AD&D benefits are available if you are covered under the Active Plan of benefits through employer contributions or Self-Pay. The policy provides a benefit payment for your loss of life, limbs, or the entire and irrecoverable loss of sight, including such losses resulting from occupational injury or accidents. Benefits are payable if the loss results directly from bodily Injuries sustained solely through accidental means and occur within 90 days after the date of the accident causing the loss.

No more than the amount of one principal payment is payable for multiple Injuries or death.

Life Insurance and AD&D benefit amounts payable to a beneficiary differ depending on how you maintain coverage.

Life Insurance

	Eligible Participant	Spouse	Child
Policy Amount	$50,000	$2,500	$2,000

Accidental Death & Dismemberment Insurance

For eligible employees only

Type of Loss	Benefit Amount	Type of Loss	Benefit Amount
Life	$50,000	Both feet	$50,000
One hand and one foot	$50,000	Both hands	$50,000
One foot & sight in 1 eye	$50,000	Sight in one eye	$25,000
One hand & sight in one eye	$50,000	One foot	$25,000
Sight in both eyes	$50,000	One hand	$25,000
Hearing, both ears/Speect	$50,000	Thumb and index finger	$12,500

Complete a Beneficiary Designation Form. Changes can be made to your designation at any time and take effect as of the date the form is received by the Fund Office.

If any designated beneficiary dies before you, the share that he or she would have received will be payable equally to the remaining designated beneficiary or beneficiaries, if any, that survive the participant; and if no designated beneficiary survives you or if no beneficiary has been designated, payment will be made to:

• Your widow or widower, if surviving you; or
• if no spouse survives you, in equal shares to your children that survive you; or
• if no children survive you, to your living parents equally, or to the surviving parent; or
• if neither parent survives you, in equal shares to your brothers and sisters who survive you; or
• if no siblings survive you, to your estate.

The insurance company may deduct from the amount payable an amount to be applied for funeral and other expenses related to your last illness and death, but only when benefits have been properly assigned by the beneficiary. Funeral homes are familiar with the process of benefits assignment and can help you with the necessary paperwork.

Contact the Health Benefits Department at 312-787-9455, phone option 3, Monday through Friday from 8:00 a.m. to 4:30 p.m. (CT) to report a death and request an application. Please be aware that the process may take 4-6 weeks before payment is received.

If you become totally and permanently disabled while you are eligible for the life insurance benefit and before you reach age 60, you may apply for a waiver of premium. If approved, the Health Fund will continue your life insurance benefit by paying the required premium as long as you remain disabled and the group policy remains in force. You and your doctor must first file proof of total and permanent disability with the Fund Office within three (3) months after loss of eligibility. The Health Benefits Department will work with you to complete the application.

If approved by The Hartford, continued proof of disability will be required on a regular schedule, but not less than once a year. Life insurance on waiver of premium will be discontinued in the event that annual proof of disability is not provided, or if Hartford finds that the disability no longer qualifies as total and permanent. In either event, the group policy is discontinued, your life insurance benefit will terminate.

Applying or qualifying for a disability benefit with the Pension Fund does not constitute application for this Disability Death Benefit extension.

Contact the Health Benefits Department at 312-787-9455, phone option 3, Monday through Friday from 8:00 a.m. to 4:30 p.m. (CT) to report a death and request an application.