Accidental Death & Dismemberment (AD&D)

Accidental Death & Dismemberment (AD&D)  


Our online enrollment and “My Account” functions are temporarily unavailable at this time. We regret this inconvenience.

If you are looking to enroll, make coverage changes or update your beneficiary designations, paper forms are available on the product option under “My Benefits”. These may be mailed, emailed or faxed to the address on the “Contact Us” tab.


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. NYL GBS'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. 

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 NYL GBS.

Option 1

Enroll Online

Option 2

Download Your Enrollment Application

Complete, sign and date the enrollment application and return to NYL GBS at the address shown on the form.


If you have questions, please call 1.800.828.3485 to speak to a NYL GBS 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 U.S. employee of Genesys, regularly working a minimum of 20 hours per week.

    Your Family - You may elect to cover your lawful spouse under age 70 and your unmarried dependent children who are under age 19 (or under age 24 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 $25,000 units from $25,000, up to a maximum of $500,000 of coverage for yourself.


    Your Spouse - Your Spouse's benefit amount will be either 50% or 100% of your elected coverage amount, not to exceed $500,000.

    Your Children - Your children can be covered equal to 10% of your benefit amount. The benefit amount per child cannot exceed $25,000.

  • Your Monthly Cost

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

    Monthly Cost of Insurance


    Employee Only

    $0.013 per $1,000 of coverage

    Spouse Only

    $0.013 per $1,000 of coverage

    Child Only

    $0.013 per $1,000 of coverage




    You can buy coverage for yourself only or for yourself, your spouse and your children.

    Costs are subject to change.

    Employee only coverage: if you elect coverage of $150,000, your cost for Accidental Death & Dismemberment would be

    $150,000÷1,000 x $0.013 = $1.95 per month.

  • Benefit Reductions

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

    • At age 65 Benefits will be reduced to 65% of the benefit amount selected.
    • At age 70 Benefits will be reduced to 45% of the benefit amount selected.
    • At age 75 Benefits will be reduced to 30% of the benefit amount selected.
    • At age 80 Benefits will be reduced to 20% of the benefit amount selected.

    Accidental Death & Dismemberment benefits for your insured dependents will be based on your selected benefit amount. Benefits for your spouse will cease at age 70.

  • 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, NYL GBS 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: NYL GBS will pay this % of the benefit amount

    You or Your Spouse

    Your Children

    Accidental loss of life 100% 100%
    Total paralysis of both upper and lower limbs; Loss of any two: hand, foot or eyesight; Loss of speech and hearing in both ears 100% 200%
    Paraplegia 75% 150%
    Uniplegia 25% 50%
    Loss of one eye, hand, or foot; Loss of speech or loss of hearing in both ears; Total paralysis of both legs; Total paralysis of arm and leg on one side of the body 50% 100%
    Loss of thumb and index finger on same hand 25% 50%

    If you suffer multiple injuries in one covered accident, you’ll receive only one amount—the largest amount to which you’re entitled.

    If a dependent child dies within 90 days of a covered loss, we will pay only the loss of life benefit.


    Loss of a hand or foot

    means severance through or above the wrist or ankle joint. 

    Loss of sight

    means the total, permanent loss of 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). 


    means complete separation and dismemberment of the limb from the body. 


    means total loss of use, without severance, of a limb. This loss must be determined by a doctor to be complete and not reversible.
  • Other Benefit Features

    It’s not easy to predict how a serious accident will affect your family. In addition to the benefits previously outlined, Accidental Death & Dismemberment provides benefits to help meet special needs and respond to special circumstances as follows:

    The Seat Belt and Supplemental Restraint Benefit

    This benefit is payable if an insured person dies as a direct result of injuries sustained in a covered accident while driving or riding in an automobile, while wearing a properly fastened seat belt (or if the insured is a child, a child restraint as defined by law). That person’s death benefit will be increased by 10% but not more than $25,000. If the insured person was also positioned in a seat protected by a properly-functioning and properly deployed Supplemental Restraint System (Air bag), we will increase that person’s death benefit by an additional 5%.

    Verification of the actual use of the seat belt and that the supplemental restraint system inflated properly on impact at the time of the accident, must be part of an official report of the accident, or be certified, in writing, by the investigating officer(s) and submitted with the claim.

    If it is unclear whether the insured had been wearing a seat belt or that the person was positioned in a seat protected by a properly functioning and properly deployed air bag, the plan will pay a benefit of $1,000.

    For Exposure and Disappearance

    Benefits are payable if you suffer a covered loss due to unavoidable exposure to the elements as a result of a covered accident. If your body is not found within one year of the disappearance, forced landing, stranding, wrecking or sinking of the conveyance in which you were riding, on a trip otherwise covered, it will be presumed that you sustained loss of life as a result of a covered accident.

    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.

    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.

    The Benefit for Children Requiring Special Care

    Accidental Death & Dismemberment helps parents with children who survive severe accidents. If an insured child suffers a covered accidental injury, we will double the benefit amount, up to $50,000. If your child subsequently dies within 90 days as a result of the accident, then we will pay only the death benefit payable under the plan.

    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.

    For Dual Accidents

    If you have elected coverage for yourself, your spouse and your children and, as a result of the same accident or separate Covered Accidents that occur within the same 24-hour period, you and your spouse die within one year of the Covered Accident, we will increase your spouse’s benefit amount to 100% of yours. Both benefits combined cannot be more than $1,000,000.

    For Victims of Crime

    PAI pays an additional benefit for employees who are victims of crime. If you die as the result of a felonious assault, robbery, holdup or kidnapping during a holdup, while at work or while traveling on business, we will increase your benefit amount by 25% to a maximum of $50,000. We will not pay if you are assaulted by a fellow employee or household or family member.

    The Education Benefit

    If you are the primary source of income for your family, the loss of that income could be devastating to your family, especially if a college education for your children is one of your long-term goals. Accidental Death & Dismemberment provides benefits for training or education, as follows:

    • For your children. If you or your insured spouse dies in a Covered Accident, we will pay an extra benefit for each insured child who is enrolled in college or is in the 12th grade and enrolls in college within one year of the accident. To help pay college expenses, we will increase your benefit amount by 5% or $5,000, whichever is less, for each qualifying child. This benefit is payable each year for four consecutive years as long as your child continues his/her college education.

    If you don’t have a qualifying dependent child, we will pay an additional $1,000 to your beneficiary.

    Child Care

    If you have elected to cover your family members and you and your insured spouse dies as a result of a Covered Accident, Accidental Death & Dismemberment will pay an additional benefit to help pay for your children’s day-care expenses.

    To receive the Child Care Benefit, you must have a surviving child under 13 who is enrolled in a licensed day-care center at the time of your death, or within one year afterward. The following conditions will apply:

    • This benefit will be an annual sum for each covered child of up to 5% of your benefit amount, but not more than $5,000 a year for up to four years, or until the dependent child’s 13th birthday, whichever happens first.
    • We will make the payment to the child’s surviving custodial parent or legal guardian. Each payment will be made to the end of a 12-month period in which there were documented child care center expenses.

    Waiver of Premium

    If you have elected coverage for yourself and your family members, and you lose your life in a covered accident, your insured family members will continue to be covered under the plan—without making premium payments—for 12 months. At that time, their coverage will end unless they convert to an individual policy.

  • What is not covered?

    Plan benefits are not payable if losses result directly or indirectly from or are caused by:

    • Intentionally self-inflicted injuries or suicide while sane or insane;
    • Commission or attempt to commit a felony or an assault;
    • Any act of war, declared or undeclared;
    • Any active participation in a riot or insurrection;
    • 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.)

    Benefits are also not payable if:

    • 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;
    • While the covered person is engaged in the activities of active duty service in the military, navy or air force of any country or international organization (this does not include Reserve or National Guard training, unless it extends beyond 31 days);
    • 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);
    • Flying 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 that is:
      • An ultra-light or glider, designed to be used in outerspace;
      • Being used by any military authority, except the Air Mobility Command or its foreign equivalent;
      • Being flown by the covered person or in which the covered person is a member of the crew;
      • Being used for parachuting, hang-gliding, crop dusting, spraying or seeding, giving and receiving flying instruction, fire fighting, sky writing, skydiving, pipeline or power line inspection, aerial photography or exploration, racing or endurance tests, stunts 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).

    The basic level, for which your employer pays, provides a monthly benefit up to 60% of your covered monthly earnings—to the program maximum of $10,000 per month.

  • When Your Coverage Begins and Ends

    An employee may enroll for Accidental Death & Dismemberment coverage at any time without providing proof of good health. Coverage becomes effective as of the date you become eligible. 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, you must be actively at work and he/she must not be an inpatient in a hospital, or confined at home and under the care of a physician for sickness or injury, or receiving disability benefits, or unable to perform the normal daily activities of the person of the same age and sex. Your coverage will continue as long as Genesys and NYL GBS continue to offer the program under the group policy, you are an eligible employee, you do not serve more than 30 days of full-time active duty in any armed forces, and you pay the premium when due. Coverage for your spouse and dependent children ends when their premiums are not paid or when your dependents are no longer eligible, whichever occurs first.

  • Changing from the Group Plan to Individual Coverage

    If this group coverage ends before you reach age 70 for any reason except nonpayment of premium, 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 NYL GBS.
  • 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 'Contacts 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 NYL GBS Benefits Guide 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 NYL GBS Benefits Guide 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


  • Do I have to complete 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 – NYL GBS 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 or change your beneficiary when you enroll for Accidental Death & Dismemberment Insurance online or you can complete a beneficiary designation form by going to the Forms section above, download and submit to New York Life Group Benefit Solutions. Once you have enrolled for Accidental Death & Dismemberment 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 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.