Group Basic Life and AD&D Insurance
Each Active Full‐Time Employee of a participating Employer working 30 or more hours per week, except any person working on a temporary or seasonal basis.
Basic Life and AD&D: A choice of $15,000 $20,000 or $25,000
Coverage is employer-paid
|Age||Original Benefit Reduced To|
- Living Benefit Rider (expressed as Accelerated Death
- Benefit in some states and Imminent Death Benefit in PA)
- Air Bag Benefit
- Conversion Privilege
- FMLA/MSLA Continuation
- Seat Belt Benefit
- Waiver of Premium
- Bereavement Counseling Service
- Travel Assistance Service
|For Accidental Loss of:||Amount Payable|
|Both hands or both feet||100%|
|Sight of both eyes||100%|
|One hand and one foot||100%|
|One hand and sight of one eye||100%|
|One foot and sight of one eye||100%|
|Speech and hearing||100%|
|One hand or one foot||50%|
|Sight of one eye||50%|
|Speech or hearing||50%|
AD&D benefits will not be payable for a loss: caused by suicide or intentionally self‐inflicted injuries; caused by or resulting from war or any act of war, declared or undeclared; to which sickness, disease or myocardial infarction, including medical or surgical treatment thereof, is a contributing factor; sustained during an insured’s commission or attempted commission of an assault or felony; to which the insured’s acute or chronic intoxication is a contributing factor; or to which the insured’s voluntary consumption of an illegal or controlled substance or a non‐prescribed narcotic or drug is a contributing factor. For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS‐6422, et al.
Basic Life and AD&D Insurance Premium Table
Plan Holder: Professional Insurance Agents of Wisconsin
Scheduled Benefit: Each eligible employee may elect an amount of insurance shown in the table below.
Benefit amounts are reduced according to the age-based reduction chart shown in the Life/AD&D brochure.
- Determine the age band: Employee age = Employee age at their last birthday.
- Select a benefit amount.
- Rates change as insured moves from one age bracket to the next
|Benefit Amount||Age 18-34||Age 35-39||Age 40-44||Age 45-49||Age 50-54||Age 55-59||Age 60-64||Age 65-69||Age 70+|