Coverage For You

You're eligible for PAI if you are an active, regular full-time or part-time employee of Cornell University, scheduled to work a minimum of 1,000 hours per calendar year or more, or you worked 1,000 hours a year or more during the immediately preceding calendar year or 910 hours for County Extension faculty and staff.

Coverage for your Family

If you buy coverage for yourself:

Your lawful spouse is eligible if he or she is under age 70.

Your unmarried dependent children and your domestic partner’s unmarried dependent children are eligible if they are under age 19, or under age 25 if they are full-time students; or 19 years of age or older if primarily supported by the employee because of mental or physical handicap.

A child includes an Employee’s natural child, adopted child, beginning with any waiting period pending finalization of the child’s adoption, stepchild, child for whom the Employee is legal guardian as long as the child depends on the Employee for financial support.

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

Coverage for You

Select from $10,000 to $500,000 worth of coverage in $10,000 increments. If you select a benefit amount over $250,000, the amount cannot exceed 10 times your base annual salary.

Coverage for Your Family

Spouses can receive either 100% or 50% of the coverage amount you choose for yourself. The maximum coverage amount cannot exceed $250,000.

The coverage amount for children is 10% of your benefit amount. So if you elect $100,000 worth of coverage for yourself, your child’s coverage is $10,000. The maximum coverage amount is $25,000. Costs are the same, regardless of the number of children you insure.

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. 

Rates are subject to change

Example:
If you select $250,000 of coverage for yourself, 50% benefit for your spouse and 10% for your dependent children, then:

The total monthly cost for you and your family would be $4.00 ($2.50 + $1.25 + $0.25).

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

• At age 70 Benefits will be reduced to 68% of the benefit amount selected
• At age 75 Benefits will be reduced to 47% of the benefit amount selected
• At age 80 Benefits will be reduced to 32% of the benefit amount selected
• At age 85 Benefits will be reduced to 16% of the benefit amount selected
   

If you elect coverage for your family members, Personal Accident Insurance benefits for your insured family members will be based on your selected benefit amount. Other plan benefits based on your selected amount will be determined by this reduction schedule. Coverage for your spouse/domestic partner ends when he or she reaches age 70. These reductions also apply if you elect coverage after age 69.

To help protect yourself and your family against losses due to accidents, Personal Accident 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 and external event that results in injury or death and that occurs while coverage is in force. To help survivors of tragic accidents adjust to new living circumstances, NYL GBS will pay benefits for dismemberment, loss of eyesight, speech and hearing, and paralysis.

Only one benefit (the largest) will be paid for losses from the same accident.

• Coma means a profound state of unconsciousness which resulted directly and independently from all other causes from a covered accident, and from which the insured is not likely to be aroused through powerful stimulation. This condition must be diagnosed and treated regularly by a physician. Coma does not mean any state of unconsciousness intentionally induced during the course of treatment of a covered injury unless the state of unconsciousness results from the administration of anesthesia in preparation for surgical treatment of that covered accident.
• Loss of a hand or foot means complete severance through or above the wrist or ankle joint.
• Loss of sight means the total, permanent loss of all vision in the eye.
• Loss of speech means total, permanent and irrecoverable loss of audible communication.
• Loss of hearing means total and permanent loss of the ability to hear any sound in both ears.
• Loss of a thumb and index finger or four fingers means complete severance through or above the metatarsophalangeal joints (the joints between the fingers and the hand).
• Paralysis means total loss of use, without severance, of a limb. This loss must be determined by a doctor to be complete and not reversible.
• Loss of a toe means complete severance through the metatarsophalangeal joint.
• Severance means complete and permanent separation and dismemberment of the limb from the body.

It’s not easy to predict how a serious accident will affect your family. Some accidents could seriously affect your finances—especially if extensive rehabilitation is needed. That’s why PAI gives you these additional benefits to help meet special needs.

Living benefits

We will pay benefits if you, or an insured family member, are seriously injured in a covered accident that results in dismemberment, loss of eyesight, speech and hearing, and paralysis. If you suffer multiple covered losses in one covered accident, you’ll receive only one benefit— the largest benefit to which you’re entitled.

Increased accidental injury benefit for children

We will pay double the child’s coverage amount if your insured child suffers an accidental injury. The maximum payment amount is $50,000.

If the child dies within 90 days of the accident, you will receive the death benefit only.

Children Requiring Special Care

Personal Accident Insurance helps parents with children who survive severe accidents. This additional benefit can help parents cope with the ongoing financial obligations associated with caring for children who require continued medical attention, rehabilitation services and a specialized educational environment.

Seat Belt Benefits

We will automatically increase the benefit amount by 10% if you or an insured family member die in a motor vehicle accident while wearing a seat belt. Maximum benefit is $10,000.

We will pay $1,000 if it isn’t clear whether the Insured had been wearing a seat belt.

Seat belt benefit applies to accidents occurring while driving or riding in a validly registered four wheel private passenger (or employer-owned) car, station wagon, jeep, pickup truck or van-type car. Seat belt must be properly fastened, factory installed/ manufacturer-approved.

If the insured is a child, while protected by a child restraint system as defined by state law.

No benefit will be paid if the official accident report is either not provided to us or it indicates that no seat belt was worn.

Coma benefit

If you, your spouse, or your children have been in a coma for one full month as a result of a covered accident, we will pay a coma benefit, as shown in A Valuable Combination of Benefits.

We will make 11 monthly payments, provided the person remains in a coma during this period. If the person recovers, the payments will stop.

If the insured person dies while the monthly coma benefit payments are being made, or if the insured person remains in a coma after the 11 monthly payments have been made, he or she will be entitled to a lump sum payment equal to the full benefit amount.

Plan benefits are not payable if:

• An injury or a loss results, directly or indirectly, from or is caused by, self-inflicted injuries or suicide while sane or insane;
• Commission or attempt to commit a felony;
• Any act of war, declared or undeclared;
• Any active participation in a riot, insurrection or terrorist act;
• Bungee jumping;
• Parachuting;
• Skydiving;
• Parasailing;
• Hang-gliding;
• Sickness, disease, physical or mental impairment, or surgical or medical treatment thereof, or bacterial or viral infection, regardless of how contracted. (This does not include bacterial infection that is the natural and foreseeable result of an accidental external cut or wound or accidental food poisoning.)
• The loss occurs while the covered person is voluntarily using any drug, narcotic, poison, gas or fumes except one prescribed by a licensed physician and taken as prescribed;
• While operating any type of vehicle while under the influence of alcohol (intoxicated is defined by the law of the state in which the covered accident occurred) 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;
• Traveling in an aircraft that is owned, leased or controlled by the sponsoring organization or any of its subsidiaries or affiliates (an aircraft will be deemed to be ‘’controlled’’ by the sponsoring organization if the aircraft may be used as the sponsoring organization wishes for more than 10 straight days, or more than 15 days in any year);
• Aviation, except as a fare-paying passenger on a scheduled or charter flight operated by a scheduled airline;
  • An aircraft being defined as a vehicle which:
    1. has a valid certificate of airworthiness; and
    2. is being flown by a pilot with a valid license to operate the Aircraft

Coverage Start Dates

Your coverage will start on the date we receive your completed and signed application and your payroll authorization form. If you’re not actively at work on your start date, we’ll defer your start date until you’re actively at work.

For your spouse’s coverage to become effective:

• Your spouse must not be hospitalized or receiving outpatient care for chemotherapy or radiation.
• Your spouse must not be confined at home under the care of a doctor.
• Your spouse must not be receiving disability benefits. 
• Your spouse must be able to perform the normal daily activities of a person of the same age and gender without another person’s help or supervision.

For your dependent children’s coverage to become effective:

• You must be actively at work.
• Your children must not be hospitalized or confined at home under the care of a doctor for sickness or injury.

Coverage end dates

Your coverage will end on whichever comes first:

• Your employer cancels the group policy.
• You are no longer an eligible employee.
• You are no longer actively at work.
• You don’t pay the premiums.

Spouse or dependent children coverage will end on whichever comes first:

• Your coverage ends.
• Their premiums are not paid.
• They’re no longer eligible.

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.