Plan Summary

The Accidental Death and Dismemberment (AD&D) Insurance plan offers accidental death and dismemberment insurance for employees and their spouse or domestic partner and eligible children. You may select coverage levels that range from $25,000 to $500,000.

In addition to benefits payable in the event of accidental death or dismemberment, this plan provides the following benefits:

  • Zurich Travel Assist – travel assistant program that provides benefits when you travel at least 100 miles from your home.
  • Benefits to care for surviving family members including benefits to pay for daycare expenses, higher education benefits, and retraining benefits.
  • Benefits for covered injuries including home alteration and vehicle modification benefits, hearing aid benefit, and therapeutic counseling benefits.
  • Additional benefits paid in certain situations such as carjacking, coma, and natural disaster benefits.
  • If an accidental death claim is paid due to the death of a covered employee, family coverage continues premium-free for one year after death.
  • Continuation of group policy coverage at retirement.
  • Conversion of coverage to an individual policy at the end of employment.

See the Plan Brochure for an explanation of all benefits under this plan.



You must meet the following requirements to be eligible for this plan:

  • Eligible for State Group Health Insurance; and
  • Are not receiving a Wisconsin Retirement System (WRS) annuity.


An eligible dependent includes:

  • Spouse
  • Domestic Partner
  • Children as defined as your or your spouse’s or domestic partner’s unmarried children, who are:
    • At least 15 days old, and
    • Dependent upon your for at least 50% of their financial support.
  • Children remain eligible for coverage until the earliest of:
    • The end of the month in which he/she marries, or
    • The end of the year in which the child is no longer dependent upon you for at least 50% of their financial support, or
    • The end of the year in which the child turns 19, except
      • If child is a full-time student, he/she is eligible until the end of the year in which the child turns 25 or ceases to be full-time student, whichever is earlier.

Note: If you and your spouse/domestic partner are both eligible for this plan as employees, you and your spouse/domestic partner may only be covered as an employee or a dependent – not both. This rule also applies to children who are also eligible for this plan as an employee.


  • You may enroll, change, or cancel your coverage at any time.
  • Coverage is effective on the first of the month on or following receipt of your application. You may enroll within your first 30 days via eBenefits or with a paper application and you may submit a paper application at any time after your first 30 days to enroll.

Premiums & Coverage

You may enroll in Employee or Family coverage. If you enroll in Family coverage, the benefit amount of your covered family member will be a percentage of the employee benefit amount.

Monthly Premiums and Coverage Levels
Benefit Amount $25,000 $50,000 $100,000 $150,000 $200,000 $250,000
Employee Only $0.73 $1.45 $2.90 $4.35 $5.80 $7.25
Family $1.10 $2.20 $4.40 $6.60 $8.80 $11.00
Monthly Premiums and Coverage Levels (cont’d)
Benefit Amount
$300,000 $350,000 $400,000 $450,000 $500,000
Employee Only $8.70 $10.15 $11.60 $13.05 $14.50
Family $13.20 $15.40 $17.60 $19.80 $22.00

The University does not contribute towards the premium.

Beneficiary Information

You are strongly encouraged to submit a 

Beneficiary Designation

Beneficiary Designation

to ensure benefits are paid according to your wishes. If there is no eligible beneficiary, or you do not name one, benefits will be paid in the following order:

  • Your surviving spouse or domestic partner, otherwise;
  • Your surviving children equally, otherwise;
  • Your surviving grandchildren equally, otherwise;
  • Your surviving parents equally, otherwise;
  • Your surviving siblings equally, otherwise;
  • Your estate.

All claims associated with the death of a covered family member will be paid to the covered employee.

Forms & Publications

  • Application – Complete and submit to your institution’s benefits office to enroll in the plan.
  • Beneficiary Designation – Complete and submit to UW System Administration to name who you would like to receive benefits payable upon your death.
  • Conversion Form – Follow the instructions on the conversion bulletin to learn how to convert your group policy to an individual policy. Must be under age 70 to convert.
  • Continuation Form – Contact your benefits office if you need a continuation form.

Plan Administration

The Accidental Death and Dismemberment Insurance plan (group policy #GTU 8364005) is administered by University of Wisconsin System Administration and Hausmann-Johnson Insurance and underwritten by Zurich American Insurance Company.