Life Insurance / Disability

The Plan provides self-funded life insurance for employees and dependents, and accidental death and dismemberment benefits for employees only. The following summary of those benefits are presented here for your convenience, but the specific terms and conditions of those benefits are determined by the terms of those policies. The Plan also provides weekly disability benefits, which are self-funded and which are payable in accordance with the rules set out below.

To file a claim for Life Insurance or Accidental Death or Dismemberment Insurance, call the Trust Fund Office at (408) 288-4508. To file a claim for Weekly Disability Benefits, call the Trust Fund Office at (408) 288-4400.

Beneficiary

Your beneficiary may be any person or persons you name. You may change your beneficiary any time by making a written request upon a form available at the Trust Fund Office or the local Union Office. A change of beneficiary form must be returned to the Local Union Office to be effective. If you do not name a beneficiary, benefits will be paid to your estate or at the option of the Trustees to your surviving spouse, child or children, mother, father, sister(s), or brother(s).

Plan Summary

Active member under age forty (40)  $60,000
Active member age forty (40) to forty-five (45)  $50,000
Active member age forty-six (46) to fifty (50)  $40,000
Active member age fifty-one (51) to fifty-five (55)  $30,000
Active member age fifty-six (56) to sixty (60)  $20,000
Active member age sixty-one (61) to sixty-five (65)  $10,000
Active member age sixty-six (66) to seventy (70)  $5,000
Retired member under age seventy (70)  $4,000
Retired member age seventy (70) and up  $1,000
Spouse  $1,000
Children fourteen (14) days but less than six (6) months  $200
Children six (6) months but less than two (2) years  $400
Children two (2) years but less than three (3) years  $800
Children three (3) years of age and up  $1,000

 

Coverage While Disabled

Your life insurance will stay in effect without additional payments to the Plan if you become totally disabled while covered by the Plan and before you reach the age of sixty (60). The full amount of your insurance will be paid to your beneficiary if your total disability continues until the date of your death.

You may be required, within one year of the commencement of your disability, to submit proof that the disability began while you were insured. Proof of continued disability may be required from time to time.

Accidental Death or Dismemberment Insurance

An additional benefit will be paid for any of the following losses occurring on or off the job through purely accidental means, if the loss occurs within one hundred twenty (120) days from the accident.

The full amount of your Accidental Death and Dismemberment (AD&D) insurance, which is $8,000, will be paid for the loss of: Life, Both hands or feet, Sight of both eyes, One hand and foot, One hand and sight of one eye, or One foot and sight of one eye.

One-half the amount of your AD&D insurance will be paid for the loss of: one hand, one foot, or the sight of one eye.

The death benefit is payable to your beneficiary. The dismemberment or loss of sight benefit is payable to you.

LIMITATIONS

Payment for all losses due to any one accident may not exceed the full amount of your insurance. However, the benefits paid for one loss will not prevent further payments for losses resulting from subsequent accidents.

The Group Policy provides that no benefits are payable for any loss resulting from:

  1. Infirmity of the mind or body, or illness or disease other than a bacterial infection resulting from accidental cuts or wounds, or intentionally self-inflicted injuries, or suicide or attempted suicide while same or insane.
  2. War or any act of war, or service in the armed forces of any country engaged in war or police duty.
  3. Participation in, or in consequence of having participated in, the commission of a felony.

WEEKLY DISABILITY BENEFITS FOR ACTIVE EMPLOYEES

The Plan will pay a weekly benefit of $40 to any participant who is covered as an active employee and who becomes disabled as a result of accident or illness so that he or she cannot perform his or her regular work. This weekly benefit will be paid in addition to any weekly indemnity the participant is entitled to under the State Disability Insurance Law or any Workers’ Compensation Law or Act.

Benefits will commence with the first day of disability due to an accident, or the eighth consecutive day of disability due to illness, and will continue for a maximum of twenty-six (26) weeks for any one disability. If the participant is not disabled for a full week, one-seventh of the weekly benefit will be paid for each day the participant is disabled.

A participant does not have to be confined to home to collect benefits, but must be under the care of a physician.

A participant may receive these benefits any number of times, up to an overall limitation of twelve (12) months of benefits in a twenty-four (24) month period, provided that he or she returns to active work for at least two (2) full weeks between periods of disability from the same cause. Periods of disability due to different causes will be considered different periods of disability if they are separated by return to active full-time work.

There are special claims and appeals procedures governing claims for Weekly Disability Benefits.

Short Term Disability Application

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