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Accidental Death Insurance |
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A group accidental death and specific loss insurance certificate is included in each Pennsylvania Farm Bureau Membership. Highlights of the coverage are listed below; complete details are in the contract available from Pennsylvania Farm Bureau.
KEY WORDS DEFINED
When we use these words, we mean: PFB or plan sponsor - Pennsylvania Farm Bureau, P. O. Box 8736, Camp Hill, PA 17001-8736. MSC - PFB Members' Service Corporation, P. O. Box 8736, Camp Hill, PA 17001-8736. We, our, us or Nationwide - Nationwide Life Insurance Company, Attn: Special Risks Health Department, P. O. Box 2399, Columbus, Ohio 43216-2399. Insured or PFB member - a person who is eligible for and is covered by the contract under a PFB Membership. You, your or primary insured - a person named as a member of the PFB on a PFB membership application. However, if membership is in the name of a business or similar entity and/or more than one person, only one person will be considered the primary insured under this contract. He or she must be so designated to PFB on the PFB membership application.
THIS IS LIMITED ACCIDENT INSURANCE. IT IS AN ACCIDENT ONLY POLICY. IT DOES NOT PAY BENEFITS FOR LOSS RESULTING FROM SICKNESS, DISEASE, OR BODILY INFIRMITY. PLEASE READ OUR CERTIFICATE CAREFULLY.
PFB membership--a membership in the PFB consisting of: (1 ) you; (2) your legal spouse who resides in the same household as you; and/or (3) each unmarried child under 19 years of age of either or both you and your legal spouse, provided such child resides in the same household as you (a child away from such household on a temporary basis as a full-time student as defined below will be considered, for insurance purposes, as residing in the same household as you).
An unmarried child under age 23 who is a full-time student attending an accredited high school or accredited school of higher education will continue to be eligible under the contract after he or she becomes age 19.
An unmarried child who is unable to hold a self-sustaining job because of developmental, mental, or other physical incapacity (as defined by Pennsylvania law) will continue to be an insured, regardless of age, after he or she becomes age 19, provided such incapacity occurs: (1 ) before age 19; or (2) between ages 19 and 23 if a full-time student as defined above.
The term child includes: (a) a natural child; (b) a stepchild; (c) a foster child; (d) a legally adopted child (including any waiting period before adoption is finalized); and (e) a child under either or both you and your insured spouse's legal guardianships.
Injury--a bodily injury which meets all of the following conditions: (1 ) it is caused solely by an accident which happens while the contract is in force on the insured; (2) it results in loss covered by the contract; and (3) neither the injury nor the loss may result, in whole or in part, from sickness, disease, or bodily infirmity, or from any cause other than the accident.
TERM OF A PERSON'S COVERAGE
A person's coverage begins on the later of: (1 ) the effective date of the contract; or (2) when he or she becomes a PFB member.
A person's coverage ends on the first of these to occur:(1) when he or she is no longer a PFB member; (2) the date to which premium has been paid; or (3) the premium due date coinciding with or next following the termination date of the contract.
THE BENEFIT AMOUNTS which apply to an insured are shown in the Table of Losses.
EXCLUSIONS AND LIMITATIONS
We shall not pay benefits for loss resulting, in whole or in part, from: (1) intentional self-destruction or attempt at it, or intentional self-inflicted injury while sane or insane; (2) ware or an act of war, declared or undeclared; (3) the use of occupancy or any motor vehicle designed and licensed for use on public roads; (4) ptomaine or food poisoning, bacterial infection (except through an accidental wound) or disease; or (5) participation by the insured in any civil disturbances.
ACCIDENTAL DEATH AND SPECIFIC LOSS BENEFIT
If, as a result of injury, an insured either loses his or her life or suffers on or more of the specific losses listed in the Table of Losses below, we shall pay the applicable amounts shown. Both the injury and the loss must result, directly and independently of all other causes, from the accident causing the injury. The loss must occur within one year from the date of the accident causing the injury. The one year time limit does not apply to the loss of life benefit.
TABLE OF LOSSES
For the Loss of: PFB MEMBERSHIP STATUS* First Year of Membership Second Consecutive Year of Membership Third Consecutive Year of Membership Fourth Consecutive Year of Membership Fifth Consecutive Year of Membership Six or More Consecutive Years of Membership Life .... $1,000 $1,300 $1,600 $1,900 $2,200 $2,500 Each Hand .... 500 650 800 950 1,100 1,250 Each Foot..... 500 650 800 950 1,100 1,250 Sight of Each Eye .... 500 650 800 950 1,100 1,250
* A PFB membership must be certified by the PFB to be in good standing for one of the above mentioned membership classes. A PFB membership otherwise in a Second Consecutive Year of Membership class or higher which achieves good standing after a given January 1 will revert to a First Year of Membership and will advance to higher membership classes only in the same manner an any other First Year of Membership.
Specific loss means: (1) the actual, total, permanent, and irrecoverable loss of a natural hand or natural foot completely severed at or above the wrist or ankle joint; or (2) the actual, total, uncorrectable, permanent, and irrecoverable loss of the entire sight of a natural eye.
We shall not pay more than 100% of the face amount which applies to an insured for all of his or her losses from any one accident under the contract. No specific loss benefit will be paid if the loss of life benefit is payable.
CLAIMS INFORMATION
When must written notice be given? Written notice of claim must be given within 30 days after a covered loss occurs or it must be given as soon thereafter as reasonably possible. The notice must be sent to MSC or our Home Office. It should include the policy number(602-9100516), the claimant's name, your name and the insured's name.When must proof of loss be given? Written proof must be given to MSC or us within 100 days after the date of loss. If it is not reasonably possible to give such proof, it should be given as soon thereafter as otherwise reasonably possible; but no later than one year from the time it is otherwise due. The one year limit is waived if the claimant is legally incapable of giving such proof.When will we pay claims? Benefits due will be paid when we receive proper written proof of loss.To whom will we pay claims? We shall pay the loss of life benefits to an insured's designated beneficiary on file with us at the time of payment.How may the beneficiary be changed? You may change your beneficiary and those insured covered under your PFB membership, if applicable, only on the forms we supply. The beneficiary's consent is not needed unless the designation is irrevocable. Changes may be made only during the insured's lifetime and must be received, in writing, by us at our Home Office.
GENERAL INFORMATION
What if the contract does not conform with Pennsylvania law? If any provision of the contract conflicts with Pennsylvania law, such provision is amended to conform to the law's minimum requirements.
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