RL-ACC3-ADR2-23-IN 3 ADR-12967 (11/25) PORTABILITY If you continue your coverage under the Certificate’s PORTABILITY provision, then coverage under this rider will also be continued during portability. Continued coverage under this provision is subject to all the terms of this rider. AD&D BENEFITS We will pay an AD&D benefit as shown on the SCHEDULE OF BENEFITS if a Covered Person meets any of the conditions described below as the result of Injuries received in a Covered Accident. The Injury must occur, and the loss resulting from the Injury must begin, while the Covered Person is covered under this rider. Accidental Death: A benefit is payable if Injuries received in a Covered Accident cause a Covered Person’s death within 90 days after the Covered Accident. Your benefit is payable to your named Accidental death beneficiary. If there is no named beneficiary, benefits will be paid according to the BENEFIT PAYMENTS provision in the Certificate. Your Spouse's and Child's benefit is payable to you. Note: No Accidental death benefit is payable if the Covered Person is eligible for the common carrier benefit. Common Carrier: A benefit is payable if Injuries received in a Covered Accident occur while a Covered Person is a fare paying passenger in a common carrier, and the Injuries cause the Covered Person’s death within 90 days after the Covered Accident. Your benefit is payable to your named Accidental death beneficiary. If there is no named beneficiary, benefits will be paid according to the BENEFIT PAYMENTS provision in the Certificate. Your Spouse's and Child's benefit is payable to you. “Common carrier” for this benefit means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities. Dismemberment: A benefit is payable to you if a Covered Person’s loss (as described below) occurs within 90 days after a Covered Accident. The benefit amount varies based on the type of loss as shown on the SCHEDULE OF BENEFITS. The types of eligible loss under this benefit are limited to the following: Loss of both hands. Loss of both feet. Total and permanent loss of sight in both eyes. Loss of one hand or one foot AND permanent loss of sight in one eye. Loss of one hand AND one foot. Loss of one hand OR one foot. Loss of two or more fingers or toes. Loss of one finger OR one toe. “Loss” for this benefit means the physical loss of: A hand: the hand is removed through or above the wrist joint. A foot: the foot is removed through or above the ankle joint. Sight in an eye: total and permanent loss of sight. A finger: the finger is removed at the joint proximate to the first interphalangeal joint where it is attached to the hand. A toe: the toe is removed at the joint proximate to the first interphalangeal joint where it is attached to the foot. If a Covered Person loses a finger or toe, and within 90 days of that loss, loses a hand or foot on the same side of the body as the result of the same Covered Accident, the benefit amount payable for the loss of the finger or toe will be subtracted from the benefit payable for the loss of the hand or the foot. If an Accident benefit is payable after laceration repair of a finger, toe, hand, foot or eye and that body part is later lost due to the same Covered Accident, the amount of the laceration repair benefit will be subtracted from the dismemberment benefit. PORTABILITY FOLLOWING DEATH OR DIVORCE If you die or divorce and your Spouse continues portability under the PORTABILITY FOLLOWING DEATH OR DIVORCE provision of the Spouse Accident Rider, then coverage under this rider will also be continued under your Spouse’s coverage. Continued coverage under this provision is subject to all the terms of this rider.
Accident Insurance Plan for Noblesville Schools Employees Page 45 Page 47