearing |
66 2/3% |
| Thumb And Index Finger Of The Same Hand |
33 1/3% |
| Four Fingers Of One Hand |
33 1/3% |
| Hearing In One Ear |
16 2/3% |
| All Toes Of One Foot |
12 1/2% |
| Use Of Both Arms Or Both Hands |
100% |
| Use Of One Arm Or One Leg |
75% |
| Use Of One Hand Or One Foot |
66 2/3% |
