For only $10 a year, your beneficiary will receive a $20,000 benefit in the event of your ON-DUTY accidental death (including travel to & from authorized activities). In the event of an OFF-DUTY accidental death, a $10,000 benefit will be paid. In addition, if you suffer a Severe Burn over 20% or more of your body, a lump sum benefit of $5,000 is paid. It is important to know that IF a department chooses the additional policy for their members there are certain age limits present. IF a department member is above the age of 70 the following applies:

Member Age 70-79 the policy payout is cut in half. The payout would be $5,000 for AD&D and $10,000 for LODD; ALSO $2500 would be the payout for severe burns.

Member age 80+ the policy will only pay $2,500 for AD&D and $5,000 for LODD; ALSO $2,000 would be the payout for severe burns.

Please be sure to be aware of these stipulations and inform your set beneficiaries. SFFMA will keep a record of payment for this policy and report it to VFIS.

For specific coverage questions, contact Barbara Marzean at VFIS of Texas at 800-252-9435.

BENEFICIARY FORM


 
NVFC 24 Hour Accidental Death & Dismemberment Program - $15 per person/year
All NVFC personal members are automatically enrolled in a 24-Hour $10,000 Accidental Death and Dismemberment group policy. This policy will pay for a covered loss resulting from a bodily injury to a member. If a bodily injury results in death, the principal sum of $10,000 will be paid to the named beneficiary. If an injury causes the member’s death while that person is engaged in an Emergency Duty, then the death benefit payable is doubled to $20,000. Emergency Duty means participating in, including travel directly to and from, any fire suppression or emergency response; any rescue or emergency medical activity; or any training exercise.
If a bodily injury results in dismemberment, a benefit will be paid to the member according to the schedule of losses listed in the policy.
There is also an additional Seat Belt Benefit. This will pay an additional 10% of the death benefit if death occurs while the member was wearing a properly fastened seat belt. This applies to Private Passenger Cars as well as to emergency service vehicles.
NVFC personal members may select and name their own beneficiaries and are free to change the selection at any time. The appropriate forms are available on our website.
There are Exclusions from Coverage. The policy will not pay any claim for a loss that is caused by, contributed by, or resulting from: Intentionally self-inflicted injury while sane or insane, suicide, or any attempt at suicide; War, or any act of war, declared or undeclared; Service or full-time active duty in the armed forces of any country or international authority; Disease of the body, bodily or mental infirmity, or any bacterial infection other than bacterial infection due directly to an accidental cut or wound; Operating, learning to operate, or serving as a member of a crew of an aircraft; or while in any Aircraft operated by or under military authority; or while in any Aircraft being used as a test or experimental purpose; or while in any Aircraft owned or leased on or on behalf of the Policyholder or any division, subsidiary or affiliate of the Policyholder, or by the Insured and members of his or her family or boarding or alighting from such Aircraft; active participation in a riot; the Insured’s voluntary use of any narcotic, unless prescribed for the Insured by a Doctor.
This AD&D program is administered by Provident Agency, Inc., Pittsburgh, PA. The policy is issued by Unum Life Insurance Company of America.
This information is a summary only. For actual policy language please refer to Policy 129557-2992 which is on file. If there is a conflict between this summary and the policy, the provisions of the policy govern at all times.

BENEFICIARY FORM


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