Basic AD&D Insurance

Basic AD&D Insurance also pays additional benefits, including:

Accidental Burn and Disfigurement Benefit - If a covered person suffers a covered injury that leaves him/her disfigured, and that covered injury resulted directly and independently of all other causes from a covered accident, and the disfigurement satisfies the following conditions:

• reconstructive or cosmetic surgery is required to restore the employee’s physical abilities or correct disfigurement, and must be performed within twelve months of the covered accident;
• a Physician must determine that the burn satisfies all of the following:
  1. involves the minimum percentage shown below;
  2. be classified as shown below; and
  3. results in disfigurement or loss of physical abilities.
     • 75-100% Body Disfigurement = 100% of the Principle Sum
     • 50-74% Body Disfigurement = 50% of the Principle Sum
     • 25-49% Body Disfigurement = 10% of the Principle Sum
     • Burn Classification Third Degree

For purposes of this benefit: Disfigurement or Disfigured means spoiled or deformed appearance that can be corrected by means of reconstructive or cosmetic surgery.

Brain Damage — If a covered person becomes brain damaged within 30 days and as a result of a covered accident, the plan will pay 100% of the principal sum. The covered person must be hospitalized for treatment of the brain damage at least 7 of the first 30 days of the injury, and the brain damage must continue for at least 12 consecutive months.

If, after 12 consecutive months of continuous brain damage, a physician determines that the covered person is permanently and totally disabled due to the brain damage, benefits will be paid in a lump sum at the beginning of the 13th month following the original date of the injury. The amount payable will not exceed the AD&D principal sum for the covered person whose covered accident is the basis for the claim. 

Carjacking Benefits - If the covered person suffers a covered loss resulting directly and independently of all other causes from a covered accident that occurs during a carjacking of an automobile that the covered person was operating, getting into or out of, or riding in as a passenger. A carjacking benefit of 10% multiplied by the percentage of the principal sum applicable to the covered loss will be paid, up to a maximum of $25,000.

Verification of the carjacking must be made part of an official police report within 24 hours of the Carjacking, or as soon as reasonably possible, or be certified in writing by the investigating officer(s) within 24 hours or as soon as reasonably possible.

Felonious Assault and Violent Crime Benefit - If a covered person suffers a covered loss resulting directly and independently of all other causes from a covered accident that occurs during a violent crime or felonious assault as described below. A police report detailing the felonious assault or violent crime must be provided before any benefits will be paid. The covered accident must occur while the covered person is on the business or premises of the Employer.

To qualify for benefit payment, the covered accident must occur during any of the following:

1. actual or attempted robbery or holdup;
2. actual or attempted kidnapping;
3. any other type of intentional assault that is a crime classified as a felony by the governing statute or common law in the state where the felony occurred.

The insurance company will pay a hospital stay benefit, subject to the following conditions and exclusions, when the covered person suffers a covered loss resulting directly and independently of all other causes from a covered accident that occurs during a violent crime or felonious assault if all of the following conditions are met:

1. the covered person is covered for hospital stay benefits under this Policy;
2. the hospital stay begins within 30 days of the violent crime/felonious assault;
3. the hospital stay is at the direction and under the care of a Physician;
4. the covered person provides proof satisfactory to Cigna that his/her hospital stay was necessitated to treat covered injuries sustained in a covered accident caused solely by a violent crime or felonious assault;
5.  the Hospital Stay begins while the covered person’s insurance is in effect.

A felonious assault/violent crime benefit of 10% multiplied by the percentage of the principal sum applicable to the covered loss will be paid, up to a maximum of $25,000 as well as a hospital stay benefit of $100 per day to a maximum benefit period of 365 days per hospital stay, per covered accident.

Exposure and Disappearance Coverage - If a covered person suffers a covered loss which results directly and independently of all other causes from unavoidable exposure to the elements following a covered accident, the accidental death and dismemberment benefit will be payable. 

If a covered person disappears and is not found within one year from the date of the wrecking, sinking or disappearance of the conveyance in which the covered person was riding in the course of a trip which would otherwise be covered, it will be presumed that the covered person’s death resulted directly and independently of all other causes from a covered accident.

Home Alterations and Vehicle Modifications — If a covered person suffers a covered loss, other than a loss of life, due to an accident, the plan will pay a benefit equal to 10% of the principal sum, to a maximum of $10,000, for home alterations and vehicle modifications to accommodate the participant's injury.

This benefit will be payable if all of the following conditions are met:

1. Prior to the date of the Covered Accident causing such Covered Loss, the Covered Person did not require the use of any adaptive devices or adaptation of residence and/or vehicle;
2. As a direct result of such Covered Loss, the Covered Person now requires such adaptive devices or adaptation of residence and/or vehicle to maintain an independent lifestyle;
3. The Covered Person requires home alteration or vehicle modification within one year of the date of the Covered Accident.

Monthly Coma Benefit — If a participant is in a coma for at least 31 consecutive days as a result of an accident, a monthly coma benefit of 1% of the principal sum will be paid. This benefit will be paid until the participant's recovery, the 11th month of payment, or the participant's death, whichever is earliest.

If the participant dies while in a coma or remains comatose after 11 months of benefit payments, the plan will pay a lump sum to the participant's beneficiary equal to the principal sum.

Owned Aircraft Coverage – If the Covered Person suffers a Covered Loss that results directly and independently of all other causes from a Covered Accident that occurs during travel or flight in, including getting in or out of, any Aircraft that is owned, leased, operated or controlled by Leidos, Inc. or any of its subsidiaries or affiliates benefits will be payable.

Pilot Coverage – If a covered person suffers a covered loss resulting directly and independently of all other causes from a covered accident that occurs while the covered person is flying as a licensed pilot or member of the crew of an aircraft the accidental death and dismemberment benefit will be payable if the covered person meets the following requirements:

1. Completes and maintains a combined minimum of 200 hours of military, private or professional logged flight hours;
2. Is flying as a pilot or member of the crew of an Aircraft for which he is qualified and is on a list of eligible Aircraft maintained by the Subscriber, including a substitute Aircraft with no greater seating capacity while a listed Aircraft is withdrawn from normal use due to breakdown, repair, servicing, loss or destruction; 
3. Is flying as a pilot or member of the crew of an Aircraft that is not owned, leased, operated or controlled by Policyholder or Subscriber; or
4. Is not giving or receiving flight instruction.

Rehabilitation — If a covered person suffers a covered loss due to an accident, the plan will pay a benefit equal to 10% of the principal sum, to a maximum of $10,000, for covered rehabilitative expenses. The covered person must require rehabilitation within two years of the covered loss. 

Seat Belt(s) and Airbag Benefit — If a participant dies as a direct result of injuries sustained in a covered accident while driving or riding in an automobile and he or she was wearing a seat belt, New York Life Group Benefit Solutions will pay a seat belt benefit to the designated beneficiary.

The benefit will be at least $1,000, to a maximum of 25% of the participant's benefit or $25,000, whichever is less. A participant's beneficiary will receive the seat belt benefit if:

• The automobile the participant was driving/riding in was equipped with seat belts;
• The seat belt(s) was in actual use and properly fastened at the time of the covered accident; and
• The position of the seat belt(s) was certified in the official report of the covered accident or by the investigating officer. A copy of the police accident report must be submitted with the claim. If certification is not available but it is clear that the participant was properly wearing a seat belt, New York Life Group Benefit Solutions will pay the additional benefit. If, however, certification is not available and it is not certain that the participant was wearing a seat belt, then the benefit will be fixed at $1,000.

Additionally, New York Life Group Benefit Solutions will pay an additional 10% of the employee's, spouse's or registered domestic partner's benefit, to a maximum of $12,500, if a seat belt benefit is payable to him or her, and he or she was positioned in a seat that was protected by a properly functioning, original, factory-installed supplemental restraint system (airbag) that inflates on impact. 

Verification of the proper inflation of the supplemental restraint system at the time of impact must be part of the official accident report or be certified, in writing, by the investigating officers.

"Automobile" means a self-propelled, private passenger motor vehicle with four or more wheels that is of a type both designed and required to be licensed for use on the highway of any state or country. Automobiles include but are not limited to sedans, station wagons, sport utility vehicles, Jeep, pickups, vans, campers or motor homes. Automobiles do not include mobile homes or motor vehicles used for mass or public transportation.

No benefit will be paid if the accident causing the participant's death occurred as a result of participation in a race, or a speed or endurance test.

Secure Travel - New York Life Group Benefit Solutions Secure Travel is a comprehensive worldwide travel assistance program including pre-trip planning, assistance while traveling and emergency assistance. All of the program services are available when the covered person is traveling 100 miles or more from home. Services for medically necessary transport, return of dependent children, return of a traveling companion, visit of a family member/friend and repatriation of remains are covered by the program. Expenses for local ambulance or medical care are not covered under the program.

Terrorism Benefits — If a covered person suffers a covered loss caused directly and independently of all other causes while the victim of a Terrorist Act the amount payable is the Principal Sum multiplied by the percentage of the covered loss.

"Act of terrorism" refers to a hostile or violent act carried out by a group of persons having political, military or territorial goals, but who are not operating on behalf of a sovereign state. Their purpose is to compel an act or omission by any other person or any government entity.

War Risk Benefits — If a covered person suffers a covered loss of life or dismemberment due to war or an act of war, whether declared or undeclared, and such loss occurs within 365 days of the covered accident, benefits are payable. For more information about these benefits and any provisions, refer to the plan's certificate of coverage.

War risk benefits do not apply if the loss occurs in the United States or in any nation in which the covered person is a citizen.

Basic AD&D Insurance will not pay benefits for death or dismemberment resulting directly or indirectly from:

• Intentionally self-inflicted injury, or any such attempt, while sane or insane;
• Commission or attempt to commit a felony or an assault;
• Commission of or active participation in a riot or insurrection;
• Declared or undeclared war or act of war;
• Flight in, boarding or alighting from an aircraft or any craft designed to fly above the earth’s surface as follows:
  1. being flown by the covered person or in which the covered person is a member of the crew;
  2. being used for crop dusting, spraying or seeding, giving and receiving flying instruction, fire-fighting, sky writing, sky diving or hang-gliding, racing, stunt or acrobatic flying; or
  3. an ultra-light or glider;
  4. designed for flight above or beyond the earth’s atmosphere;
• Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or would or accidental ingestion of contaminated food;
• Travel in any aircraft owned, leased or controlled by Leidos, or any of its subsidiaries or affiliates. An aircraft will be deemed to be ''controlled'' by Leidos if the Aircraft may be used as Leidos wishes for more than 10 straight days, or more than 15 days in any year;
• Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;
• A covered accident that occurs while engaged in the activities of active duty service in the military, navy or air force of any country or international organization. Covered accidents that occur while engaged in Reserve or National Guard training are not excluded until training extends beyond 31 days;
• Operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant. Under the influence of alcohol, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the covered accident occurred.

Only one amount, the largest to which the employee is entitled, will be payable for all losses resulting from one covered accident.