Accidental Death & Dismemberment Insurance
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Presented and Administered
by Selman & Company

Group Accidental Death & Dismemberment Insurance
Underwritten by New York Life Insurance Company
:: Plan Description

The following information describes a member insurance benefit available to all participating Credit Union members ages 18 and over. Please read carefully.

Plan Features

The plan offers full 24-hour protection against a covered accidental injury anywhere in the world (subject to U.S. regulations on restricted countries), on or off the job, on business, on vacation and at home. It covers you while flying (as a passenger only) in any licensed civilian aircraft. Your eligible dependents will be covered only if you elect the Family Plan.

If you are an active member of a participating Credit Union, you are at least 18 years old and residing in the U.S. (except FL, NY, SD, VT and WA), you may take advantage of $2,000 of Group Accidental Death & Dismemberment (AD&D) Insurance, at no cost to you. As such, you are also eligible to enroll in the Voluntary AD&D Plan (premiums will be conveniently deducted from your Credit Union account) for you, your lawful spouse, and your unmarried dependent children under age 19 or under age 25 if a full-time student. The Basic (non-contributory) Coverage is for the member only.

Family Protection
If the Family Plan is selected, it will automatically insure your lawful spouse for 50% of your Voluntary Principal Sum (60% if there are no dependent children). Each eligible dependent child will be insured for 20% of the Voluntary Principal Sum.

Benefits up to $250,000
We think you'll wish to consider the merits of selecting Voluntary protection. The cost is affordable (just pennies per day) for up to $250,000 of benefits. Plus, when you purchase any one of the Voluntary Principal Sum amounts, you'll receive added insurance benefits. These are terrific values and combine to make this a fine protection package.

Benefit Amount and Premium Information
If you choose the Voluntary Coverage in addition to the Basic Coverage paid for by your Credit Union, you become eligible for the Family Plan. The chart below illustrates Member Only and Family Plan monthly premium rates. Coverage is available up to $250,000, in the options shown. Many Credit Union members choose an amount approximately two to five times their annual income. You should select the amount that is closest to your family's needs.

Your Cost

Current Monthly Premiums as of 2017

Voluntary Principal Sum*

Member Only Cost Per Month

Family Plan Cost Per Month






















*Please note that coverage reduces at later ages, as described below, under Benefits at Later Ages .

The premium contributions shown reflect the current rate and benefit structure. Benefit amounts are not guaranteed and are subject to change by agreement between the Executive Trust and New York Life Insurance Company. Premiums may be changed by agreement between the Executive Trust and New York Life Insurance Company on any premium due date and on any date which benefits are changed. However, your rates may be changed only if they are changed for all others in the same class of insureds. For example, a class of insureds is all others with the same issue age.

Added Benefits

Choosing Voluntary Insurance Provides You With Valuable Added Benefits Including:

1) Anti-Inflation Benefit
Your Voluntary Principal Sum will increase 5% after 24 months of continuous coverage and each 24 months thereafter on your anniversary date, up to a maximum of 25%. If you increase your coverage, this benefit will be applied separately to each additional amount. Likewise, if coverage is reduced, any benefit which was increased will be reduced proportionately.

2) Coma Benefit
An additional benefit will be paid provided 100% of the Principal Sum has not been paid, if: (a) an Insured Member lapses into a Coma as a result of an accidental injury; (b) the Coma occurs within 365 days of the accidental injury; and (c) the Coma has lasted for a minimum of 30 days. The benefit will be equal to 1% of the Insured Member's Principal Sum. This benefit will be paid monthly until the earliest of the following: (1) the date the Insured Member is no longer in a Coma; (2) the date of the Insured Member's death; or (3) $2,500 has been paid.

3) Accident In-Hospital Benefit
When a covered accident requires that an Insured Person be hospitalized, the plan will pay a monthly benefit of 1% of the Voluntary Principal Sum, to a maximum monthly amount of $1,500, beginning with the first day of hospitalization so long as the Insured Person incurs an in-hospital confinement of at least 8 days, and said confinement commences within 30 days of the accident. The benefit is payable for each month of continuous confinement up to a maximum period of 12 months. Pro rata payment will be made for periods less than a full month.

4) Education Benefit
If the death of the Insured Member results from a covered accident, the plan will pay in addition to all other benefits, 2% annually, up to $2,500, of the Voluntary Principal Sum on behalf of any insured dependent child who, on the date of the accident, is enrolled as a full-time student in a school for higher learning (e.g. college or vocational school). Benefits are also payable if the child subsequently enrolls as a full-time student in a school for higher learning within one year following the date of the member's death. These benefits are payable for a maximum of four consecutive years, but will end earlier if the dependent child ceases to be enrolled as a full-time student in a school for higher learning or reaches age 25. If no children qualify, $1,000 will be paid to the Beneficiary.

5) Day Care Benefit
New York Life will pay an additional benefit if an Insured Member's death is a Covered Loss and such Insured Member has Dependent Insurance in force for his or her child(ren) and: 1. at the time of such Insured Member's death, his or her Insured Child(ren) is under age 7 and is enrolled in a Day Care Program; and 2. satisfactory proof of enrollment, as described below, is provided to New York Life prior to the last day of the 12th month on or next following the Insured Member's death. If it is not possible to give proof within such period, it must be given as soon as reasonably possible. The benefit amount is the lesser of: (a) 2% of the amount payable under the Insured Member's Principal Sum Amount; or (b) $2,500, or (c) the actual amount of Day Care costs for up to one year.

6) Handicapped Child Benefit
If the Insured Member dies as the result of a covered accident, insurance in force ma continue for a handicapped insured child. B>

7) Survivor Spouse Benefit
Spouse Insurance or Dependent Insurance in force on an Insured Spouse and Insured Child on the day the Insured Member dies will continue, if the Contribution is paid. Insurance in force for only an Insured Child will not continue.

Note: Benefits 1-7 described above are not included in the No-Cost (Basic) coverage.

How the Plan Works

Your Benefit Payment Summary
If a specified loss is caused directly and independently by an accidental injury while coverage is in force, and said loss occurs within 365 days of the injury, the plan will pay as follows:

% of Principal Sum

Loss of Life


Loss of Two Limbs


Loss of Sight of Both Eyes


Loss of Speech and Hearing


Loss of One Limb


Loss of Sight of One Eye


Loss of Speech or Hearing


Loss of one limb and the loss of one sight in one eye


Loss of Thumb and Index Finger of Same Hand


Quadriplegia (total paralysis of both upper and lower limbs)


Paraplegia (total paralysis of both lower limbs)


Hemiplegia (total paralysis of upper and lower limbs on one side of the body)


Loss of limb means actual severance at or above the wrist or ankle joint. Loss of sight, speech, and hearing means complete and irrevocable loss thereof. Paralysis means complete and irreversible paralysis of such limbs. The total benefit payable for all losses due to a single accident will not be more than the Principal Sum. Only one amount, the largest to which the Insured Person is entitled, is paid for all losses resulting from one accident.

Additional Plan Provisions

The beneficiary is the person last designated by you in writing, and recorded as such by or on behalf of New York Life. Payments for losses other than for your loss of life will be made to you. The beneficiary for dependent(s) coverage is the member.

Benefits at Later Ages
The Basic benefit amount and the Voluntary benefit amount reduce by 50% at member age 70 and are further reduced by 75% at member age 75.

Effective Date of Coverage
The $2,000 of Basic Coverage is effective the first of the month following acceptance of the Enrollment Form. Your new or increased Voluntary coverage will become effective on the date specified by New York Life Insurance Company, provided the initial premium contribution has been paid and a completed application has been submitted and approved. Thereafter, premium will be deducted from your account as indicated on your Enrollment Form. A Certificate of Insurance will be provided.

30-Day Free Look
When you receive your Certificate of Insurance, read it carefully. If you are not completely satisfied with the terms of your new insurance, simply return your Certificate, without claim, within 30 days and your premium will be promptly refunded. Your insurance will then be invalidated.

Your coverage will end on the earliest of the next premium due date if you are no longer an eligible member of a Credit Union that is participating in the Executive Trust; the premium due date, if the required premium is not paid when due; the date the insured person enters full-time active duty in the Armed Forces; the date the group policy is terminated or modified to end coverage for the class of eligible persons to which the Insured Person belongs; or the date the Insured Person requests to end such coverage. Termination will not affect a claim for a covered loss due to an accident that occurred while coverage was in effect. Coverage for your insured spouse or child will end when your coverage ends or when the dependent eligibility requirements are no longer being met.

Exclusions and Limitations

No benefits will be paid for a loss caused by or resulting from: intentionally self-inflicted injury, suicide or any attempt thereat, while sane or insane; voluntary self-administration of any drug or chemical substance not prescribed by, and taken according to the directions of a doctor (accidental ingestion of a poisonous substance is not excluded); use of alcohol; incarceration for or participation (except as a victim) in a crime, illegal occupation/activity, riot, insurrection of terrorist activity; declared or undeclared war or act of war; an accident which occurs while on active duty service in any armed forces; the covered person's participation in an organized race; hang-gliding, parasailing, or parachuting, except parachuting for self-preservation; operating, riding in or descending from any aircraft except when riding as a passenger; sickness, disease, bodily or mental infirmity or medical or surgical treatment thereof; or bacterial or viral infection, regardless of how contracted.

This information is a brief description of important features of the plan. It is not a contract. The complete terms and conditions of coverage are set forth in group policy number G-29530-0 on Policy Form GMR issued in Delaware to the Trustee of 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. Please keep this material as a reference for filing with your Certificate of Insurance. You must also be a member of a Credit Union participating in the Executive Trust.

Underwritten by: New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010, under Group Policy No. G-29530-0 on Policy Form GMR-FACE/G-29530-0.

New York Life is licensed/authorized to transact business in all of the 50 United States, the District of Columbia, Puerto Rico and Canada. However, not all groups plans it underwrites are available in all jurisdictions. Please check the applicable insurance brochures for current availability. New York Life's state of domicile is New York, and NAIC ID# 66915.

Administered by: Selman & Company, 6110 Parkland Boulevard, Cleveland, OH 44124. Phone: 877.665.7563

Arkansas Insurance License# 247064

California Insurance License# 0I01599

Your Credit Union incurs costs in connection with this sponsored plan. To provide and maintain this valuable member benefit, it is reimbursed for these costs. Your Credit Union also receives a fee in connection with this plan.

Accidental Death & Dismemberment Insurance
Underwritten by New York Life Insurance Company
51 Madison Avenue, New York, NY 10010 on Policy Form GMR
Sponsored by Golden Circle Credit Union, Inc.
Presented and Administered by Selman & Company
6110 Parkland Boulevard
Cleveland, OH 44124
877-665-7563 - Phone
440-646-9339 - Facsimile
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