Reg Jones Expert's View

Excuse me for bringing up the subject of injury and death, but some employees have been asking an important insurance question: What happens if I have a fatal accident or one that results in the loss of eyesight or a limb?

If you are an employee covered by FEGLI Basic or Option A-Standard insurance, you receive accidental death and dismemberment (AD&D) coverage at no additional cost. AD&D insurance is a source of additional money if you have a fatal accident or one that results in the loss of a limb or eyesight. The death or loss must 1) occur within 90 days of the accident and 2) be a direct result of injury sustained in that accident, not from other causes. (Just to refresh your memory, Basic insurance is equal to your base salary rounded up to the nearest $1,000 plus $2,000. Option A-Standard insurance is worth a flat $10,000. These are your principal amounts of coverage.)

If you lose your life as a result of an accident, your survivors will receive the Principal amount of your insurance coverage plus an equal amount of AD&D. For example, if you were covered by Basic insurance in the amount of $70,000, the total payment from FEGLI would be $140,000 ($70,000 plus $70,000). If you were enrolled in Option A-Standard, the payable amount would be $20,000 ($10,000 plus $10,000). If you have both kinds of coverage, you’ll get both payments.

If you survived that accident and lost a hand, foot or the sight in one eye, you would receive half the amount of your Principal coverage. For example, in the above example, if you lost one limb you would receive you $35,000 if covered by Basic insurance and $5,000 if covered by Option A. If you lost two or more limbs, you would receive the full amount, $70,000 or $10,000 (or both, if you have both kinds of coverage).

Of course, there is an upper limit to what can be paid under AD&D. For all eyesight or limb loses resulting from any one accident, you may receive no more than an amount equal to the Principal. Note: There is no lifetime limit on coverage. If you suffer a loss in a subsequent accident, payment may be made again.

While AD&D is generous in its coverage, there are some limitations on the circumstances under which it may be paid. The Office of Federal Employees’ Group Life Insurance (OFEGLI) will not pay AD&D benefits if your death or loss is in any way the result of, is caused by, or is contributed to by:

  • physical of mental illness;

  • the diagnosis or treatment of physical or mental illness;

  • ptomaine or bacterial infection, unless it is caused by an accidentally sustained external wound;

  • hernia, no matter how sustained;

  • a war (declared or undeclared), any act of war, or any armed aggression against the United States, in which nuclear weapons are actually being used;

  • a war (declared or undeclared), any act of war, or any armed aggression or insurrection in which you are in actual combat at the time the bodily injuries are sustained;

  • suicide or attempted suicide;

  • injuring yourself on purpose;

  • illegal or illegally obtained drugs that you administer to yourself.

That in a nutshell is what AD&D insurance is. For information about a specific case, you may call OFEGLI at 1-800-633-4542.