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Presented and Administered
by Selman & Company

Accidental Death & Dismemberment Insurance
:: Plan Description

Accidental Death & Dismemberment (AD&D) insurance provides an easy and affordable way to provide a monetary benefit to you or your beneficiary if you suffer certain accidental injuries or an accidental death.

$1,000 of Basic AD&D...at No Cost To You.
As a Credit Union member age 18 and over you are eligible for up to $1,000 of Basic Accidental Death & Dismemberment (AD&D) Insurance provided at no cost to you. This coverage is fully paid for by the Credit Union! The plan offers 24-hour protection against a covered accident anywhere in the world, on or off the job, on business, on vacation or at home. Covered bodily injuries suffered by the Insured must eb the result, directly and independently of all other causes of a sudden, unforeseeable and external event and result in a covered loss. Coverage is subject to applicable terms, limitations and exclusions.

Escalator Benefit (Members Only)
The Insured member's $1,000 of Credit Union-paid coverage and Additional Coverage (if selected) will increase 5% after 24 months of continuous coverage and each 24 months thereafter on the Insured member's anniversary date, up to a maximum of 25%, with no increase in premium.

In addition to the Credit Union-paid coverage, we think you'll wish to consider the merits of selecting additional protection. The cost to obtain the Additional Principal Sum (hereinafter "Additional Coverage") is affordable (just pennies per day) for up to $300,000.

Family Coverage Available
If you choose to purchase Additional Coverage, you become eligible for the Family Plan. If the Family Plan is selected, it will automatically insure the Insured's legal spouse for 50% of the Insured's Additional Coverage (60% if there are no dependent children). Each unmarried dependent child will be insured for 20% of the Insured's Additional Coverage (25% if there is no spouse). In the event of the Insured's death, the Family Plan option may continue.

Added Insurance Benefits with the Purchase of Voluntary AD&D Coverage
The Benefits below are only available with Additional Coverage.

Permanent Total Disability
Permanent Total Disability Benefits will be paid to a covered Member who is under age 65 and becomes Totally Disabled, resulting directly and independently of all other causes from, and within 180 days of, a Covered Accident. To qualify for benefits, the covered Member must remain Totally Disabled during the Benefit Waiting Period (12 months) shown in the Schedule of Benefits and at the end of the Benefit Waiting Period, must be expected to remain so disabled, as certified by a Physician, for the rest of his life.

Hospital Stay Benefit
When a covered accident requires that an Insured Person be hospitalized, the plan will pay a monthly benefit of 1% of the Insured Person's Additional Coverage beginning with the first day of hospitalization so long as the Insured Person is hospitalized for at least 7 days so long as the Insured Person is hospitalized at the direction and under the care of a Physician, the stay begins within 30 days of the Covered Accident, and begins while the covered Person's Insurance is in effect. The plan will play a maximum of up to $3,000 per month for a period of up to 12 months. Pro rata payment will be made for periods less than a full month.

Common Carrier Coverage
Benefits pays an additional amount equal to the Insured's Voluntary Principal Sum if the loss results from an injury that occurs while the Insured Person is riding as a fare paying passenger, in or on a public conveyance being operated commercially by a licensed common carrier to transport passengers for hire.

Seat Belt Benefit
If a loss of life occurs while wearing a seatbelt and operating or riding as a passenger in an Automobile, Addisonal Coverage benefits will be automatically increased to 50% of your Voluntary Principal Sum. Benefits will be paid in one lump sum.

Verification of proper use of the seatbelt at the time of the Covered Accident must be a part of an official police report of the Covered Accident or be certified, in writing, by the investigating officer(s) and submitted with the Covered Person's claim to US. If such certificate or police report is not available or it is unclear whether the Covered Person was wearing a seatbelt. We will pay a default benefit of $1,000 to the Covered Person's beneficiary.

Special Education Benefit
If the Family Plan is chosen, the policy will pay, in addition to all other benefits, 2% annually of your Additional Coverage (up to a maximum of $5,000 per year for a maximum of four years) on behalf of each qualifying dependent child who, on the date of the accident, was enrolled as a full-time student in any school for higher learning beyond the 12th grade level. Benefits are also payable if the child was at the 12th grade level and subsequently enrolls as a full-time student in a school for higher learning within one year following the date of the Insured's death. If no children qualify, $1,000 will be paid to the Beneficiary.

Child Care Center Benefit
If the Family Plan is selected and an Insured dies as the result of a covered accident, 2% of the Insured's Additional Coverage will be paid annually for each qualifying dependent child, up to $2,000 for up to two years or age 13, whichever occurs first. If there are no qualifying dependents at the time of the Insured's death, the plan will pay $1,000 to the beneficiary.

Escalator Benefit (Member Only)
The Insured's $1,000 of Credit Union-paid coverage and Additional Coverage (if selected) will increase 5% after 24 months of continuous coverage and each 24 months thereafter on the Insured's anniversary date, up to a maximum of 25%, with no increase in premium.

Termination
A covered Member's insurance will terminate on the earliest of the following dates: (1) the date this Policy or insurance for a Covered Class is terminated; (2) the date the Credit Union's participation under this Policy ends; (3) the next premium due date after the date the Covered Person is no longer in a Covered Class or satisfies eligibility requirements under this Policy; (4) the last day of the last period for which premium is paid; (5) the next premium due date after the Member ceases to be a Member in good standing of the Credit Union; and (6) with respect to a Spouse or Dependent Child, the date of the death of the covered Member or the date of divorce from the covered Member. Termination will not affect a valid claim for a loss that occurs while coverage was in force.

Effective Date of Coverage
Your new or increased coverage will become effective following receipt of your enrollment from (basic coverage only) or after your first premium is deducted from your account. Thereafter, the premium, as applicable, will be deducted quarterly. A Certificate of Insurance will be mailed to you after your effective date.

Exclusions
Benefits will not be paid for any Covered Injury or Covered Loss, which directly or indirectly, in whole or in part is caused by or results from any of the following unless coverage is specifically provided for by name in the Description of Benefits Section. (1) intentionally self-inflicted Injury, suicide or any attempt thereat while sane or insane; (2) commission or attempt to commit a felony or an assault; (3) commission of or active participation in a riot, insurrection or Terrorist Act; (4) declared or undeclared war or act of war; (5) flight in, boarding or alighting from an Aircraft or any craft designed to fly above the Earth's surface, except as: a.) a fare-paying passenger on a regularly scheduled commercial or charter airline; b.) a passenger in a nonscheduled, private Aircraft used for pleasure purposes with no commercial intent during the flight; c.) passenger in a military Aircraft flown by the Air Mobility Command or its foreign equivalent; (6) travel in or on any off-road motorized vehicle not requiring licensing as a motor vehicle; (7) participation in any motorized race or contest of speed; (8) an accident if the Covered Person is the operator of a motor vehicle and does not possess a valid motor vehicle operator's license; except while participating in Driver's Education Program; (9) 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; (10) medical or surgical treatment, diagnostic procedure, administration of anesthesia, or medical mishap or negligence, including malpractice; (11) the Covered Person's intoxication as determined according to the laws of the jurisdiction in which the Covered Accident occurred; (12) 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; (13) a Covered Accident that occurs while on active duty service in the military, naval or air force of any country or international organization.Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days.

Monthly Premiums
The Rate Chart below illustrates monthly premium rates for New Member Only Coverage and the Family Plan. Coverage is available up to $300,000.

Additional Coverage*

Member Only Coverage

Family Coverage

$25,000

$2.25

$3.38

$50,000

$4.50

$6.75

$100,000

$9.00

$13.50

$150,000

$13.50

$20.25

$200,000

$18.00

$27.00

$250,000

$22.50

$33.75

$300,000

$27.00

$40.50

*The Insurance Company reserves the right to change rates.

Schedule of Covered Losses
If injuries result directly and independently of all other cause from a Covered Accident within 365 days of the date of a covered accident, and the accident occurred while this coverage was in effect, the plan will pay a percentage* of your Basic and Additional Coverage as shown below. Life: 100%; 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, One Foot, or Sight of One Eye: 50%; Speech or Hearing: 50%; Thumb and Index Finger of Same Hand: 25%.

Only one amount, the largest to which the Insured Person is entitled, is paid for all losses if the Covered Person sustains more than one Covered Loss as a result of the same Covered Accident. Any Loss of Life benefit will be reduced by any paid or payable dismemberment/severance benefit.

(*Benefits for all covered persons will be reduced by 50% at the insureds attainment of age 70.)

30 Day Right to Cancel
You have the right to examine your Certificate of Insurance without obligation. If, within 30 days of receiving your Certificate, you are not completely satisfied, simply write "cancel" on the Certificate and return it by mail. Any premiums you may have paid will be fully and promptly refunded. However, this would be subject to 1) no claims have been incurred during the 30 day review period and 2) no claims arising during the 30 day review period are intended to be submitted.

Administered by Selman & Company, 6110 Parkland Boulevard, Cleveland, OH 44124.

This information is a brief description of important features of the plan. It is not a contract. Complete Terms and conditions of coverage are set forth in group policy number PCA-920000 issued in DE to The Executive Trust. The group policy is subject to the laws of the jurisdiction in which it is issued. Additional information is contained in the Certificate of Insurance which is issued to the persons who become insured under the plan. The availability of this offer may change and coverage may not be available in all states. Please keep this material as a reference for filing with your Certificate of Insurance.

Florida Licensed Resident Agent: Christine Carolyn Wise, 3101 W. Dr. Martin Luther King, Jr. Blvd., Tampa, FL 33607, Lic. # E026735.

Accidental Death & Dismemberment Insurance
Underwritten by Life Insurance Company of North America (LINA)
Sponsored by Mid-Atlantic Federal Credit Union
Presented and Administered by Selman & Company
6110 Parkland Boulevard
Cleveland, OH 44124
877-665-7563 - Phone
440-646-9339 - Facsimile
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