Participant Rights and Responsibilities Upon Transfer or Termination
Personal Accident Insurance Coverage
Indiana University provides the opportunity for employees to purchase optional Personal Accident Insurance from $30,000 to $500,000 of coverage. The plan covers employees and their eligible dependents. Premiums are based on the level of coverage selected and are deducted from the employee's salary on a pre-tax basis.
All full-time Academic and Staff employees may purchase Personal Accident Insurance for themselves and their eligible dependents. A dependent is a legal spouse, registered domestic partner, unmarried child through age 20, or age 24 if the child continues to be the employee's or employee's spouse's Federal income tax dependent. No one may be covered more than once under the plan. Those covered as an employee cannot also be covered as a spouse or dependent child. Coverage for disabled dependents may be kept in force beyond the age limit if proof of incapacity and dependence are provided within 31 days of the date when coverage would have ended due to the age limit.
Participation by the employee in Personal Accident Insurance ends on the date that the employee:
- terminates from the university; or
- ceases to be a member of the eligible class for coverage; or
- ceases to make any required contributions.
A dependent's coverage terminates:
- when a dependent becomes eligible for employee coverage; or
- when an individual ceases to meet the definition of a dependent; or
- when the employee's coverage terminates; or
- when required contributions are not made.
The employee, and dependents in some cases, have the right to convert Personal Accident Insurance to an individual policy without showing proof of good health.
Employee Conversion. When Personal Accident Insurance ceases under the group policy due to termination of employment with the university or transfer to an ineligible class, coverage may be converted to an individual policy without providing proof of good health. Conversion coverage is only available if the employee is under age 70.
Dependent Conversion. Dependents may also convert group coverage when they cease to be eligible for any reason except age. Dependents must apply for conversion within 31 days after their group coverage ends.
Summary of actions the participant must take to convert to an individual policy:
- Complete and return the PAI conversion application (PDF) to the designated policy underwriter at the address on the application. The application must be mailed to within 31 days after the date on which group coverage terminates. Please contact University Human Resources to request completion of the employer portion of the application: .
- Send the initial premium to the address on the application within 31 days after the date that group coverage terminates
- Pay subsequent premium payments on time.
- Notify the policy underwriter of beneficiary changes.
- Notify the policy underwriter of address and name changes.
For additional assistance with conversion of PAI, including determining premium costs for coverage and completing the forms for conversion, please call Cigna at 1-800-441-1832 and reference group policy number OK980032.