Voluntary Accidental Death & Dismemberment Insurance

COVERED LOSS*	BENEFIT RECEIVED
Life Two or more hands or feet Both upper and lower limbs (quadriplegia)** Loss of one hand or one foot and sight in one eye Loss of speech and hearing in both ears	100% of the principal sum
Loss of one hand or one foot, uniplegia (paralysis of one limb) Both lower limbs (paraplegia)** Upper and lower limbs on one side of the body (hemiplegia)** Speech Hearing in both ears	50% of the principal sum
Thumb and index finger of the same hand All four fingers of the same hand Loss of all toes of the same foot	25% of the principal sum

* A participant's loss must occur within 365 days of the date of the accident. "Member" means hand, foot or eye. "Loss of a hand or foot" means complete severance through or above the wrist or ankle joint. "Loss of sight" means total, permanent and irrevocable loss by natural, surgical or artificial means. "Loss of speech" means total, permanent and irrevocable loss of audible communication. "Loss of hearing" means total and permanent loss of hearing in both ears which cannot be corrected by any means. "Loss of a thumb and index finger" means complete severance through or above the metacarpophalangeal joints (the joints between the fingers and the hand).

** These injuries - or paralyses - mean the loss of use, without severance, of a limb. Such a loss must be determined by a doctor to be complete and not reversible.

If more than one loss is sustained by an Insured Person as a result of the same accident, only one amount, the largest will be paid. 

VAD&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, then an accidental burn and disfigurement benefit will be paid.

1. 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;
2. a Physician must determine that the burn satisfies all of the following:
   • involves the minimum percentage shown below;
   • be classified as shown below; and
   • results in disfigurement or loss of physical abilities.
     • 75-100% Body Disfigurement = 100% of the Principal Sum
     • 50-74% Body Disfigurement = 50% of the Principal Sum
     • 25-49% Body Disfigurement = 10% of the Principal 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.

Bereavement/Trauma Counseling — If a participant suffers a covered loss, the plan will pay a benefit for bereavement and trauma counseling equal to $150 per session for a maximum of 10 sessions. The participant and/or his or her immediate family members are eligible.

Brain Damage — If a participant becomes brain damaged within 30 days and as a result of a covered accident, the plan will pay 100% of the principal sum. The participant 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 months.

If, after 12 months of continuous brain damage, a physician determines that the participant 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.

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 employee 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.

Child Care Center Benefit — If a covered person dies as the result of a covered accident, the plan will pay child care center benefits for each covered dependent under age 13 equal to 10% of the employee's benefit amount, to a maximum of $5,000 a year. The plan will pay benefits for five consecutive years, or until the child turns age 13, whichever happens first. To receive benefits, the covered child must be enrolled in a child care center on the date of the covered person's death or enrolls within 365 days after the participant's date of death.

If, at the time of the accident, coverage for a dependent child is in force but there is no dependent who qualifies, the plan will pay a benefit of $1,500 to the participant's beneficiary.

"Child care center" means a facility that is licensed; is operated according to law, including laws and regulations applicable to child care facilities; and provides care and supervision for children in a group setting on a regular daily basis. It does not include hospitals, the child's home or care provided during normal school hours while a child is attending grades one through twelve.

Common Accident Benefit — If a covered person dies as a result of a common accident and are survived by one or more dependent children, the spouse's or registered domestic partner's benefit amount will increase to 100% of the employee's principal sum, to a maximum of $500,000. "Common accident" means the same or separate accidents occurring within the same 24-hour period.

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 and the principal sum will be paid.

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.

Home Alterations and Vehicle Modifications — If a participant 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.

Increased Dependent Child Dismemberment Benefits — If a covered person's covered child suffers a covered accidental injury, the plan will pay 100% multiplied by the percentage of the Child's Principal Sum applicable to the covered loss, to a maximum of $100,000. If the child subsequently dies within 365 days of the same covered accident, the loss of life benefit will not be reduced by the dismemberment benefit received under the increased dependent dismemberment benefit.

If a covered child sustains more than one covered loss from a single covered accident, the plan will pay double the benefit amount only for the largest amount to which the child is entitled.

Insurance Continuation Expense Benefit - The insurance provider will pay 3% of the Employee’s Principal Sum, up to a $3,000 Maximum Benefit per year for up to a Maximum Benefit Period of 3 years, if a surviving covered Spouse or Registered Domestic Partner or a surviving covered Dependent Child(ren) elects to continue group medical and dental insurance provided by the Employer of an Employee who died, subject to all of the following conditions and exclusions:

1. the covered Employee’s death results directly and independently of all other causes from a Covered Accident;
2. the covered Employee is survived by a covered Spouse or covered Dependent Child(ren) who was insured under this Policy on the date the employee died;
3. the covered Spouse or covered Dependent Child(ren) is also covered under a medical or dental plan sponsored by the Employer at the time of the covered Employee’s death;
4. the covered Spouse or covered Dependent Child(ren) notifies Us of their election, within 60 days of the covered Employee’s death, to continue their existing coverage under group insurance plans sponsored by the Subscriber as permitted by state or federal continuation law.

This benefit, payable annually, equals premiums required to continue insurance described above, as long as the total of Insurance Continuation Benefits paid for a surviving Spouse or Registered Domestic Partner and/or Dependent Child(ren) does not exceed the Maximum Benefit. The benefit will be paid at the end of each year during which medical and dental insurance is continued, if this insurance provider receives a request for reimbursement and proof of premiums paid during that year. Benefits will continue to be paid until the earliest of the following dates:

1. the date a surviving Spouse or Registered Domestic Partner and/or surviving Dependent Child(ren) is no longer eligible to continue medical and dental insurance coverage;
2. the date Insurance Continuation Expense Benefits paid total the Maximum Benefit; and
3. the end of the Maximum Benefit Period

Benefits are payable to the surviving covered Spouse or Registered Domestic Partner, or the person who actually paid the premium on the surviving covered Spouse’s or Registered Domestic Partner’s or Dependent Child(ren)’s behalf, if other than the surviving covered Spouse or Registered Domestic Partner.

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 minus any amounts paid for covered losses or paralysis.

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 the Policyholder, Subscriber; or 
4. is not giving or receiving flight instruction.

Rehabilitation — If a participant suffers a covered loss due to an accident, the plan will pay a benefit equal to 20% of the principal sum, to a maximum of $10,000, for covered rehabilitative expenses. Rehabilitative expenses must be incurred within two years of the covered accident.

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.

In the case of a child, "seat belt" means a child restraint — as required by state law and approved by the National Highway Traffic Safety Administration — that is properly secured at the time of the accident and is being used as recommended by its manufacturer for children of like age and weight.

Additionally, New York Life Group Benefit Solutions will pay an additional 10% of the covered person'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 Assistance — 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.

Special Education Benefit — If an employee elects family coverage, VAD&D Insurance will pay an additional benefit for education assistance, as follows: :

• For an employee's covered spouse or registered domestic partner: The plan will pay an additional 10% of the employee's principal sum, to a maximum of $10,000, for up to three years when the spouse or registered domestic partner enrolls in any accredited school within one year of the employee's death. Enrolling in school must be for the purpose of retraining or refreshing skills needed for employment. The spouse or registered domestic partner must incur expenses that must be paid directly to, or approved and certified by, the same school.
• For an employee's covered dependent children: The plan will pay an additional 10% of the employee's principal sum, to a maximum of $10,000, for up to four consecutive years when the child enrolls as a full-time student before age 26. The school must be a college, university, or other institute of higher education. The expenses of higher education should be related to tuition, fees, books, room and board, and transportation, and must be paid directly to, or approved and certified by, the same school.

If the employee does not have a qualifying dependent for the Education and Training Benefit, $1,000 will be paid to the employee's beneficiary. 

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 applicable to 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.

VAD&D Insurance will not pay benefits if a loss results, directly or indirectly, from or is caused by:

• Intentionally self-inflicted injuries, suicide or any 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 wound 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.