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Addl AD&D Coverage and Rates

Addl AD&D Coverage and Rates

Insurance Benefits Trust of PORAC

Each active member of PORAC under age 70, who is a member in good standing.

Choose from a minimum of $10,000 to a maximum of $500,000 in $10,000 increments.
Spouse and Children:
Spouse: A choice of 50% or 100% of Member benefit amount.
Eligible Dependent (Children): 20% of Member benefit amount

You must be insured in order for dependents to be covered. Dependents are:

- Your legal spouse under age 70, not legally separated or divorced from you or your
domestic partner named on an affidavit of Domestic partnership
- Your unmarried dependent children from birth to age 26.

A person may not have coverage as both a Member and Dependent. Only one insured spouse
may cover dependent children.

AD&D Schedule

For Accidental Loss of: First
Life 100%
Two or more members 100%
Speech and hearing 100%
One Member 50%
Speech or Hearing 50%
Thumb & Index finger of same hand 25%

Member means hand, foot, or eye.

CONTRIBUTION REQUIREMENTS: Coverage is 100% Member pai

RATES:  See attached rate sheet.


- Common Disaster
- Common carrier benefit
- COMA benefit
- Day Care benefit
- Education benefit
- Exposure and disappearance
- Seat belt & air bag benefit
- Therapeutic counseling benefit
- Total loss of use benefit


- Travel Assistance Service

Benefits will not be payable for any loss to which sickness, disease, or myocardial infarction, including medical or surgical treatment thereof is a contributing factor; caused by suicide, or intentionally self-inflicted injuries; caused by or resulting from war; caused by an accident that occurs while in the armed forces of any country; caused by or resulting from: piloting any aircraft;
or riding in or getting into or out of any non-civilian aircraft or any aircraft owned, leased or operated by you or your employers; sustained during the insured’s commission or attempted commission of an assault or felony; to which the insured’s acute or chronic alcoholic intoxication is a contributing factor; or, to which the insured’s voluntary consumption of an illegal or
controlled substance or a non-prescribed narcotic is a contributing factor. For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This plan highlights are a brief description of the key features of the RSL Insurance Plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-8605 etal.

Reliance Standard Life Insurance Company

insurance premium table