Voluntary Accidental Death and Dismemberment Insurance
- Enrollment and Changes
- Benefit Amount and Premium Changes
- Your Benefits
- Additional Special Benefits
- Emergency Travel Assistance Services
- Restrictions and Exclusions
- When Coverage Ends
- Claiming Benefits
Voluntary Accidental Death and Dismemberment Insurance
Q. How does Voluntary AD&D insurance work?
A. This insurance provides benefits payable in the event of accidental death or
These benefits are in addition to benefits payable under the Basic AD&D Insurance. Voluntary AD&D is
different from Basic AD&D and also offers a number of special benefits such as emergency assistance
while you are traveling.
You may elect coverage of one to eight times your annualized monthly benefit pay, rounded to the
next higher $1,000. The maximum coverage is $5,000,000.
Enrollment and Changes
You may enroll in or increase Voluntary AD&D any time by using EDA available on the
ExxonMobil Me HR Intranet site. Enrollment forms are also available from Benefits Administration
for those individuals who do not have access to EDA.
Your coverage is effective as soon as your EDA election is made or as soon as your enrollment form is received by
You may also lower or discontinue this coverage at any time. The change is effective the first of the month
following the date your election is made via EDA or your form is received by Benefits Administration.
Benefit Amount and Premium Changes
Voluntary AD&D monthly rates are $0.023 per $1,000 of coverage. Your benefit amount automatically changes effective the first of the month following a pay change.
This coverage pays benefits for death or losses resulting from an injury incurred within one
year of an accident,
provided the accident occurs while you are covered by this insurance. Subject to certain restrictions, benefits are
paid to your beneficiary in the event of your accidental death or to you for certain accidental injuries.
The benefit paid is determined by the extent of your loss. The maximum benefit for any one accident is 100% of
the amount of coverage even if you suffer more than one loss described below:
|For loss of...
||Voluntary AD&D pays this percentage
of your coverage amount...
|Any combination of a hand, a foot or sight of one eye
|Quadriplegia — complete and irreversible paralysis of all four limbs
|Speech and hearing
|Paraplegia — complete and irreversible paralysis of both lower limbs
|Hemiplegia — complete and irreversible paralysis of
the entire arm and the entire leg on the same side of the body
|Either hand or foot
|Sight of one eye
|Speech or hearing in both ears
|Thumb and index finger of the same hand
- Loss of a hand or foot means severance through or above the wrist or ankle joint.
- Loss of sight means total and irrevocable loss of sight.
- Loss of speech or hearing means entire ability to speak or entire
ability to hear lasting continuously for 12 consecutive months.
- Loss of thumb and index finger means complete severance through or above the
knuckle (metacarpophalangeal joint in both fingers).
Voluntary AD&D will pay 100% of your coverage amount for the loss of your life if:
- Loss of life results from unavoidable exposure to the elements and after one year, your body has not
been found after the conveyance in which you were traveling disappeared, made a forced landing,
sank or was wrecked.
- Maximum benefits under Voluntary AD&D for any single
accident are $5,000,000.
Additional Special Benefits
Voluntary AD&D includes these additional benefits:
- Hospital benefit — Pays a benefit, if as a result of an accident,
you are confined in a hospital. The benefit equals 1% of your Voluntary AD&D coverage up to a maximum
monthly benefit of $2,500 — excluding the first four days and up to a maximum hospital stay of
- Seat belt benefit — Pays an additional benefit if your
death results from injuries sustained while you were driving or riding in a private passenger
car and it is verified that you were wearing a properly fastened, original, factory-installed
seat belt. This additional benefit equals 10% of your Voluntary AD&D coverage amount with a
minimum benefit of $1,000 up to a maximum of $25,000.
- Child care center benefit — Helps pay covered child care expenses for each
eligible dependent child
who, on the date of the accident that resulted in your death, was 12
years of age or younger and enrolled in a licensed child care center. The benefit is an annual
amount equal to the lesser of 3% of your Voluntary AD&D coverage or the actual cost of the child
care center up to a maximum of $5,000 a year per child.
This benefit is paid for a maximum of
four consecutive years. If no dependent children qualify on the date of your death, an additional
benefit of $1,000 is paid to your beneficiary.
- Education benefit for dependent children — Pays an annual amount equal to 2% of your Voluntary AD&D coverage up to a maximum of $5,000 each year for each dependent child if the child on the date of the accident that resulted in your death, was:
- Enrolled as a full-time student in a college, university or vocational
school above the 12th grade level; or
- At the 12th grade level and subsequently enrolls as a full-time student in a college, university
or vocational school within 365 days following the date of the accident.
This benefit is payable for up to four consecutive years as long as the dependent child remains a full-time student.
If no dependent children qualify for this benefit on the date of your death, an additional benefit of $1,000 is
paid to your beneficiary.
- Training benefit for a spouse — Pays a benefit if your spouse is enrolled in an accredited school for the purpose
of training or refreshing skills needed for employment at the time of your death. This benefit is
the actual cost incurred for enrolling for one year in the school, up to a maximum of $5,000.
Voluntary AD&D uses the following definition of “child” for these additional benefits:
- Any natural child, legally adopted child or stepchild. “Child” also means a child:
- over whom you are the sole court-appointed legal guardian or managing conservator; or
- for whom you have assumed a legal obligation for support immediately prior to the child’s adoption by you, if the child is residing with you.
Child does not include a foster child.
For more information on Special Benefits, contact MetLife (see Information Sources
on page 2).
Emergency Travel Assistance Services
In addition to these special benefits, the coverage also provides emergency life travel assistance to you, your spouse and your
dependent children when traveling internationally or domestically 100 miles or more from home. Services
are provided through AXA Assistance USA, Inc. (AXA) and include: life consultation, hospital admission, life fly supervised
transportation and emergency medication.
While most travel is covered by AXA, there are some exceptions. For example, trips over 90 days and any travel by your spouse on
behalf of your spouse's employer will not be covered.
For more information about Emergency Travel Assistance Services, contact AXA
(see Information Sources on page 1).
Restrictions and Exclusions
The insurance does not pay if the loss results from or is caused by:
- Physical or mental illness, diagnosis of or treatment for the illness;
- An infection, unless it is caused by an external wound
that can be seen and which was sustained in an accident;
- Suicide or attempted suicide;
- Injuring oneself on purpose;
- The use of any drug or medicine;
- A war, or warlike action in time of peace, including terrorist acts, unless:
- you are an innocent bystander and not a participant, or
- you sustain a Covered Loss during transport by the armed forces of any country or international authority while traveling on business for the Employer;
- Committing or trying to commit a felony or other serious crime or an assault;
- Any poison or gas, voluntarily taken, administered or absorbed;
- Service in the armed forces of any country or international authority,
except service as a member of an Armed Forces organized Reserved Corp of the United States
or United States National Guard;
- Operating, learning to operate, or serving as a member of a crew of an aircraft,
other than serving as a pilot or crew member of an aircraft owned or leased by, or on behalf of,
the employer or any subsidiary or affiliate of the employer;
- While in any aircraft operated by or under any military authority (other than the Military Airlift Command or while traveling on business for the Employer);
- While in any aircraft being used for a test or experimental purposes;
- While in an aircraft used or designed for use beyond the earth's atmosphere;
- While in any aircraft for the purpose of descent from such
aircraft while in flight — such as skydiving — except for self-preservation; or
- Driving a vehicle while intoxicated as defined by the laws of the
jurisdiction in which the vehicle was being operated.
When Coverage Ends
All accidental death and dismemberment coverage ends the earlier of the day your employment
as a regular employee ends or the end of the month
that you elect to discontinue coverage.
There is no conversion option for Voluntary AD&D coverage.
If a participant suffers a covered loss, please contact Benefits Administration
with the following information:
- Participant's name;
- The date of the injury or death;
- The nature of the injuries;
- The place the accident occurred; and
- A brief description of how the accident occurred.
Once Benefits Administration receives notice, MetLife will be
notified of the pending claim. If you (or someone else) cannot immediately notify Benefits
Administration of the covered loss, do so as soon as possible. Both Benefits Administration
and MetLife must be notified within 365 days of the covered loss by either
contacting Benefits Administration at 800-262-2363 or by submitting the appropriate claim
To obtain a claim form, contact Benefits Administration. If you request a claim
form but don't receive it within 15 days of your request, you can file a claim without it by
writing a letter (including supporting documentation) to MetLife.
A certified death certificate is required for all claims for an accidental
death. MetLife can request an autopsy in connection with a death claim
(except where not permitted by law). MetLife also may require other papers
or documents. Once MetLife receives this information, the claims
administrator settles the claim by making payment to you (or your beneficiary). MetLife
has the right to examine any covered person who suffers a loss for which a
claim is pending.
Under normal circumstances, MetLife sends you or your
written notice of its decision on the claim within 90 days after receiving the
completed claim form. Sometimes, though, more time is needed due to special circumstances.
If this is the case, the determination period can be extended for up to an additional 90 days.
You or your beneficiary must be notified of the reason for the delay before the original
90-day period expires. You or your beneficiary also must be given a date as to when MetLife
expects to make a decision.
Coverage is provided by the insurer, MetLife, who is also the claims administrator.
Determination of benefits payable is made by MetLife.