MANITOBA PUBLIC SCHOOL EMPLOYEES Group LIFE INSURANCE PLAN
ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
 

Accidental Death and Dismemberment Insurance (AD&D) benefits are paid in addition to any benefits payable under your Basic Life Insurance or Family Life Insurance coverages. Subject to some exclusions (see below), coverage is provided anywhere in the world, 24-hours-a-day!

A serious accident causing death or bodily injury could happen in a split second, any time, anywhere. It could mean major changes and adjustments in your family life. You or a family member could be confined to a wheelchair. Your home may require extensive renovations or your vehicle might need special modifications. During the period of shock and grief that follows an accident, you or your loved ones shouldn't face the added burden of financial uncertainty.

AD &D Insurance provides a lump-sum payment in the event of death or loss of a limb, sight, hearing, etc. resulting from an accident. This valuable benefit could help you or your family member with such costs as:

  • home renovations;
  • vehicle modifications;
  • living aids, such as a wheelchair; or
  • prosthetic devices, such as artificial limbs.

Amount of Coverage

You may insure yourself, or yourself and your family. You choose the amount of insurance (called the principal sum) in units of $15,000 to a maximum of $300,000.

If you choose the "Employee and Family" option, you insure yourself and your eligible dependents as follows:

  • You are covered for the full principal sum.
  • If you do not have eligible dependent children, your spouse is covered for half of your principal sum.
  • If you have a spouse and eligible dependent children, your spouse is covered for 40% of your principal sum and each eligible dependent child is covered for 5% of your principal sum.
  • If you do not have a spouse, each eligible dependent child is covered for 10% of your principal sum.

Open Enrolment

Every September you are allowed to add new AD&D coverage, increase existing coverage or add coverage for your dependents. No evidence of insurabilty is required. For more information or to change your coverage, see your plan administrator.

Benefits

If you die, the benefit is paid to your designated beneficiary(ies) or to your estate if you do not have a beneficiary. If you suffer a covered loss, the benefit is payable to you. You are the beneficiary if your spouse or eligible dependent children die or suffer a covered loss.

You must provide proof of loss within 90 days of the date of the loss. For losses resulting from and occurring within 365 days of an accident, your Accidental Death and Dismemberment Insurance pays benefits according to the following schedule:

Loss of Benefit
Life
Both arms or both legs
Use of both arms
Both hands or both feet
Use of both hands or both feet
One hand and one foot
One hand and entire sight of one eye
One foot and entire sight of one eye
Entire sight of both eyes
Speech and hearing in both ears
100% of the principal sum
One arm or one leg
Use of one arm or one leg
75% of the principal sum
One hand or one foot
Entire sight of one eye
Speech or hearing in both ears
50% of the principal sum
Thumb and index finger or at least four fingers on the same hand 25% of the principal sum
All toes on the same foot 12.5% of the principal sum
Use of both legs (paraplegia)
Use of both arms and both legs (quadriplegia)
Use of an arm and leg on the same side of the body (hemiplegia)
200% of the principal sum

Explanation of Losses

Loss of one arm means severance at or above the elbow. Loss of a leg means severance at or above the knee. Loss of a hand means severance at or above the wrist. Loss of a foot means severance at or above the ankle. Loss of thumb and fingers means severance at or above the metatarsophalangeal joints. Loss of toes means severance at or above the metatarsophalangeal joints. Loss of sight, loss of speech or loss of hearing must be total, permanent, and irrecoverable. Loss of use of a limb must be total, continuous for 12 months, and then must be determined to be permanent and irrecoverable before the benefit is payable.

Limitations

The maximum amount paid for all losses to an insured person resulting from any one accident is the principal sum, and only the largest percentage is paid for injuries to the same limb.

Other Features

In the event of accidental death:

  • Child Educational Benefit - children are reimbursed for their enrolment fees as full-time students in a post-secondary institution for up to four consecutive years following the accident, if they are enrolled at the time of the accident. The maximum amount payable for the entire period is the lesser of 5% of the principal sum and $5,000.

  • Spouse Occupational Training Benefit - in the event of employee accidental death, spouses are reimbursed for their enrolment fee in an accredited occupational program for up to three years after the accident. The maximum amount payable for the entire period is the lesser of 10% of the principal sum and $10,000.

In the event of accidental death or dismemberment:

  • Family Transporation Benefit - if a covered person is hospitalized more than 150 kms from home as a result of an accident, expenses for economy class transportation and moderate quality lodging expenses for one family member to join the person who becomes hospitalized are covered. If a private vehicle is used, covered expenses for transportation are limited to $.20 per km traveled. Telephone expenses and taxicab and car rental charges are included. The maximum amount payable is $2,000.

  • Education Benefit - if a covered person is required to change occupations as a result of the accident, tuition fees for enrolment in a post-secondary institution for training in a new occupation are reimbursed provided that the person is enrolled within 365 days of the accident. The maximum amount payable is $10,000. Expenses are only reimbursed if within two years after the accident.

  • Wheelchair Benefit - if a covered person is required to use a wheelchair as a result of an accident, expenses for alterations to the person's home and vehicle are covered when incurred within 365 days of the accident. The maximum amount payable is $10,000 for all home and vehicle modifications combined.

Exclusions

Your Accidental Death and Dismemberment Insurance plan does not provide benefits for losses as a result of:

  • Illness, disease or medical and surgical treatment
  • Attempted suicide or suicide
  • Parachuting or skydiving
  • Intentially self-inflicted inury
  • War, rebellion or hostilities of any kind whether or not the insured person is a participant
  • Paricipation in a riot or a civil disturbance
  • Participation in a criminal offence or provoking an assault, excluding driving a motor vehicle while blood alcohol content is in excess of the legal limit
  • Use of any prohibited substance, including but not limited to any substances listed under the Controlled Drugs and Substances Act, its Schedules or other comparable criminal legislation; or
  • A plane crash when: the insured was a pilot or a crew member, the aircraft did not have a certificate of airworthiness, or the aircraft was not flown by a licensed pilot.

Cost Sharing

You pay the full cost of any coverages you elect.

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