Employee Group Life Insurance

Who Provides Our Life Insurance Benefits?

Aetna Life Insurance Company has been designated by the Trustees to provide group life insurance benefits for any participant who is eligible for coverage under the Welfare Fund. If you are an active covered participant and you die from any cause, your designated beneficiary will be paid $50,000.

Does Our Life Insurance Include Accelerated Death Benefits?

Yes, while covered under the Welfare Fund for Life Insurance you become terminally ill, you may request that Aetna pay an Accelerated Death Benefit (herein call ADB). Upon Aetna's approval of any such request, they will pay you up to 37,500 (75% of the life benefit of $50,000).

The benefit will also allow the participant to apply for this benefit if diagnosed wiht amyotrophic lateral sclerosis (a/k/a Lou Gehrig's Disease); end stage heart, 6, liver and/or pancreatic organ failure wherein the person is not a transplant candidate; a medical condition requiring artificial life support, without which the person would die; or a permanent neurological deficit resulting from a cerebral vascular accident (eg., stroke) or a traumatic brain injury which are both expected to result in life-long confinement in a Hospital or Skilled Nursing Facility. A terminal illness diagnosis requires the life expectancy must be no longer than 24 months. For the aforementioned named medical diagnoses, the life expectancy requirement does not apply.

The ADB program is very complicated. Contact the Fund Office for specific details regarding this benefit.

Can I Continue Life Insurance If I Fail To Remain Covered Under The Group Plan?

If your Welfare Fund coverage terminates, you may apply, without medical examination or other evidence of insurability, for an individual life insurance policy through Aetna Life Insurance Company. Your application for conversion and premium payment must be made within 31 days after the termination of your insurance. Contact the Fund Office for complete details.

Your group life insurance is payable if you die within the 31-day period following termination of insurance, whether or not you have applied for conversion to an individual policy.

What Is Accidental Death Or Dismemberment Insurance?

If, while you are insured, you are injured in a non-employment related accident and the accident is the sole cause of the injury, the injury is the sole cause of the covered loss and the covered loss occurs within one year of the date of accident, you or your beneficiary will receive the following benefits:

The Loss Must Result From And Occur Within One Year Of The Accident.

Accidental dismemberment benefits are payable to the participant, but life insurance and accidental death benefits will be paid to your designated beneficiary.

Only one of the above amounts, the largest, will be paid on an Accidental Death or Dismemberment claim which results from one accident. No more than $50,000 is payable for all losses resulting from the same accident. The benefit for Accidental Death is in addition to your basic life insurance benefit.

Additional Accidental Death Benefits

The following are additional benefits and will be payable if, while insured, a participant suffers a bodily injury by accident and if, within 365 days after accident, he or she suffers a loss of life solely as a direct result of the accident.

1. Passenger Restraint and Airbag Benefit:
   If a covered loss of life of the participant occurs as a direct result of a motor vehicle accident and the insured is properly using a passenger restraint and (if the driver) is properly licensed, a benefit will be payable. If an airbag is activated as a result of the same accident, an additional benefit will be payable. Passenger restraint and airbag usage will require verification. The benefit provides for $10,000 for use of a passenger restraint and an additional $5,000 if an airbag is activated.
2. Education Benefit for Dependent Child and/or Spouse:
   If a loss of life of the participant occurs as a direct result of an accident, an education benefit will be payable on behalf of each dependent child and/or a surviving spouse for a maximum of 4 years from the date of death, with verification of continued entitlement. The benefit provides for an annual maximum of $1,000.
   
   A dependent child means a child who is, your biological child, or your adopted child, or your stepchild, any other child you support that lives with you in a parent-child relationship, and, for the purpose of this benefit, is an unmarried, full-time student and is attending school, up to and including the last grade of high school, or is under the age of 23 and attending college or trade school on a regular basis at the time or your death, or enrolls in college or trade school within 365 days after the claim has been approved.
   
   The Education Benefit will be payable to the dependent child if that child has attained the age of majority. Otherwise, the Education Benefit will be payable to the guardian of the estate of the minor, or to the Custodian under the Uniform Transfer to Minors Act, or an adult caretaker, when permitted under applicable state law.
3. Child Care Benefit:
   If you suffer a loss of life solely as a direct result of an accident, a Child Care Benefit may be payable with respect to any dependent child enrolled in a legally licensed child care center. The benefit, not to exceed $600 per year, is payable for a maximum of 4 years from the date of death.
   
   For the purposes of this benefit, a dependent child means a child who is under age 13 and is enrolled in a legally licensed child care center on the date of the accident or subsequently enrolled in a legally licensed child care center within 90 calendar days after the date the claim is approved and is either your biological child, or your adopted child, or your stepchild, or any other child you support who lives with you in a parent-child relationship.
   
   The Child Care Benefit will be payable to the guardian of the estate of the minor, or to the Custodian under the Uniform Transfers to Minors Act, or an adult caretaker, when permitted under applicable state law.
4. Repatriation of Remains Benefit:
   This Plan pays a Repatriation of Remains Benefit for the actual expenses incurred to prepare a person's body for transportation to a mortuary if, as a direct result of an accident for which a benefit is payable under this section, he or she suffers loss of life while outside a 200 mile radius from his or her principal place of residence. The maximum benefit payable is $5,000.
5. Coma Benefit:
   If a covered participant suffers a bodily injury caused by an accident and as a direct result becomes comatose, a monthly benefit of $1,000 of the Principal Sum less any benefit amount paid or payable because of the same accident will be payable for 11 months after the person has been continually comatose for at least 30 consecutive days. After 12 months of continuous coma, the full Principal Sum less any benefit amount paid or payable because of the same accident is payable.

Exclusions

Accidental Death or Dismembermetn insurance benefits will not be paid for any covered loss which in any way resulted from, or was casued or contributed to by, any of the following:

• a bodily or mental infirmity.
• a disease or bacterial infection.*
• medical or surgical treatment.*
• suicide or attempted suicide.
• an intentionally self-inflicted injury.
• a war or any act of war (declared or not declared).
• commission of or attempt to commit a felony.
• use of alcohol, intoxicants, or drugs, except as prescribed by a physician. An accident in which the blood alcohol level of the operator of a motor vehicle meets or exceeds the level at which intoxication would be presumed under the law of the state where the accident occurred shall be deemed to be caused by the use of alcohol.
• air or space travel. This does not apply if a person is a passenger, with no duties at all, on an aircraft being used only to carry passengers (with or without cargo).

• These do not apply if the loss is caused by:

  • An infection which results directly from the injury.

  • Surgery needed because of the injury.

  • Medical malpractice

The injury must not be one which is excluded by the terms of this section.

In the event that you die while covered in the Welfare Fund, your named beneficiary will receive $50,000 in Employee Group Life Insurance. The Employee Group Life Insurance is administered through AETNA. 

The proceeds will be paid to your named beneficiary, as designated and recorded on the beneficiary card in the Fund Office.

Beneficiary: You may name anyone you wish as your named beneficiary and you may change your beneficiary at any time by filling out a new beneficiary form. These forms may be obtained by calling or writing the Fund Office or via the forms section of this website.

Conversion Privilege: If your insurance: (1) terminates because: (a) you are no longer a member of the classes eligible; or (b) your employment terminates; or (2) is reduced on or after your attainment of age 60 in any increment or series of increments aggregating twenty percent or more of the amount of coverage in force before the first reduction on account of such age, you may convert to an individual contract of life insurance.

You must make written application for such contract and pay the first premium within 31 days after insurance ceases. A medical examination is not required. You may choose to convert to an amount equal to, or less than, the amount which terminated under this Plan. Such insurance will be on one of the forms then being written by ULLICO, except term or disability insurance.

The premium for such contract will be based on: (1) your age; (2) the class of risk to which you belong; and (3) the amount of insurance.

The covered contract may, if you choose, be preceded by term insurance for not more than one year. You may also convert to an individual contract of life insurance if your insurance terminates because: (1) this Plan terminates; or (2) the insurance on the class to which you belong terminates. You will have the right to convert under the same conditions and limitations as set forth above. However, the amount of such individual contract will not be more than the amount of the insurance on your life on the date of termination less any amount of life insurance for which you may become eligible under any group contract within 45 days after the date insurance ends. The individual life insurance contract will be effective at the end of the 31 day period; the premium must be paid before that period ends.

Limitation: A Person who holds an individual contract of life insurance obtained through exercise of this conversion privilege will not be entitled to exercise the conversion privilege a second time, even if he is otherwise eligible, as long as such individual contract of life insurance remains in force, unless he provides evidence of good health satisfactory to the Company. The effective date of such individual contract shall be designated by the Company.

Extension of Coverage upon Termination: If you die within such 31 days from the date your group coverage is terminated the company will pay your Life Insurance Benefits as though you were still insured under the group plan.

Filing for Benefits: To obtain benefits hereunder, a claimant must contact the Fund to obtain the required claim forms. The claim form must be completed and then returned to the Fund Office together with proof of death or disability within 12 months of the date of death. Failure to file with prescribed period may be grounds for denying the claim unless the claimant can show good cause for non compliance within the prescribed time period.

Claims Appeal Procedure: If you disagree with the disposition of a claim, you may request a review. Please refer to the Claims Appeal Procedure described in this booklet.

Accidental Death And Dismemberment Insurance

Upon receipt of proper proof of loss, Accidental Death and Dismemberment (AD&D) benefits will be paid if: a participant, while covered, suffers a non-employment related accidental injury as a direct result of the accident, and independent of all other causes, suffers a "covered loss" within 365 days after the accident.

A "covered loss" is defined as a permanent loss of: life, a hand by severance at or above the wrist joint, a foot by severance at or above the ankle joint, an eye involving irrecoverable and complete loss of sight, two or more phalanges of both the thumb and index finger from one hand, hearing involving irrecoverable and complete loss of hearing in both ears, speech involving irrecoverable loss of speech, quadriplegia involving irrecoverable and complete loss of use in all four limbs, paraplegia involving irrecoverable and complete loss in both legs and lower trunk, or hemiplegia involving irrecoverable and complete loss of use of one side of the body.

The amount of benefit to be paid for a "covered loss" is as follows:

• Life: 20,000
• Two Hands: 50,000
• Two Feet: 50,000
• Sight of Two Eyes: 50,000
• One Hand and One Foot: 50,000
• One Hand and Sight of One Eye: 50,000
• One Foot and Sight of One Eye: 50,000
• One Hand or One Foot: 25,000
• Sight of One Eye: 25,000
• Thumb and Index Finger of Same Hand: 12,500
• Speech and Hearing: 50,000
• Speech or Hearing in Both Ears: 25,000
• Quadriplegia: 50,000
• Paraplegia: 25,000
• Hemiplegia: 25,000

If a covered participant suffers more than one loss in any one accident, the benefit shall be made for the loss for which the largest amount is payable.