Accidental Death and Dismemberment Insurance (AD&D)

  1. Overview
  2. Publications
  3. Forms

Plan Overview

Description: The plan protects you against losses resulting from a covered accident. You may select a coverage amount up to $500,000. Your dependents are covered for a percentage of the benefit amount you select, subject to certain maximums. The plan also includes Zurich Travel Assist®, a comprehensive travel assistance program that provides benefits and services when you are traveling 100 miles or more from your residence.

Premiums

Accidental Death & Dismemberment Premium Table

Learn More

Vendor

Zurich American Insurance Company

Send questions to: benefits@ohr.wisc.edu

Forms

Note: Use Adobe Reader to open and complete PDF forms.
MAC Users: Do not use "Preview," a PDF reader.

Application | Submit to your Payroll & Benefits Office

Accidental Death and Dismemberment Insurance Application, UWS-1245

Beneficiary Designation | Submit to your Payroll & Benefits Office

Beneficiary Designation, UWS-1247

Conversion

Conversion Privilege Bulletin, UWS-1250