AD&D Benefit Summary

Benefit Summary - FOR LOSS OF

Life

Full Benefit Amount

Both arms & both legs

Full Benefit Amount

One arm & one leg

Full Benefit Amount

Speech & one of: hand, foot or sight of one eye

Full Benefit Amount

Use of both arms & both legs

Full Benefit Amount

Both hands, both feet, or sight of both eyes

Full Benefit Amount

Hearing & one of: Hand, foot or sight of one eye

Full Benefit Amount

Use of both arms or both legs

75% Benefit Amount

Use of one arm and one leg

75% Benefit Amount

One arm or one leg

50% Benefit Amount

One hand or one foot or sight of one eye

50% Benefit Amount

Speech or hearing

50% Benefit Amount

Use of one arm or one leg

50% Benefit Amount

Use of both hands or both feet or a combination of hand and a foot

50% Benefit Amount

Use of one hand or one foot

25% Benefit Amount

Thumb & index finger of same hand

25% Benefit Amount

Other Benefits:

Permanent Total Disability

Covers Employee Only

Special Education Benefit

Covers Employee Only

Hospital Benefit

Covers Employee Only

Seatbelt Benefit

Covers Employee Only

Felonious Assault Benefit

Covers Employee Only

Common Disaster Survivor's Benefit

When spouse is also injured

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