|
To be filled out by those employees that want to name a different person other than the hierarchy established on page 13 of policy. Store owners can keep the form on file. Form does not need to be returned to GHRA or Insurance Company.
|
AXIS Coverage |
BENEFITS |
EXAMPLE |
| REFER TO POLICY FOR SPECIFIC DEFINITIONS |
| Premium |
$19.95 Per Store |
Includes all Fulltime and Part-time |
| |
| Rate Guarantee |
11/01/2011-12/31/2014 |
Premium Guaranteed for 38 months |
| |
| Felonious Assault |
$510,000 Benefit |
If Employee is killed due to Felonious |
| Accidental Coverage |
24 Hour Coverage |
Assault, beneficiary will receive |
| |
|
benefit. |
| |
| Accidental Death and |
$10,000 Benefit |
Employee is killed from any accident |
| Dismemberment |
24 hour Coverage |
Beneficiary will receive benefit |
| |
| Aggregate limit |
$5,000,000 |
Example: Policy will pay a maximum of |
| |
|
$5 million per event. If there are more |
| |
|
than 10 employees killed in 1 event, |
| |
|
$5 million will be divided between |
| |
|
total number of employees |
| |
| Worldwide Coverage |
Worldwide Coverage |
Example: employee is killed in car crash |
| |
|
while on vacation in Europe. Policy |
| |
|
would pay $10,000 Accident Benefit |
| |
| Hospital |
$100 per day for any Accident |
Example: employee is hurt in car wreck |
| Indemnity |
|
and spends 9 days in hospital. Policy |
| Benefit |
|
pays $900 |
| |
| Bereavement and Trauma |
$250 per session maximum |
Employee is killed due to Felonious |
| Counseling Benefit |
20 max. number of sessions |
Assault or accident. Spouse has access |
| |
$5000 max benefit per loss |
to benefit. |
| |
| Home Alteration and |
20% of Principal Sum subject |
Example--ramp built at house after |
| Vehicle Modification |
to a maximum benefit of |
employee is paralyzed |
| Benefit |
$50,000 |
|
| |
| Home Invasion Benefit |
Deductible--$100 |
Example: Employee misses work due |
| |
Lost salary benefit--$1000 |
to home invasion |
| |
|
|
| |
Residential Security Benefit is |
Example: As a result of home invasion, |
| |
$1,000 |
employee has to replace locks or adds |
| |
|
security system |
| |
| Medical Evacuation |
100% of Usual and Customary |
Example: Cover Loss or Emergency |
| Benefit |
|
Sickness that warrants emergency |
| |
|
Evacuation while he is 100 miles |
| |
|
outside a 100 mile radius of home |
| |
| Repatriation Benefit |
100% of Usual and Customary |
Example: Employee loses life due to |
| |
|
accident more than 100 miles away |
| |
|
from Primary Residence. Benefit pays |
| |
|
for return of body including embalming |
| |
|
or cremation |
| |
| Paralysis Benefit |
Quadriplegia--100% |
Benefit will be based on whether claim |
| |
Paraplegia--75% |
is result of Felonious or any other |
| |
Hemiplegia--75% |
accident |
| |
Uniplegia--25% |
|
| |
| Parent Care Benefit |
10% of Principal Sum subject to |
Example: Benefit depends of Felonious |
| |
maximum of $50,000 |
or any other accidental death. Parent |
| |
|
must be be receiving support |
| |
|
evidenced by US tax return showing |
| |
|
parent as a dependent |
| |
| Rehabilitation Benefit |
10% of Principal Sum subject to |
Benefit will be based on whether claim |
| |
maximum of $25,000 |
is result of Felonious or any other |
| |
|
accident |
| |
| Coma Benefit |
1% or Principal Sum |
Must occur within 30 days of incident. |
| |
for 1st 11 months. |
Benefit calculated on $510,000 or |
| |
100% of Total Benefit |
$10,000 depending on incident |
| |
If still in Coma after 11 |
|
| |
months |
|
| |
| Seat Belt and Airbag |
Seatbelt--$2500 |
Example: employee is killed in car |
| Benefit |
Airbag--$500 |
crash while wearing seatbelt. |
| |
|
Note: Benefit paid in addition to |
| |
|
$10,000 Accident Benefit |
| |
| Beneficiary Form |
Employees are NOT required to complete a beneficiary form. |
| |
The policy is set up for the following beneficiaries for all employees: |
| |
1. Spouse |
|
| |
2. If no spouse, beneficiary is child or children |
| |
3. If no spouse or children, then parents |
| |
4. If no spouse, no children, no parents then siblings |
| |
5. If none of the above apply, money goes to Estate of the Insured |
| |
|
|
| |
Beneficiary form is available for those employees that want to list another beneficiary other than the hierarchy established in the policy. |
| |
| |
|
|
| QUESTIONS |
Breeden Benefit Group |
Available Day or Evening |
| |
Darrell Breeden |
|
| |
Darrell@breedenbenefitgroup.com |
Office-512-495-9799 |
| |
www.breedenbenefitgroup.com |
Cell--512-567-9797 |
