Accidental Death & Dismemberment (AD&D) - Voluntary - Employee Paid

Accidental Death & Dismemberment (AD&D) - Voluntary - Employee Paid  

Accidental Death & Dismemberment

Valuable protection on or off the job.


"As long as you've got your health . . ."

If you're physically healthy, you can work, play, take care of your family, and enjoy life. The same holds true for your financial health. For long-term financial well-being, you need to understand where you are, be aware of where you want to go, and have a plan to get you there.

But, if something were to happen to you, all your hard work - and everything you have - could be lost unless you've taken steps to protect yourself and your family. Cigna's Accidental Death & Dismemberment (AD&D) insurance can help you protect your family’s financial health at a cost you can afford. Usually for a few dollars a month, you can receive thousands of dollars worth of protection that can help provide security and peace of mind for you and your family. This coverage also provides protection on or off the job.

Having adequate insurance coverage is not only the basis for a sound financial blueprint; it also provides the protection you need to help ensure that your family, your home and your finances will be protected.

Who needs Accidental Death & Dismemberment (AD&D) Insurance?

You do. Accidental Death & Dismemberment (AD&D) insurance can help you pay expenses if you are seriously injured or killed in a covered accident. This coverage can help ensure that tragedy doesn't take both an emotional and a financial toll on your family. By purchasing Accidental Death & Dismemberment (AD&D) insurance through your employer, you benefit from:

  • Affordable coverage at group rates
  • Convenient payroll deduction
  • Guaranteed issue amounts
  • Access to knowledgeable service representatives

Please read the plan information for a full disclosure of plan provisions, benefits, exclusions, limitations, and effective dates of coverage prior to making your selections.

You can Enroll for AD&D Insurance Online by using the "Enroll Online" button. Or, you can Complete An Enrollment Application and submit to Cigna.

Option 1

Enroll Online

Option 2

Download Your Enrollment Application

Complete, sign and date the enrollment application and return to Cigna at the address shown on the application.


If you have questions, please call 1.800.828.3485 to speak to a Cigna representative (Monday through Friday, 8 AM to 5 PM CST or 9 AM to 6 PM EST).

My Benefits

  • Who is Eligible for Coverage?

    You - You are eligible for coverage if you are an active full-time or part-time employee of Lehigh Valley Health Network, regularly working a minimum of 16 hours per week.

    Your Family - You may elect to cover your lawful spouse under age 70 and your unmarried dependent children who are at least 15 days old and under age 19 (or under age 25 if they are full-time students). Children must be dependent upon you for support and maintenance.

    No one may be covered more than once under this plan. If covered as an employee, you cannot also be covered as a dependent.

  • How Much Coverage Can You Buy?

    You - You may select coverage in increments of $10,000, beginning at the minimum amount of $20,000 up to the maximum of $1,000,000. Maximum benefit amounts in excess of $150,000 are subject to 10 times your annual compensation.

    Your Family - Your Spouse's benefit amount will be either 50% or 100%, subject to a maximum benefit of $250,000. Each of your covered children’s benefit amounts will be 10% of your coverage not to exceed $25,000.

    Each family member’s coverage is a percentage of the benefit amount you select. It will depend on who your insured family members are at the time of a covered accidental loss.

  • Your Monthly Cost

    Your cost will depend on the benefit amount and coverage option you select.

    Monthly Cost of Insurance

    Employee Only

    $0.025 per $1,000 of coverage

    Family Coverage

    $0.039 per $1,000 of coverage


    Rates are subject to change.

  • When You Reach Age 65

    As you grow older, your benefits will be reduced according to the following schedule:

    At age 70 benefits will be reduced to 70% of the benefit amount selected.
    At age 75 benefits will be reduced to 45% of the benefit amount selected.
    At age 80 benefits will be reduced to 30% of the benefit amount selected.
    At age 85 benefits will be reduced to 15% of the benefit amount selected.

    Other program benefits based on your selected benefit amount will be determined by this reduction schedule. Coverage for your spouse ends when he or she reaches age 70. These reductions also apply if you elect coverage after age 69.

  • A Valuable Combination of Benefits

    To help protect yourself and your family against losses due to accidents, Accidental Death & Dismemberment Insurance pays 100% of the benefit amount you select for accidental loss of life occurring within 365 days of a covered accident. A covered accident is a sudden unforeseeable event that results in injury or death and that occurs while coverage is in force. To help survivors of severe accidents adjust to new living circumstances, Cigna will pay benefits for dismemberment, loss of eyesight, speech and hearing, and paralysis.

    If, within 365 days of a covered accident, bodily injuries result in: Cigna will pay this % of the benefit amount:

    Loss of life


    Total paralysis of upper and lower limbs, or
    Loss of any two: hand, foot or eyesight, or
    Loss of speech and hearing in both ears


    Total paralysis of upper and lower limbs on one side of the body, or
    Loss of one: hand, foot, or sight in one eye, or
    Loss of speech, or
    Loss of hearing in both ears


    Loss of thumb and index finger on same hand,
    Loss of all four fingers on the same hand


    Loss of all toes on the same foot



    If the same accident causes more than one of these losses, we will pay only one amount, but it will be the largest amount that applies.

    Loss of hand or foot means complete severance through or above the wrist or ankle joint. Loss of sight means the total, permanent loss of the sight of the eye. The loss of sight must be irrecoverable by natural, surgical, or artificial means. Loss of speech means total, permanent and irrecoverable loss of audible communication. Loss of hearing means total and permanent loss of hearing in both ears, which cannot be corrected by any means. Loss of a thumb and index finger means complete severance through or above the metacarpophalangeal joints (the joints between the fingers and the hand). Paralysis means loss of use, without severance, of a limb. This loss must be determined by a doctor to be complete and not reversible. Severance means complete separation and dismemberment of the limb from the body.

  • Other Benefit Features

    It’s not easy to predict how a serious accident will affect your family. Some accidents could have serious financial ramifications if extensive rehabilitation is required. A widowed spouse may need to enhance work skills or acquire new ones. In addition to the benefits previously outlined, Accidental Death & Dismemberment Insurance provides benefits to help meet special needs and respond to special circumstances as follows:

    The Seat Belt Benefit

    Wearing a seat belt when you’re in a moving vehicle is probably the simplest and certainly the cheapest way to protect yourself from injury due to accidents. To encourage insureds to adopt this practice, Accidental Death & Dismemberment Insurance offers the Seat Belt Benefit.

    This benefit automatically increases your coverage amount by 10%, up to $10,000, if you or a covered family member is killed in a covered accident while driving or riding in a private passenger vehicle and while wearing a properly fastened seat belt (or, if the insured is a child, while protected by a child restraint system as defined by state law). This additional Seat Belt Benefit will be no less than $1,000 or no more than $10,000.

    If the official accident report is not available, and it isn’t clear whether the insured had been wearing a seat belt, the plan will pay a benefit of $1,000. No benefit will be paid if the official accident report indicates that no seat belt was worn at the time of the accident.

    Felonious Assault

    An additional benefit equal to 25% of the Principal Sum will be paid if:

    • Bodily injury or death takes place while the Insured
      • is on the business of the Organization; or
      • is on any premises of the Organization; and
    • Bodily injury or death is the direct result of any of the following:
      • Actual or attempted robbery or holdup;
      • Actual or attempted kidnapping;
      • Any other type of intentional assault that is a crime classified as a felony by the governing statute or common law in the state where the felony occurred;
      • Felonious assault inflicted by persons other than fellow employees or members of the insured’s family or household.

    No other policy provision or condition is changed in any way.

  • What is not covered?

    This plan doesn’t cover losses resulting directly or indirectly from, or caused by:

    • Intentionally self-inflicted injury, suicide or any attempt thereat while sane or insane;
    • Commission or attempt to commit a felony or an assault;
    • Commission of or active participation in a riot or insurrection;
    • Bungee jumping; parachuting; skydiving; parasailing; hang-gliding;
    • Declared or undeclared war or act of war;
    • Flight in, boarding or alighting from an Aircraft or any craft designed to fly above the Earth’s surface:
      • Except as a passenger on a regularly scheduled commercial airline;
      • Being flown by the Covered Person or in which the Covered Person is a member of the crew;
      • Being used for: Crop dusting, spraying or seeding, giving and receiving flying instruction, fire fighting, sky writing, sky diving or hang-gliding, pipeline or power line inspection, aerial photography or exploration, racing, endurance tests, stunt or acrobatic flying; or
        Any operation that requires a special permit from the FAA, even if it is granted (this does not apply if the permit is required only because of the territory flown over or landed on);
      • Designed for flight above or beyond the earth’s atmosphere;
      • An ultra-light or glider;
      • Being used for the purpose of parachuting or skydiving;
      • Being used by any military authority, except an Aircraft used by the Air Mobility Command or its foreign equivalent;
    • Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food;
    • Travel in any Aircraft owned, leased or controlled by the Subscriber, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be ‘’controlled’’ by the Subscriber if the Aircraft may be used as the Subscriber wishes for more than 10 straight days, or more than 15 days in any year;
    • A Covered Accident that occurs while engaged in the activities of active duty service in the military, navy or air force of any country or international organization. Covered Accidents that occur while engaged in Reserve or National Guard training are not excluded until training extends beyond 31 days;
    • Operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the Covered Person has been provided a written warning against operating a vehicle while taking it. Under the influence of alcohol, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Accident occurred;
    • Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage.
  • When Your Coverage Begins and Ends

    You may enroll for voluntary AD&D coverage at any time without providing proof of good health. Coverage becomes effective on the later of the date you become eligible, the date we receive your completed enrollment application, or the date you authorize any necessary payroll deductions. Provided the application has been received and the appropriate premium paid, dependent coverage will start when your coverage begins. If you are not actively at work, the effective date of your insurance will be deferred until you are actively at work. For insurance for your spouse and/or children to become effective, he/she must not be an inpatient in a hospital, receiving chemotherapy or radiation therapy on an outpatient basis, confined at home and under the care of a physician for sickness or injury or totally disabled. Your coverage will continue as long as you remain an eligible employee, pay your premium when due and we agree with your employer to continue this group policy. For your spouse and dependent children, coverage ends when your coverage terminates, when their premiums are not paid or when he or she is no longer eligible, whichever occurs first.


    Totally disabled means, if the covered person is employed, he/she is unable to perform any work for which he/she is (or may reasonably become) qualified by education, training or experience. If the covered person is not employed, totally disabled means he/she is unable to perform all the activities of daily living without human supervision or assistance.

  • Changing from the Group Plan to Individual Coverage

    If this group coverage is reduced or ends for any reason except non-payment of premium or age, you can convert to an individual policy. No medical certification is needed. To continue coverage, you must apply for the conversion policy and pay the first premium in effect for your age and occupation within 31 days after your group coverage ends. Family members may convert their coverage as long as they have not reached the maximum age limitation. Converted policies are subject to certain benefits and limits as outlined in your certificate, should you become insured under the plan.

  • Designating Your Beneficiary

    You can designate your beneficiaries during the enrollment process and maintain your beneficiaries online once your coverage is issued by clicking on "My Account" at the top right corner of your screen.

    If the listed beneficiary is a trustee or a trust, you will need to enter the trustee's name, the name of the trust and the date of the trust agreement. The trust document must be presented in order for the claim to be processed.

  • Apply Today

    You can Enroll For Accidental Death & Dismemberment Insurance Online by using the "Enroll Online" button. Or, you can Complete An Enrollment Application and submit to Cigna.

  • How Do I Pay My Premiums?

    You pay your premiums through payroll deduction. The total depends on how much coverage you select.

  • How Your Claims Are Paid

    Claim forms can be obtained online under the Forms section below or by calling the toll-free number listed on the 'Contact Us' page.


Enroll online by clicking on the “Enroll Online” link under Option 1 above; this will speed up your enrollment process.

These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing. Click here to download a free copy of Adobe Acrobat Reader.

Enrollment Applications

If you submit your enrollment application via a paper form, we will enter it into the Cigna Trusted Advisor® website so you can view it online through My Account.

Enrollment Application

Beneficiary Form

If you submit your beneficiary designation via a paper form, we will enter it into the Cigna Trusted Advisor® website so you can view it online through My Account.

Beneficiary Designation Form - Voluntary

Change Forms

Voluntary Accidental Death & Dismemberment (AD&D) Insurance Change Form

Claim Forms 

The information requested in the forms below is required for us to begin reviewing your claim. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim.

Accidental Death & Dismemberment (AD&D) Insurance Claim Form

Accidental Death & Dismemberment (AD&D) Insurance Claim Form (Online) - Employer use only


  • Do I have to provide proof of good health?

    No. You do not need to provide proof of good health regardless of the coverage amount you are applying for.

  • Who can enroll for Accidental Death & Dismemberment (AD&D) insurance?

    You can enroll for yourself, your spouse and eligible dependents.

  • Am I protected in remote areas of the world?

    Yes - Cigna Secure Travel® can arrange and cover the cost of transportation to get you to a different hospital or medical facility or to be repatriated to your place of residence for treatment. And, in the event of a fatality, we’ll arrange and cover the cost of transporting remains back to the country of origin

  • How do I designate a beneficiary?

    You can designate your beneficiary when you enroll for Accidental Death & Dismemberment (AD&D) insurance online or you can complete a beneficiary designation form by going to the Forms section above, download and submit to Cigna. Once you have enrolled for Accidental Death & Dismemberment (AD&D) insurance, you can view and update your beneficiary online through My Account at the top right corner of this page.

  • Are there any other programs I should know about?

    Yes. Our Accidental Death & Dismemberment (AD&D) insurance plan includes many value-added programs, offered at no additional cost, to help you and your family maintain your health, well-being and sense of security throughout your lifetime. To see which programs are available to you select "Value-Added Programs" from the menu above.