What is Dismemberment?

If an Employee or eligible Dependent suffers a loss due to an Injury in an accident, he/she may be entitled to Dismemberment benefits. Dismemberment benefits are payable for accidental loss of a member (hand or foot), loss of sight, loss of hearing and loss of use. All of the losses listed below are considered dismemberment for the purposes of filing a claim. Certain conditions, which are set forth in your certificate booklet, are required in order to be eligible for this benefit.

	LOSSES COVERED FOR DISMEMBERMENT BENEFITS   Loss of One or Both Hands     Loss of One or Both Feet     Loss of Entire Sight of One or Both Eyes     Loss of Speech or Hearing     Quadriplegia (total paralysis of both upper and lower limbs)     Paraplegia (total paralysis of both lower limbs)     Hemiplegia (total paralysis of upper and lower limbs on one side of the body)     Loss of Thumb and Index Finger (on same hand)

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How do I file a Dismemberment Claim?

Contact your Campus Benefits Office or click here for claim forms and instructions.

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How much will I receive for Dismemberment benefits?

Upon approval of your claim, payment will be made for those losses set forth in the Table of Losses below.

The total amount of benefits payable for all losses to any one person resulting from any one accident will not be greater than the AD&D Benefit Amount.

	TABLE OF LOSSES AMOUNT PAYABLE   Loss of Life   The Full AD&D Benefit Amount   Loss of Both Hands   The Full AD&D Benefit Amount   Loss of Both Feet   The Full AD&D Benefit Amount   Loss of Entire Sight of Both Eyes   The Full AD&D Benefit Amount   Loss of One Hand and One Foot   The Full AD&D Benefit Amount   Loss of One Hand and Entire Sight of One Eye   The Full AD&D Benefit Amount   Loss of One Foot and Entire Sight of One Eye   The Full AD&D Benefit Amount   Loss of Speech and Hearing (both ears)   The Full AD&D Benefit Amount   Quadriplegia (total paralysis of both upper and lower limbs)   The Full AD&D Benefit Amount   Paraplegia (total paralysis of both lower limbs)   One-Half the Full AD&D Benefit Amount   Loss of One Hand   One-Half the Full AD&D Benefit Amount   Loss of One Foot   One-Half the Full AD&D Benefit Amount   Loss of Entire Sight of One Eye   One-Half the Full AD&D Benefit Amount   Loss of Speech   One-Half the Full AD&D Benefit Amount   Loss of Hearing (both ears)   One-Half the Full AD&D Benefit Amount   Hemiplegia (total paralysis of upper and lower limbs on one side of the body)   One-Half the Full AD&D Benefit Amount   Loss of Thumb and Index Finger (on same hand)   One-Half the Full AD&D Benefit Amount

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How long will it take to process a Dismemberment Claim?

Benefit payments are processed within 10 calendar days of receipt of documentation supporting eligibility for dismemberment benefits.

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