PAYROLL DEDUCTION
GROUP ACCIDENT INSURANCE
FOR EMPLOYEES OF
STATE OF FLORIDA
Participating Agencies: JUDICIAL BRANCH
Departments of: MANAGEMENT SERVICES
ENVIRONMENTAL PROTECTION
LEGAL AFFAIRS
BUSINESS & PROFESSIONAL REGULATION
LAW ENFORCEMENT
FLORIDA PAROLE COMMISSION
FLORIDA FISH AND WILDLIFE CONSERVATION COMMISSION
The bulletin is a descriptive statement of the insurance benefits.
It is not intended to be a contract of insurance.
The full provisions and benefits are set forth in the insurance policy.
Administrator
ANTHONY FINALDI & CO., INC.
755 Benjamin Chaires Road, Tallahassee, Florida 32317
Phone: (850) 385-2880 Fax:(850) 385-3213
Email: afcoforlife@hotmail.com
Web: http://www.afcoforlife.com
Underwritten by:
Dear Employee:
We are pleased to announce that you are eligible to participate in our
DESCRIPTION OF COVERAGE
Under this plan, you are covered 24 hours a day anywhere in the world, whether you are at home or on the job. You are also covered when traveling on business or for pleasure, including when you are flying as a passenger (but not as a crew member or pilot) in any aircraft licensed to carry passengers except Military Aircraft other than MAC (Military Air Command). You are covered as a pilot, operator or member of a crew only if you have been specifically identified in a written agreement for this coverage and only with respect to those aircraft also identified in the agreement.
ELIGIBLE PERSONS
All active full-time employees*. Part- time employees are also eligible; however, benefits are lower. You may also insure your spouse and unmarried children to 19 years of age (to age 25 if a full time student at school and primarily dependent on you for support). *Full- time employees equals 25 hour or more per week.
You may choose to cover yourself under the Individual Plan, or yourself and family under the Family Plan.
INDIVIDUAL PLAN
As a full-time employee, you may select any Principal Sum from $20,000 to a maxim of
$300,000 but not to exceed ten (10) times your annual salary for limits in excess of $250,000.
Part-time employees can select benefits up to $100,000 only.
If you are a full-time employee pilot you will be insured for the lesser of your selected Principal Sum or $100,000 while acting as a pilot or crewmember on a Policyholder owned, leased or operated aircraft. If your occupation is police, security, prison guard or highway construction employee you can select benefits up to $100,000 only.
FAMILY PLAN
If you selected this plan, your spouse and eligible children will be insured for the following:
BENEFITS FOR ACCIDENTAL DEATH AND DISMEMBERMENT
If an injury results in any of the following losses within 365 days after the accident, this plan will pay:
AMOUNT
Principle Sum .............................................................................................Life
Principle Sum .............................................................................................Both Hands or Both Feet or the sight of Both Eyes
Principle Sum .............................................................................................One Hand and One Foot
Principle Sum .............................................................................................Either Hand or Foot and the Sight of One Eye
Principle Sum .............................................................................................Speech and Hearing
Principle Sum .............................................................................................Movement of Both Upper and Lower Limbs (Quadriplegia)
Three Quarters
of Principle Sum .........................................................................................Movement of Both Lower Limbs (Paraplegia)
One-Half of Principle Sum ..........................................................................Movement of Both Upper and Lower Limbs
of One Side of the Body (Hemiplegia)
One-Half of Principle Sum ..........................................................................Either Hand or Foot
One-Half of Principle Sum ..........................................................................Sight of One Eye
One-Half of Principle Sum ..........................................................................Speech or Hearing
One-Quarter of Principle Sum. ...................................................................Thumb and Index Finger of Either Hand
"Injury" means bodily injury directly resulting from an accident, and independent of all other causes. Loss resulting from sickness or disease, or medical or surgical treatment of sickness or disease is not covered. The accident must occur while you are covered under the policy.
The term "Loss" as used herein shall mean with regard to hands and feet, actual severance through or above wrist or ankle joints; with regards to eyes, entire and irrevocable loss of sight; with regard to thumb and index finger, actual severance through or above metacarpophalangeal joints; with regard to speech and hearing, entire and irrevocable loss thereof; movement of limbs, complete and irreversible paralysis of such limbs.
COMMON CARRIER BENEFIT
If you or your covered dependents are injured while riding as a passenger on a common carrier, the amount of Principle Sum payable under the Accidental Death and Dismemberment Benefit will be doubled. However, the Principle Sum will never be increased by more than the Common Carrier Limit of $100,000.
A Common Carrier is a vehicle operated by a business organized and licensed to transport passengers for hire, and operated by an employee of that business. The Policyholders business does not qualify as a Common Carrier under this contract.
YOUR BI-WEEKLY PREMIUM PAYROLL DEDUCTION
YOUR BI-WEEKLY PREMIUM PAYROLL DEDUCTION *Your principle sum reduces on the Premium Date or next following date
ENROLLMENT PROCEDURE You may enroll by completing in ink the enrollment form provided.
Mail to: Anthony Finaldi & Co., Inc. Your premium will be deducted from your PAYCHECK. EFFECTIVE DATE If you are eligible for coverage under this plan and you make a written request for coverage
If, after the Policy Effective Date, you as an eligible person for coverage under this plan, make written request for coverage, a change in or for additional coverage, such coverage shall become effective the first day of the month next following the date such request is received by Anthony Finaldi & Co., Inc. If more than one written request has been made by you, then whichever is the most recent request on file with Anthony Finaldi & Co., Inc. shall govern. Coverage for eligible dependents shall become effective concurrent with your coverage. EDUCATION BENEFIT If your dependents are covered under the family plan and you die, and the principle sum is payable, the plan will pay an Education Benefit to each student. The education benefit will be the lesser of 5% of your Principal Sum or the maximum amount of $5,000. To receive this benefit, a student must show proof that, on the date of your death
This benefit is payable every year in which the student meets the above definition If an Education Benefit would be payable, but no person qualifies as a student, the plan will pay the minimum amount of $1,500 according to the terms of the beneficiary section. SEAT BELT BENEFIT If you suffer a loss payable under the Accidental Death and Dismemberment Benefit, the plan will pay an additional benefit of 10% of your principle sum to a maximum amount of $25,000 if injury occurred:
This benefit does not cover loss if you are operating the automobile under the influence of any intoxicant, excitant, hallucinogen, narcotic or other drug, or similar substance as verified in the police accident report. Automobile means a four-wheeled, private passenger car, station wagon, van or jeep-type vehicle, which is not being used as a Common Carrier. Common Carrier means a vehicle operated by a business organized and licensed Seat Belt means a belt, lap restraint, or shoulder restraint installed by the manufacturer of the Automobile. Online Enrollment Form: Click Here EXCLUSIONS This policy does not cover loss caused by or resulting from: (1) intentionally self-inflicted injury, suicide or attempted suicide; whether sane or insane; (2) war or act of war, whether declared; or undeclared; (3) injury sustained while in the armed forces of any country or international authority; (4) injury sustained while riding on any aircraft except a Civil or Public Aircraft, or Military Transport Aircraft; (5) *injury sustained while operating or serving as a crewmember of any aircraft (unless previously consented to in writing by the company). *NOTE: if you are insured under the policy as an active full- time employee pilot of the Policyholder then exclusion #5 will not apply to you. BENEFICIARY Your beneficiary shall be the individual or individuals you designate on the enrollment form.
TERMINATION You will be covered as long as you are an active eligible employee, pay premiums when due and the Plan remains in force. Coverage of dependents terminates when your own coverage terminates or when they are no longer eligible. CONVERSION PRIVILEGE EMPLOYEE ONLY If your coverage terminates because you are no longer eligible, you may convert to a policy from Hartford Life and Accident Insurance Company and no evidence of insurability is required. You must request conversion in writing to Hartford Life and Accident Insurance Company and pay the initial premium within 31 days of the date this coverage terminates. Dependent coverage cannot be converted. There are limitations on the amount of coverage you are eligible to convert. See your certificate for details. Administrator ANTHONY FINALDI & CO., INC. Online Enrollment Form: Click Here Underwritten by
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