Hartford PT - AD&D - Schedule of Insurance

Schedule of Insurance

Cost of Coverage

Non-Contributory Coverage: Basic Accidental Death and Dismemberment Insurance

Eligible Class(es) For Coverage

All Part-Time Active Employees who are citizens or legal residents of the United States, its territories and protectorates, excluding temporary, leased or seasonal Employees.

Part-time Employment: All Part-time Active Employees covered by a Collective Bargaining Agreement and all Part-time Active Employees working for Teamsters Union Local 170, Teamsters Local 170, Health & Welfare Fund or Local 170 Teamsters Federal Credit Union who have accumulated 400 hours of credited employment within a 6 month continuous period and who continue to contribute 250 hours per quarter to maintain coverage, provided the appropriate contributions have been made to the fund.

Accidental Death and Dismemberment Benefit (AD&D)

Basic AD&D Principal Sum

Principal Sum Amount

Additional Benefits

Seat Belt Coverage
Seat Belt Benefit Amount: 100% of Principal Sum to a maximum amount of $25,000
Minimum Benefit: $1,000

Repatriation Benefit
Maximum Amount: $5,000

Child Education Benefit
Maximum Amount: $3,000
Percentage of Principal Sum: 100%
Minimum Amount: $1,000

Waiver of Premium

Conversion Right
Conversion Limit: $25,000