Schedule of Loss

If within one year from the date of the accident, injury results in any of the following specific losses, the Plan pays a sum for injury resulting from an accident. Each sum is calculated based on the amount of principle sum.

Percentage of Principle Sum
For Loss of: Member/ Spouse Dependent Children
Life 100% 100%
Both hands 100% 400%***
Both feet 100% 400%***
Entire sight of both eyes 100% 400%***
One hand and one foot 100% 400%***
One hand and entire sight of one eye 100% 100%
One foot and entire sight of one eye 100% 100%
Speech and hearing in both ears 100% 400%***
One arm or one leg 100% 200%****
One hand or one foot 100% 100%
Entire sight of one eye 100% 100%
Speech 100% 200%****
Hearing in both ears 100% 200%****
Thumb and index finger of the same hand 100%** 200%
Hearing in one ear 100%*** 25%
Use of both arms or both hands 100% 100%
Use of both legs or both feet 100% 100%
Use of one arm or one hand 100% 75%
Use of one leg or one foot 100% 75%
Paralysis benefits:
Quadriplegia (all four limbs) 100% 400%***
Paraplegia (both lower limbs) 100% 200%****
Hemiplegia (upper and lower limbs of one side of body) 100% 200%****
** The maximum benefit amount payable will not exceed a total of $250,000.
*** The maximum benefit amount payable will not exceed a total of $200,000.
**** The maximum benefit amount payable will not exceed a total of $100,000.

“Loss” means, with regard to:

Hands and feet: Actual severance through or above the wrist or ankle joint;
Arms and legs: Actual severance through or above the elbow or knee joint;
Thumbs and fingers: Actual severance through or above the metacarpophalangeal joints;
Eyes: Entire and irrecoverable loss of sight;
Speech and hearing: Entire and irrecoverable loss of speech and/or hearing;
Paralysis: Permanent and irrecoverable paralysis;
Loss of use: Permanent, total and irrecoverable loss of use. The loss of use must be continuous for 12 months from the date of accident.

The total benefit paid for all losses sustained by one person as a result of any one accident will not exceed the principle sum.

Only one benefit, the largest, is payable to each insured for all losses resulting from one accident.