| Other Programs | ||
| The Western States Health & Welfare Trust Fund of the OPEIU provides the following additional programs. Click on a tab below for additional details. | ![]() |
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| Life Insurance | ||
| The Western States Health & Welfare Trust Fund of the OPEIU provides life and accidental death and dismemberment (AD&D) insurance to employees only. Dependents are not eligible for this benefit. | ||
| Life Insurance Benefits | ||
Life Insurance provides benefits to your beneficiary if you die while insured under the Group Policy. There are no exclusions or limitations to Life Insurance. |
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| Amount of Insurance | ||
The benefit levels available to you for your Life, Accidental Death and Dismemberment and Short Term Disability coverages are determined in accordance with the terms of the Labor Agreement between your Employer and your Local Union. Information regarding your specific benefits can be obtained from the Trust Administrator, A&I Benefit Plan Administrators. |
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| Other Provisions | ||
There is a Continued Life Insurance benefit if you become Totally Disabled while insured and before your 60th birthday. A Continued Life Insurance claim form can be obtained from A&I Benefit Plan Administrators. You may have a Right To Convert to an individual policy of life insurance if your Life Insurance ends or is reduced. Contact the Administrative Office of the Trust for details and to obtain the application form. Application must be made within 31 days from the loss or reduction of the benefit. The insurance provided and benefits payable are not assignable |
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| Accidental Death & Dismemberment Insurance | ||
Accidental Death and Dismemberment Insurance provides benefits for dismemberment or death resulting from Accidental Bodily Injuries. The maximum amount of your Accidental Death and Dismemberment Insurance is determined according to the terms of the Labor Agreement between your Employer and your Local Union. The Maximum Amount is payable for accidental death or if Accidental Bodily Injury results in loss of:
One‑half the Maximum Amount is paid if Accidental Bodily Injury results in loss of
"Loss" means permanent severance of the hand or foot from the body at or above the wrist or ankle joint, or entire and irrecoverable loss of sight. |
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| Seat Belt Benefit | ||
| The Standard Insurance Company will double the Accidental Death Benefit, if you die as a result of an automobile accident and you were wearing a Seat Belt at the time of the accident. The Group Policy contains a detailed explanation of this Seat Belt Benefit. | ||
| Exclusions and Limitations to Accidental Death and Dismemberment Insurance | ||
The death or dismemberment must occur as the direct result of the Accidental Bodily Injury, independent of all other causes, and within 365 days of the accident. The accident must occur while you are insured under the Group Policy. No benefit will be paid if either the Accidental Bodily Injury or the loss is caused or contributed to by: (a) Insurrection, war, or act of war, (b) Suicide or any other intentionally self‑inflicted injury, while sane or insane (c) Committing or attempting to commit an assault or felony, or actively participating in a violent disorder or riot, (d) the voluntary use or consumption of any poison, chemical compound or drug (including but not limited to prescribed medications), (e) Any sickness or pregnancy existing at the time of the accident, (f) Heart attack or stroke, (g) Medical or surgical treatment for any of the above. |
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| Claim Provisions and Procedures | ||
| Filing a Claim | ||
| All claims for benefits should be submitted to A&I Benefit Plan Administrators. Life claims must include a certified copy of the death certificate. You should obtain claim forms from the Personnel Department or directly from the Trust Office. All death benefits will be paid according to the provisions of the Group Policy. | ||
| Time Limits for Filing a Claim | ||
| All benefits must be claimed within 90 days after the date of loss, or as soon thereafter as reasonably possible. In any case, you may claim benefits within one year from the date of initial disability. Claims not filed within these time limits will be denied and no benefit will be paid. These limits will not apply during any period you lacked the legal capacity to file a claim. | ||
| Independent Examination and Autopsy | ||
Standard has the right to have you examined at Standard's expense in connection with a claim for Accidental Dismemberment benefits or disability benefits. Any such examination will be conducted by one or more physicians or vocational specialists of Standard's choice. Standard has the right to have an autopsy performed at Standard's expense except where prohibited by law. |
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| Proof of Loss | ||
| The person claiming benefits must provide Standard with satisfactory written Proof of Loss and certain other information. No benefits will be paid until Standard has received satisfactory Proof of Loss. | ||
| Review Procedure | ||
You have the right to a review of any denial by Standard of all or any part of your claim. If you do not receive a written decision on our claim within 90 days after your claim is received, you will have an immediate right to ask for a review under the review procedure, as if your claim had been denied. To obtain a review, you should send a written request for review to Standard within 60 days after you receive notice of the denial. No special form is required. As a part of your request for review, you may submit issues and comments in writing and provide additional documentation in support of your claim. You may review pertinent documents related to your request for review. Standard will review your claim promptly after receiving your request for review. You will receive written notice of Standard's decision within 60 days after your request for review is received, or within 120 days if special circumstances require an extension. The written decision you receive will include the reasons for the decision and reference to the provisions of the Group Policy on which the decision is based. |
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| Time Limits on Legal Actions | ||
| No action at law or in equity may be brought to recover under the Group Policy until 60 days after written Proof of Loss has been provided to Standard. | ||
| All information provided on this web site is in summary and intended to provide highlights of your plans. We strongly recommend referring to the Plan booklet for complete details before making any decisions related to your eligibility, benefits and coverage. | ||