Accidental Death & Dismemberment (AD&D)

You can enroll on UCPath. After your Period of Initial Eligibility (PIE), you can increase, decrease, cancel, or enroll in coverage by completing the UCPath Benefits eForm: Submit New Form. In the Reason For Request, select Change AD&D.

Use the enrollment form PDF available from Prudential to enroll in coverage. The level of coverage for which you are eligible depends on your level of coverage as an employee. See the plan costs chart for more information.

The plan provides benefits if the accident results in:

• Death or dismemberment or loss of sight, speech, or hearing caused by an accident
• Paraplegia, quadriplegia, or hemiplegia
• Coma lasting more than 30 days
• Permanent and total disability caused by an accident

In addition to receipt of the principal sum, your family members may also receive the following if you die:

• Special educational benefits for your spouse or eligible domestic partner and/or children
• Your child’s higher education costs provided the child is enrolled in an institution of higher education on the day of the accident, or, if the child is a high school student, the child must enroll in an institution of higher education within one year of high school graduation
• Day care expenses for covered children under age 13 for up to four years if you die in an accident.

You should designate a beneficiary immediately upon enrolling in AD&D insurance. Your beneficiaries do not have to be the same as those you’ve chosen for your UC Retirement Plan benefits.

You may name more than one beneficiary and specify the percentage that each beneficiary is to receive online or by submitting form UBEN 116. A beneficiary may be a person, trustee or organization.

You can change your beneficiaries at any time. If no beneficiary is named or if your beneficiary is no longer living, any benefits will be paid to your survivors in the following order:

• Surviving legal spouse or surviving domestic partner; or, if none,
• Surviving children, on an equal-share basis; or, if none,
• Surviving parents on an equal-share basis; or, if none,
• Surviving siblings; or, if none,
• The member’s estate.

If a family member is covered by AD&D, you are automatically named the beneficiary. You can change this online or by submitting form UBEN 119 (Designation of Alternate Beneficiary) PDF.

If you need assistance completing the claim form, call UCPath at (855) 982-7284 to work with a beneficiary care coordinator. For reference, UC’s policy number is 97000.

When you leave UC employment or retire, you may be able to continue life insurance benefits. You have different options depending upon the plan.