| Benefits • AD&D Coverage • Benefit Summary |
| Life |
Full Benefit Amount |
| Both arms & both legs |
Full Benefit Amount |
| One arm & one leg |
Full Benefit Amount |
| Speech & one of: hand, foot or sight of one eye |
Full Benefit Amount |
| Use of both arms & both legs |
Full Benefit Amount |
| Both hands, both feet, or sight of both eyes |
Full Benefit Amount |
| Hearing & one of: Hand, foot or sight of one eye |
Full Benefit Amount |
| Use of both arms or both legs |
75% Benefit Amount |
| Use of one arm and one leg |
75% Benefit Amount |
| One arm or one leg |
50% Benefit Amount |
| One hand or one foot or sight of one eye |
50% Benefit Amount |
| Speech or hearing |
50% Benefit Amount |
| Use of one arm or one leg |
50% Benefit Amount |
| Use of both hands or both feet or a combination of hand and a foot |
50% Benefit Amount |
| Use of one hand or one foot |
25% Benefit Amount |
| Thumb & index finger of same hand |
25% Benefit Amount |
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| Permanent Total Disability |
Covers Employee Only |
| Special Education Benefit |
Covers Employee Only |
| Hospital Benefit |
Covers Employee Only |
| Seatbelt Benefit |
Covers Employee Only |
| Felonious Assault Benefit |
Covers Employee Only |
| Common Disaster Survivor's Benefit |
When spouse is also injured |
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