Accidental Death and Dismemberment - Frequently Asked Questions

When accidents occur, they can be financially, emotionally and physically devastating. Although employees have medical insurance to offset costs, and may have sick leave that is available to cover wages, most often there are still large out-of-pocket costs. Life insurance is a benefit if death occurs, but not if the injury leaves a person with permanent loss of use. An accident is just that, an accident. It is not something most people prepare for in advance, and the results can be catastrophic. To be better prepared for such an occurrence, members may consider purchasing Accidental Death & Dismemberment Insurance. Public Employees Health Program offers an Accidental Death & Dismemberment Program that provides benefits for death, permanent loss of use of limbs, speech, hearing or eyesight due to an accident on or off the job. Below are some of the most frequently asked questions about PEHP Accidental Death & Dismemberment Program.

• Who is eligible to enroll in PEHP’s Accidental Death & Dismemberment Program?
• How does an employee enroll in the Accidental Death & Dismemberment Program?
• When can an individual enroll in PEHP’s Accidental Death & Dismemberment Program?
• What options are available under PEHP’s Accidental Death & Dismemberment Program?
• What is the definition of a dependent?
• Is there a benefit if I am on active military duty, or flying an airplane?
• How do I submit a claim?
• Can the AD&D benefits be continued after termination of employment?

All employees who are offered PEHP’s Accidental Death & Dismemberment as part of their benefits package are eligible to enroll.

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Enrollment forms for the Accidental Death & Dismemberment program can be found in the employees new hire and/or open enrollment packets. They may also be obtained through their employers human resource department or by calling PEHP’s customer service department at 801-366-7555 or 1800-765-7347. Once the applicable form is obtained, simply fill out all requested information, including beneficiary information and return to PEHP.

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An individual can enroll in the PEHP Accidental Death & Dismemberment program at any time during the year. Changes in coverage can also be made throughout the policy year.

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Accidental Death, Dismemberment, Loss of Use and Loss of Sight Benefit

Accidental Death, Dismemberment, Loss of Use and Loss of Sight Benefit includes an individual option as well a family option. Under the individual plan an employee can select a principal sum ranging from $25,000 to $250,000. With the family option the principal amount the employee chooses would automatically insure the spouse for 40% of the employees principal sum and each eligible dependent is insured for 15% of the employees principal sum. If the employee has no dependent children, the spouse’s coverage increases to 50% of the employees principal sum. If an employee has no spouse, dependent children’s coverage would increase to 20% of the employees principal sum. These applicable benefits would be payable in the event of an accident on or off the job, that resulted in death, dismemberment or permanent loss of use of limbs, sight, hearing or speech.

Accident Weekly Indemnity Benefit

When an employee enrolls in the Accidental Death & Dismemberment coverage, they are eligible to purchase weekly indemnity coverage. This benefit is good only for the employee, for injuries incurred off the job only. Accident Weekly Indemnity coverage will provide a weekly income for up to 52 weeks if an employee is totally disabled due to an accident and unable to work. The eligible amount is based on the employees gross monthly salary at the time of enrollment. The employee may purchase a lower amount of coverage than their eligible monthly gross salary, but may not buy in excess of their eligible monthly gross salary.

Accident Medical Expense Benefit

This benefit is available to the employee only, when enrolled in the Accidental Death & Dismemberment program. The Accident Medical Expense Benefit will provide up to $2500 towards the cost of out of pocket medical expenses incurred due to an accident not job related.

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An employee’s covered dependents are his/her spouse to whom he/she is legally married, and children under the age of 26 who are unmarried and dependent upon employee for support.

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Exclusions to the AD&D plan include no payable benefit’s when the insured is participating in any act of war, active military, naval and air force duty, except as provided in the Reserve-National Guard provision. Benefits are not payable if you are on board for the purpose of piloting an airplane. (see the benefit exclusions listed in the AD&D hand book for a complete listing of exclusions)

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As soon as possible following the accident, notify Deanna Sleater at Continental Insurance Agency at 801-466-0805 or 1-888-466-0805. You will be asked for your name, address, Social Security Number, and the date the accident occurred. You will then be mailed a claim form to fill out, and complete instructions on how to proceed with your claim.

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PEHP’s Accidental Death & Dismemberment Program is available to actively working employees only.

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This is a brief summary of the excellent Accidental Death & Dismemberment benefits available to public employees and their families. Please refer to the Accidental Death & Dismemberment handbook or brochure for rate information and a more detailed summary of the benefits and exclusions. You may contact PEHP at 1-800-765-7347 or 1-801-366-7555 for more information.