Comprehensive Accident Insurance Plan
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CAP Product Overview
Comprehensive Accident Insurance Plan
About Comprehensive Accident Insurance Plan
CAP IS AN ALL-IN-ONE SOLUTION, COMBINING THREE DIFFERENT TYPES OF COVERAGE, INCLUDING:
- Hospitalization due to a covered accident. Your coverage begins the first day you're in the hospital and continues for up to 500 days of being in the hospital - no waiting period necessary - no matter how minor.
- Disability due to a covered accident. After 60-day elimination period, the policy pays you, a monthly benefit for up to 12 months if you are Totally Disabled and unable to perform the activities of your usual occupation as a result of the accident.
- Accidental death provides added financial protection for any covered accidental death - including a death that occurs up to a year (365 days) after the original accident which caused the fatal injuries.
Union Plus' Comprehensive Accident Insurance Plan is limited accident only coverage for union members aged 18 to 59 who want to help their family.
You have a choice between two benefit levels:
Option 1: You and your spouse/domestic partner receive coverage for:
- $50 a day for hospitalization (up to 500 days), and
- $500 a month for disability up to one year (after a 60-day wait period and subject to worker's compensation offset); and
- $50,000 for covered accidental death.
Option 2: You and your spouse/domestic partner receive coverage for:
- $100 a day for hospitalization (up to 500 days), and
- $1,000 a month for disability up to one year(after a 60-day wait period and subject to worker's compensation offset); and
- $100,000 for covered accidental death.
This example is for purposes of illustrating the effect of the benefit reductions and is not intended to reflect the situation of a particular claimant under the policy.
Maximum Benefit Amount
Worker's Comp Benefit*
Maximum Benefit Payable
- $ 500.00 per month
Union members and spouses or domestic partners ages 18-59 provided he or she is Actively at Work and citizens or legal residents of the United States. The policy terminates at age 65.
Eligibility is based on working 20 hours or more a week or an average of 260 hours per calendar quarter. Eligibility for AFA-CWA members is based on working 240 block hours on an average basis per calendar quarter.
If your union notified Union Plus in writing that you have left the union for any other reason than retirement, then the coverage will be terminated.
Spouse means your spouse/domestic partner who:
1) is under age 60; and 2) a citizen or legal resident of the United States, its territories and protectorates; and 3) is not legally separated or divorced from You. Spouse will include your domestic partner.
** This policy has an offset for workers compensation, and if payable, the amount would be variable. The minimum benefit amount payable is $50, despite other income benefits exceeding the maximum benefit amount covered under this policy.
If a husband and wife are both Eligible Members, coverage may not be duplicated by applying as dependents of each
Be sure to see the link to the Important Medicare Duplication Notice: Click here
Comprehensive Accident Insurance Plan coverage benefits
UNION PLUS' CAP HELPS PROVIDE PROTECTION THAT IS HASSLE-FREE AND GUARANTEED ISSUE*:
Union Plus' CAP plan offers two benefit options with the following built-in features:
- This policy pays you from the first day of hospitalization due to a covered accident.
- You receive benefits in addition to any other insurance you may already have.
- Premiums do not increase and benefits do not decrease with age - you won't pay more for your coverage, or lose any of your benefits.
- Strike waiver of premium - we will pay your premium for up to one year if you are involved in a union-sanctioned strike or lockout. May not be available for all unions.
- You're protected for all covered accidents - anytime, anywhere 24 hours a day.
- You have a 60-day review period with a satisfaction guarantee.
We designed this plan to stay affordable. To control costs this plan excludes certain losses. Read the complete list of exclusions under the Terms tab.
Wondering what is not covered by this insurance program? View the Terms tab.
60-DAY SATISFACTION GUARANTEE:
Upon acceptance into this insurance plan, you'll receive a Certificate of Insurance. You have up to 60 days from the Effective Date to review your Certificate of Insurance without any obligation. If you do not like what you see, simply return the Certificate of Insurance within that timeframe, and any premiums paid will be refunded, minus any paid claims. Hassle free.
*Subject to pre-existing conditions limitations
Union Plus Comprehensive Accident Insurance Plan Rates
Member & Spouse/Domestic Partner
** Rates shown are countrywide except for Washington. For Washington rates, please call 1-800-393-0864 or click here. Rates and/or benefits may be changed on a class basis.
Frequently Asked Questions
Coverage and Dependent Questions:
I'M CONCERNED THAT A WORKERS COMPENSATION OFFSET WILL REDUCE MY BENEFIT TO $0. IS THIS POSSIBLE?
Yes, however, if your Monthly Benefit Amount would reduce to less than $50 per month due to Other Income Benefits, including Workers Compensation, then the minimum Monthly Benefit Amount under this benefit will be $50 per month.
WHY IS COMPREHENSIVE ACCIDENT PROTECTION (CAP) IMPORTANT TO HAVE?
Consider what would happen if you were unable to work for days, weeks, months from an accident? The Union Plus Comprehensive Accident Insurance Plan is a "catch-all" plan to help provide added financial protection for all covered accidents. First, it pays a daily benefit while you are in the Hospital for any kind of covered accident. Secondly, if the accident is severe enough to cause a disability - one that causes you to become unable to perform the material and substantial duties of your usual occupation - it pays an additional monthly benefit to help relieve the added financial burden caused by your inability to work. And thirdly, if the accident is fatal, the Comprehensive Accident Insurance Plan death benefit can be used to help pay the bills if you are gone.
WHAT IS AN "INJURY"?
Injury means bodily injury resulting directly from accident and independently of all other causes.
WHAT IS A "PREMIUM"?
The premium is the payment you make for an insurance policy.
WHAT DOES IT MEAN TO BE TOTALLY DISABLED?
Totally Disabled or Total Disability means a disability which, during the Elimination Period and the first 12 months during which Total Disability Benefits are payable, wholly and continuously prevents you or your spouse/domestic partner from performing the essential duties of your occupation.
This Union Plus Comprehensive Accident Plan contains a 60-day Elimination Period, meaning that benefits will be paid after a period of time during which the insured has been continuously disabled for 60 days. Benefits are not payable during the Elimination Period. Benefits are then paid for up to one year, or until the insured returns to work, dies or reaches the policy termination age of 65.
If benefits begin prior to age 65 and the insured turns 65 while collecting benefits, the benefits will continue if the insured remains disabled, until the benefit period would normally end (after a year, or a return to work or at death).
SHOULD I WAIT UNTIL I'VE SATISFIED THE ELIMINATION PERIOD TO FILE MY CLAIM?
IS THERE A PRE-EXISTING CONDITIONS LIMITATION?
Yes. Benefits will not be paid for any loss which begins during the first 24 months as the result of a pre-existing condition unless you become Totally Disabled after having been free of medical care for the condition for a 12 month period. During the first two years of coverage, losses incurred for Pre-Existing Conditions are not covered. A Pre-Existing Condition means any injury or sickness including pregnancy; diagnosed or undiagnosed, for which you have received medical care within the 12-month period prior to your coverage effective date or the date of an increase in coverage. During that time, benefits for all other accidents or illnesses will be paid under the policy provisions. You are urged to consider this limitation before dropping any coverage you may have until the waiting period is over.
ARE THERE ANY AGE REQUIREMENTS?
Yes, you must be aged 18-59 to qualify and coverage terminates at age 65.
I'M A PART-TIME OR SEASONAL EMPLOYEE. AM I STILL ELIGIBLE?
Yes, but you must work 20 hours per week or an average of 260 hours per quarter. Eligibility for AFA-CWA members is based on working 240 block hours on an average basis per calendar quarter.
WHAT DOES "ACTIVELY-AT-WORK" MEAN?
Actively-at-Work means you are working at least 20 hours per week. Eligibility for AFA-CWA members is based on working 240 block hours on an average basis per calendar quarter.
IS COVERAGE AVAILABLE FOR MY SPOUSE OR DOMESTIC PARTNER?
Yes, your spouse or domestic partner can enroll. If a husband and wife are both Eligible Members, coverage may not be duplicated by applying as dependents of each other.
DOES MY SPOUSE OR DOMESTIC PARTNER RECEIVE THE SAME BENEFIT AS ME, THE UNION MEMBER?
Yes, spouses (or domestic partners) can enroll for the same benefit amount as you.
CAN I GET COVERAGE FOR THE REST OF MY FAMILY (BESIDES MY SPOUSE/DOMESTIC PARTNER)?
CAN I COLLECT MORE THAN ONE BENEFIT WITH THIS POLICY?
Yes, if you are injured and must be hospitalized due to a covered accident you will receive a daily Hospital benefit for each day you are in the Hospital. If the injury is serious and causes you to miss work for an extended period of time, you may also collect monthly disability benefits. If your injury should result in death, your beneficiary would also collect a death benefit.
Hospital does not mean any institution or part thereof which is used primarily as:
- 1. a nursing home, convalescent home or skilled nursing facility;
- 2. a place for rest, custodial care or for the aged;
- 3. a clinic;
- 4. a place for the treatment of Mental Illness, alcoholism or Substance Abuse.
However, a place for the treatment of Mental Illness, alcoholism, or Substance Abuse will be regarded as a Hospital if:
- it is part of an institution that meets the above requirements; and
- it is listed in the American Hospital Association Guide as a general hospital.
WHAT IS THE CERTIFICATE EXAMINATION PERIOD?
Members have 60 days to review the certificate. If you change your mind within that time you are entitled to a full refund of premium less any claims paid.
WHEN DOES COVERAGE BECOME EFFECTIVE?
Coverage becomes effective on the first day of the month after your enrollment form is received and you pay your premium.
WHEN DO BENEFITS BEGIN?
The daily Hospital benefit will pay from the first day of hospitalization due to a covered accident. The disability benefit begins after a 60-day Elimination Period.
WHAT HAPPENS TO AN INSURED WHEN AN ACCIDENT OCCURS BUT DEATH DOESN'T OCCUR RIGHT AWAY?
The coverage will pay if death occurs within 365 days of the accident and the accident is found to be the primary cause of death.
IF THE INSURED MEMBER DIES CAN MY SPOUSE OR DOMESTIC PARTNER CONTINUE COVERAGE?
Yes, spouses (or domestic partners) can continue coverage if they are insured with their own policy prior to the members' death.
WILL MY BENEFITS EVER CHANGE BASED ON MY HEALTH STATUS OR AGE?
No, the benefits will remain the same until the policy terminates at age 65.
DOES THIS COVERAGE PAY IF AN INSURED IS HOSPITALIZED FOR A COVERED ACCIDENT?
Yes, it pays $50 or $100 a day (depending on the coverage selected) for each day an insured spends in the Hospital due to an accident with a maximum lifetime benefit of 500 days.
WHAT IF HOSPITALIZATION OCCURS DUE TO SICKNESS?
The coverage pays only for hospitalizations due to covered accidents. It does not pay for hospitalizations due to sickness or disabilities caused by natural causes, heart attack or other illnesses.
WHAT DOES THE STRIKE/LABOR DISPUTE WAIVER OF PREMIUM MEAN?
If an insured is in 1) a lawful, authorized strike by a union or 2) is locked out as a result of a dispute between the union and an employer, the insured doesn't have to pay premiums on this coverage. May not be available for all unions or in all states.
HOW DOES THE STRIKE/LABOR DISPUTE WAIVER OF PREMIUM WORK?
Premiums will be waived beginning with the first premium due date following a strike or lock out. Premium payments will be waived for up to one year, but will resume on the earliest of: 1. One year from when the strike or lockout began, 2. The next premium due date after resolution, 3. Next premium due date after return-to-work offer, or 4. Next premium due date after employment is terminated. May not be available in all states or for all unions.
WHAT IS THE PROCESS FOR GETTING THE PREMIUM WAIVED?
The insured must provide written proof of strike or lock out before the wavier of premium begins. It can be a note from the union, or a note from the insured with a newspaper article verifying the sanctioned or forced work stoppage.
IS IT MANDATORY TO NAME A BENEFICIARY?
No. If no beneficiary is named for the accidental death benefit it will be paid to the deceased's estate. The daily Hospital benefit and the disability benefit are paid to the insured.
CAN BENEFICIARIES BE CHANGED?
Beneficiaries may be changed at any time by calling 1-800-393-0864 to request a beneficiary form or downloading a beneficiary change form.
IS THIS ONE OF THOSE POLICIES WHOSE COST INCREASES AS I GET OLDER?
No, there is one rate for each benefit level choice. Rates do not increase as you get older. Coverage ends at age 65.
DO BENEFIT AMOUNTS DECREASE AS I GET OLDER?
No, they will remain the same as long as your policy is in force.
CAN THE COVERAGE AMOUNT BE CHANGED?
Coverage amounts can be changed anytime by calling 1-800-393-0864 or by downloading a coverage change form.
CAN THE COVERAGE BE PAID BY CREDIT CARD?
Yes, members who enroll will have various payment options.
IS THE AUTOMATIC CHECKING ACCOUNT DEDUCTION AVAILABLE?
THIS IS ACCIDENT ONLY COVERAGE.
Comprehensive Accident Insurance Plan Exclusions
The Union Plus Comprehensive Accident Plan, by The Hartford, does not cover any loss resulting from:
- Intentionally self-inflicted Injury, suicide or attempted suicide, whether sane or insane
- War or act of war, whether declared or undeclared;
Injury is defined as bodily injury resulting directly from accident and independently of all other causes.
CONDITIONS PRIOR TO EFFECTIVE DATE:
We will not pay a Benefit for any loss or period of Total Disability which:
- begins during the first 24 months of Your insurance; and
- is a result of a Pre-Existing Condition; unless such Total Disability begins after You have been free of Medical Care for the condition for a 12 month period ending any time on or after Your effective date.
CONDITIONS PRIOR TO EFFECTIVE DATE OF INCREASE IN COVERAGE:
We will not pay an increased Benefit for any loss or period of Total Disability which:
- begins during the first 24 months following the date You make a change in coverage that increases Your benefits; and
- is a result of a Pre-Existing Condition unless such Total Disability begins after You have been free of Medical Care for the condition for a 12 month period ending any time on or after Your effective date of increase.
PRE-EXISTING CONDITION MEANS ANY DISABILITY, DIAGNOSED OR UNDIAGNOSED, FOR WHICH MEDICAL CARE IS RECEIVED BY YOU:
- within the 12 month period prior to the date Your insurance starts; or
- with respect to the limitation for any increase in coverage, within the 12 month period prior to the effective date of your increase in coverage.
Your coverage terminates on the earlier of: a) the date the policy is terminated; or b) the Premium Due Date on or next following the date you: 1) cease to be a member of the Policyholder; 2) cease to be Actively-at-Work; 3) attain age 65; 4) no longer reside in the United States; or 5) fail to pay any required premium contribution.
Coverage of your Eligible Dependent terminates: a) on the Premium Due Date your coverage ceases; or b) on the Premium Due Date on or next following the date: 1) of legal separation or divorce from you; 2) he or she ceases to be Actively-at-Work; or 3) he or she attains age 65.
Please be sure to click here to read this Important Medicare Duplication Notice
In CA: A.G.I.A., Inc., License #0549207. J. Christopher Burke CA Insurance License #0F709407. J. Christopher Burke AR Insurance License #8876308.
This Web site explains the general purpose of the insurance described, but in no way changes or affects the Master Policy ADD-9927 as actually issued. In the event of a discrepancy between this Web site and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. Benefits may vary and this program may not be available to residents of all states or in all unions.
The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.
A.G.I.A., Inc. is a member of the Better Business Bureau
A.G.I.A., Inc. is the Plan Administrator that administers the insurance plan on behalf of the Hartford Life and Accident Insurance Company for the benefit of the Group Policyholder.
Union Privilege is compensated for the placement of insurance and for the services it provides to customers on behalf of the insurance company, in addition to other compensation it may receive.
This is a participating group policy under which dividends and/or experience credits may be paid to the group policyholder.
Underwritten by Hartford Life and Accident Insurance Company, Hartford, CT 06155
Policy # ADD-9927
This policy may not be available in all states.
Accident Form Series includes GBD-1000, GBD-1300 or state equivalent.