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Complete the
Personal Accident Insurance Enrollment Form. Be sure to indicate the following:
Monthly or Bi-Weekly Payroll Deduction - Individual or Family Plan - Your Principal Sum Amount.
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Indicate the full name of your beneficiary and his/her relationship to you. |
3. |
Return the completed enrollment form to
the Duke Benefits office. |
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Personal Accident Insurance
This is an accidental death & dismemberment (AD&D) insurance plan. It pays a
benefit based upon a schedule of benefits in the event of accidental death,
dismemberment, or permanent total disability as the result of an accident.
Individual or family coverage may be purchased in $10,000 increments or as a
multiple of annual salary, with a minimum of $50,000 in coverage to a maximum of
10 times annual salary (up to $750,000). This is a voluntary, employee paid
program and is paid through payroll deduction. Active employees, faculty, and
House Staff, regularly scheduled for at least 20 hours per week are eligible to
participate. This coverage terminates at retirement or termination of
employment.
Eligibility
Employees that fall into one of the following classes are eligible:
Class 1: All active full-time (working 20 hours or more per week) employees of the Policyholder, including those Duke
University employees while serving in the Medical Unit for Life Flight, who are U.S. citizens, lawful permanent resident
(resident aliens) on U.S. payroll or a non-resident alien on U.S. payroll. Eligible dependents of this class of employees
can also be covered.
Class 2: All individuals on Policyholder approved leaves of absence for the following reasons: Long Term Disability,
Medical and Personal Leave for up to one year and Sabbatical Leave for up to two years as long as the appropriate premiums
are paid.
Eligible dependents include your lawful spouse or domestic partner and dependent, unmarried children of you or your
spouse/domestic partner under age 19 (under age 26 if enrolled as a full-time student in an accredited college or university).
Also included are any legally adopted and foster children as long as they are dependent on you for support.
No eligible person may be covered more than once under this Policy. If they are covered as an Employee, they cannot also
be covered as a dependent of another Employee.
Coverage
This plan offers protection on a worldwide basis, 24 hours a day, 365 days a year against any covered accident in the course
of business or pleasure, including accidents on or off the job, in or away from the home, commuting, traveling by train, airplane,
automobile or other private and public conveyances. It also covers accidents while riding as a passenger (not as a pilot or member
of a crew) and getting on or off: (a) any licensed civilian aircraft or its foreign equivalent; (b) any transport-type aircraft
operated by the Military Airlift Command, the Department of National Defence (Canada) and the Royal Air Force Air Transport Command
of Great Britain; or (c) any aircraft of the United States Department of Defense, other than a single-engine jet. The benefits
provided herein are payable in addition to any other insurance which may be in effect at the time of the accident.
NOTE: Coverage is provided to an Insured while serving in the Medical Emergency Unit for Life Flight. Flight crewmembers are independent
contractors, rather than Duke University employees, and are therefore not eligible
for coverage.
Benefit Amount - Choose the Protection Your Family Needs
The amount of insurance you select is called the "Principal Sum." You may select a Principal Sum amount from a minimum of $50,000
to a maximum of $750,000* in $10,000 increments.
*Principal Sum amounts over $200,000 are subject to ten (10) times your annual salary.
If you select a Family Plan, your spouse's benefit will be 60% of your Principal Sum and the benefit for each child (no matter how
many) will be 20% of your Principal Sum.
NOTE: Coverage for your Spouse and/or children cannot be purchased on a "stand alone" basis. Employee participation in the program
is required in order to purchase coverage for your eligible dependents.
Benefits
Accidental Death and Specific Loss*
When you or a dependent suffers any of the following specific losses because of injuries within 12 months from the date of the
accident, we will pay for loss of:
Life |
Principal Sum |
Both Hands or Both Feet or Both Eyes |
Principal Sum |
One Hand and One Foot |
Principal Sum |
One Hand and One Eye or One Foot and One Eye |
Principal Sum |
Speech and Hearing |
Principal Sum |
One Hand or One Foot or One Eye |
One-half Principal Sum |
Speech or Hearing |
One-half Principal Sum |
Thumb and Index Finger of the Same Hand |
One-fourth Principal Sum |
If you or your covered dependent suffers multiple losses due to the same accident, only one benefit amount - the largest to which
you are entitled - is payable. Loss of hand, hands, foot or feet means actual severance at or above the wrist or ankle joint. Loss
of eye or eyes, speech or hearing means total, uncorrectable and irrecoverable loss of the entire sight, speech or hearing.
*Accidental Death and Specific Loss Benefits for Insureds age 70 and over shall be payable according to the following schedule:
- Insureds ages 70 through 74 receive 82.5% of their original Principal Sum amount.
- Insureds ages 75 through 79 receive 57.5% of their original Principal Sum amount.
- Insureds ages 80 through 84 receive 37.5% of their original Principal Sum amount.
- Insureds ages 85 and over receive 20.0% of their original Principal Sum amount.
Permanent Total Disability Benefits
If injuries result in your total disability within 365 days from the date of the accident and continues for 12 consecutive months,
and it is then documented with medical evidence to be permanent, we will pay an amount equal to your Principal Sum less any amount
paid or payable under the Benefits for Specific Loss section for a loss resulting from the same accident.
Benefits will end on whichever of the following dates occurs first: (a) your 70th birthday; (b) the date you cease to be engaged
on a full-time basis in a gainful work or service; or (c) the date your coverage terminates for any reason.
Seat Belt Usage
When you or a covered dependent receives injuries covered by the policy which result in loss of life, we will pay an additional
$25,000 if, at the time of the accident, you were the operator of or a passenger in a private passenger automobile and utilizing
a seat belt. Seat belt usage must be verified by a doctor, coroner, traffic officer or other person of competent authority.
Education Benefits
If a dependent child is enrolled in and attending either the 12th grade or an accredited college or university on the date of a
covered accident which results in your death, we will pay 5% of your Principal Sum not to exceed a maximum of $10,000 per child
per year, for each year of full-time uninterrupted college or university attendance completed during the four consecutive years
following the child's graduation from the 12th grade. If, on the date of such covered accident, Dependent Children are insured
under the Policy or Certificate but none qualify for Education Benefits, a benefit of $5,000 is payable to your designated beneficiary.
Surviving Spouse Training Benefit
If you have family coverage and suffer loss of life in a covered accident, we will pay your surviving spouse within 54 months
from the date of the accident, the expense incurred while enrolled in any college, university, licensed professional or trade
school training program not to exceed 5% of your Principal Sum. This benefit is payable provided the spouse has: (a) enrolled
for the purpose of obtaining an independent source of support or maintenance; (b) successfully completed the program; and (c)
received a certificate or degree upon completion.
Common Accident Benefit
In the event both you and your dependent spouse die due to injuries resulting from the same accident or within 24 hours of
each other if different accidents, your spouse's Principal Sum will be 100% of your Principal Sum.
Premium Waiver
If you, due to a covered injury, suffer loss of life, coverage for any insured dependents will continue without premium
payment until whichever of the following occurs first: (a) the date your spouse remarries; (b) the date the insurance
terminates; (c) the date an unmarried dependent child ceases to be eligible due to age or marriage; or (d) the date the
12-month Benefit Period ends.
HIV Occupational Accident Benefit
If the Insured suffers injuries due to a covered accident while performing his or her duties causing him or her to acquire
and test positive for Human Immunodeficiency Virus (HIV) and/or AIDS Related Complex (ARC), within one year of the covered
accident, We will pay 1% of the Insured's Principal Sum subject to a maximum of $5,000 in equal monthly installments for 24
months. Benefits will terminate at the end of the month in which the Insured dies or the date on which We have paid the Benefit
Amount, whichever occurs first.
Continuation of Medical Coverage
If the Insured's surviving dependent spouse and/or child elect to continue medical coverage under the Consolidated Omnibus
Reconciliation Act of 1985 (COBRA) or any applicable state continuation law, We will pay an annual benefit amount of 3% of
the Insured's Principal Sum up to $3,000 for a three year period.
Exposure and Disappearance
An Insured will be presumed to have suffered a covered loss due to covered injuries, if while insurance is in effect he
or she suffers exposure to the elements. An Insured will be presumed to have died if, while insurance is in effect and
after the forced landing, stranding, sinking or wrecking of a covered vehicle: (a) he or she disappears; (b) his or her
body is not found within 52 weeks of the accident; and (c) a valid death certificate is issued by a court of appropriate
jurisdiction.
Exclusions
This plan does not cover: (a) suicide or any attempt thereat while sane or insane; (b) loss caused by an act of declared
or undeclared war; (c) injuries received while participating in training exercises or maneuvers of an armed service while
a member of an armed service; (d) injuries received while traveling by air (except as provided under the Coverage section);
(e) injuries received because the Insured person was under the influence of any controlled substance unless administered
on the advice of a physician; (f) injuries received because the Insured person was intoxicated while driving a motor vehicle.
Payment of Claims
Benefits for an Insured's loss of life will be paid to their beneficiary (their estate if no beneficiary is named).
Termination Date of Coverage
Your insurance will end the first of the following dates: (a) the date you cease to be eligible; (b) the date any premium
is due and unpaid, subject to the grace period; or (c) the date the policy terminates.
Premium
The monthly premium for each $10,000 unit of Principal Sum is:
- Individual Plan: $0.27
- Family Plan: $0.47
This insurance plan is underwritten by:
Mutual of Omaha Insurance Company
Mutual of Omaha Plaza
Omaha, NE 68175
Home Office: Omaha, Nebraska
mutualofomaha.com
Duke reserves the right, in its sole discretion, to modify, suspend or
terminate this program at any time, for any reason.
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