High Limit Accidental Death and Dismemberment Insurance Plan

Accidental Death and Dismemberment Plan

SPE Group Insurance Program

Underwritten by New York Life Insurance Company

The Group High Limit Accidental Death and Dismemberment (AD&D) Insurance Plan is designed to help cushion the impact and protect you and your family from the financial effects of a covered accident with an affordable, high benefit safety net. It can be an easy, affordable way to help give your family extra financial protection—providing up to $500,000 in coverage—benefits your family could use if you are seriously injured or you die from a covered accident. seriously injured or you die from a covered accident.

Plan Information

Eligibility Requirements

You are eligible to apply for this Plan if:

  • you are a member of the Society of Petroleum Engineers
  • you are under age 70, and
  • you are a resident of the United States.

Note: Due to state regulations, this Plan is not available in SD, VT, and WA.

You can also apply for coverage for your spouse or domestic partner under age 70 and any unmarried dependent children under age 25.

A dependent that is also a member is eligible for either member or dependent coverage, but not both. If both spouses/domestic partners are covered as members, neither may insure the other as spouse/domestic partner and only one may insure eligible children.

Plan Features

Benefits of the Plan

You may choose benefit levels in increments of $50,000 to $500,000 for yourself and from $50,000 to $250,000 for your spouse/domestic partner as long as the amount of their benefit does not exceed yours. You may cover all eligible children for $10,000 each for one premium.

This Plan Provides Benefits in Two Ways

1. Payment in lump sum...

For a covered accident the benefit will be paid as follows:

100% for:

  • loss of life
  • loss of two limbs
  • loss of movement of both upper and lower limbs (quadriplegia)
  • loss of sight in both eyes
  • loss of both speech and hearing
  • loss of one limb and the sight of one eye

75% for:

  • loss of movement of both lower limbs (paraplegia)

50% for:

  • loss of one limb
  • loss of movement of both upper and lower limbs on one side of body (hemiplegia)
  • loss of sight in one eye
  • loss of speech
  • loss of hearing

25% for:

  • loss of thumb and index finger of either hand (same hand)

Definition of Loss: Loss of sight, speech, or hearing means the total and permanent loss. Loss of limb means severance through or above the wrist or ankle. Loss of thumb and index finger means severance through or above the metacarpophalangeal joints. Loss of movement of limbs means total and permanent paralysis of such limbs.

For each insured person while covered under the Policy, the maximum payable is no more than one benefit, the largest benefit, for all losses to the same limb or related to any one accident. No more than the maximum benefit will be paid for all injuries due to any one accident, except as described in the Policy.


2. Monthly Payments for Disability...

If you become totally disabled due to a covered accident, the plan will pay 1% of the benefit you selected up to $300,000. You can receive these monthly benefits for up to 100 months.

A covered accident is one which causes injury 1) as a direct result and within 365 days of the accident’s occurrence, 2) while you are insured under the policy, and 3) which is independent of disease or sickness. The permanent and total disability benefit is described fully in the Certificate of Insurance.


Valuable Benefits Prior to Age 70

Common Carrier Benefit

If a covered accident occurs while you are a passenger on a common carrier, an additional $25,000 will be payable along with your scheduled benefit. Examples of common carriers are fully licensed commercial airlines, trains, and buses.

Spouse Education Benefit

The Plan will pay your spouse an additional benefit if he/she is enrolled in an accredited post-secondary educational program on the date you incur a covered accident or within 12 months following that date. The benefit will be equal to 4% of your scheduled benefit or the actual cost of tuition, whichever is less.

Repatriation Benefit

If a covered accident occurs more than 100 miles from your permanent residence, the Plan will pay either an additional $5,000 or the cost of preparing the body for cremation or burial and transportation to the site for cremation or burial, whichever is less.

Continuous Coverage

Even if you change jobs, this Plan can stay with you. Your insurance, and that of your covered dependents, will remain in force as long as you pay your premiums when due and the Group Policy remains in effect. In the event of your death, your surviving dependents may continue their coverage.

Reductions and Exclusions

Reductions
On the premium due date following your 70th birthday, coverage reduces to a maximum of $100,000. Premiums reduce accordingly. Please see the rate table.

Exclusions
The Plan will not pay a benefit resulting from 1) air travel, except as a passenger or as a pilot (pilot's benefit limited to $100,000); 2) criminal activity unless the insured is a victim; 3) disease; 4) use of drugs; 5) military service; 6) self-inflicted injury or suicide; 7) medical, dental, or surgical treatment unrelated to the accident which would otherwise entitle the insured to benefits; and 8) war, acts of war, and/or armed conflict.

Choice of Beneficiary

Your beneficiary can be anyone you choose. You may change your beneficiary at any time by written request. Payments for losses other than loss of life will be made to you. You are the beneficiary for dependent coverage.

Effective Date

Your coverage becomes effective on the date your application and initial premium payment are received by the Administrator.

Premium Information

Semiannual Premiums

Continuous Coverage

To calculate your semiannual premium, add the member premium (yours), plus your spouse's (if your spouse/domestic partner is to be covered), plus the children's premium (if your children are to be covered). Your premium may also be paid annually. Just multiply the semiannual premium by two. If you choose to pay by credit card or electronic funds transfer, you may also pay monthly (divide the semiannual premium by six) or quarterly (divide the semiannual premium by two).

Current 2016 Semiannual Premium Contributions

Coverage Level* Member Under Age 70 Member Age 70 and Over Spouse** Under Age 70 Spouse** Age 70 and Over All Children**
$ 50,000 $ 14.25 $22.00 $13.00 $22.00 $5.00
 100,000    28.50   44.00   26.00   44.00  
 150,000    42.75 N/A   39.00 N/A (For
 200,000    57.00 N/A   52.00 N/A $10,000
 250,000    71.24 N/A   65.00 N/A coverage
 300,000    85.50 N/A N/A N/A for each
 350,000    98.50 N/A N/A N/A child)
 400,000   111.50 N/A N/A N/A  
 450,000   124.50 N/A N/A N/A
 500,000   137.50 N/A N/A N/A  

* Coverage reduces to a maximum amount of $100,000 for members and/or spouses on the premium due date coinciding with, or next following member's attainment of age 70. Premiums do not reduce.
** Rates are based on member's age.

Note: A $2.00 administrative fee is added for billing modes other than annual.

The premium contributions shown above reflect the 2018 rates and benefit structure. New York Life may change premium contributions on any premium due date but not more than once in any twelve-month period, and on any date on which benefits are changed. Your rate may change only if they are changed for all others in the same class of insureds under this group policy. For example, a class of insureds is a group of people with all the same issue age or benefit amount. Benefit option amounts are subject to change by agreement between New York Life and the Policyholder.


Understanding Your Certificate of Insurance & 30-Day Free Look

This website is only a partial description of the provisions of this insurance coverage. Once your application and premium payment have been received, you will receive a Certificate of Insurance provided under the Group Policy of G-29317-0 (Policy Form GMR) which details features, limitations, and exclusions.

It is important that you understand your coverage. Please read your Certificate thoroughly after it arrives and contact the Administrator with any questions.

After your coverage goes into effect, you will have thirty days to review your Certificate. If you are not satisfied and return your Certificate within thirty days without claim, your full premium will be refunded—no questions asked.

How to Apply for Coverage

It is important to read the General Information section of this website before applying for coverage. You have two options to enroll: To enroll online, click here. To download a paper application and complete application instructions, click here.

The Plan is underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010 under Group Policy Form GMR, Policy No. G-29317-0/FACE.

Complete details, including features, costs, eligibility, renewability, limitations and exclusions are found in the Certificate of Insurance.

John Wigle, California Agent insurance license number: 0482924. John Wigle, Arkansas Agent insurance license number: 46424.

092015

G-29317-0-Aw