United Food & Commercial Workers

Unions and Employers

Midwest Health and Pension Funds

UFCW Calumet Region Insurance Fund

Life Insurance and AD&D Benefits

Your eligible dependents are covered only if you elected Family Coverage and are working enough hours to qualify for full-time coverage.

Your Life Insurance Benefit (sometimes referred to as the Death Benefit) helps to protect your family from a sudden loss of income in the event of your death. If you die from any cause while you are an eligible active employee, the Life Insurance Benefit will be paid in a lump sum to your beneficiary.

Certificate and Description

This is an explanation of the Health Plan’s life insurance policy and is your certificate while you are insured. The policy is issued by Fort Dearborn Life Insurance Company and is on file at the Fund Office. All provisions described are determined pursuant to the provisions, definitions, exceptions and reductions of the insurance policy. In the event of a discrepancy between this description and the policy, the terms of he policy shall control.

Benefit Amount

For You $15,000
For Your Dependents  
spouse $2,500
child, age 1 year to 18 years $2,500
child, age 15 days to 1 year $100

Naming a Beneficiary and Payment of Benefit

You may name anyone you wish as your beneficiary. You may change your beneficiary at any time.

To name a beneficiary or to change your beneficiary, request that a Designation of Beneficiary for the Death Benefit form be sent to you or download a copy from the Forms page of this website; then complete and return it to the Fund Office. The designation or change will be effective when the completed form is received at the Fund Office.

If you choose to name a former spouse as a beneficiary, you must specifically identify that person as an ex-spouse under “Relationship” on the Designation of Beneficiary form. Plan provisions prohibit the benefit from being paid to a former spouse unless you specifically indicate the relationship is “ex-spouse.”

If you do not designate a beneficiary, or if your designated beneficiary is not living at the time of your death, the Life Insurance Benefit will be paid to your estate, or at the option of the insurance company, to your surviving spouse or if not surviving, in equal shares to your surviving children, or if none survive, to your parents equally or the survivor, or if neither survives, in equal shares to your brothers and sisters who survive you.

You should review your choice of beneficiary every year to make sure your choice is up to date.

The Trustees have the right to pay benefits to any organization or person as needed to properly carry out the provisions of the Plan. Those payments that are made in good faith are considered benefits paid under the Plan.

Filing a Claim

Upon notification that your death has occurred, the Fund Office will send the proper forms to your beneficiary, estate administrator or survivor. Benefits cannot be paid until a completed claim form has been received by the Fund Office.

Coverage During Disability

If you become totally and permanently disabled before age 65, your life insurance coverage will continue at no cost to you, provided you remain totally and permanently disabled until your death. Coverage extended during your disability is reduced to $2,000 when you reach age 65.

For the purpose of this benefit, totally and permanently disabled means that, due solely to an illness or injury you are prevented from engaging in any business, occupation or employment for wages or profit.

To apply for continued life insurance coverage due to a total and permanent disability, contact the Fund Office after you have been disabled for a period of nine consecutive months, but not later than one year from the date your disability started. You will be required to complete the appropriate forms and provide proof of your disability. You may also be required to take a physical exam at the insurance company’s request. You will be contacted yearly for updated medical information verifying your disability. 

Conversion to an Individual Policy

When you are no longer eligible for the Life Insurance Benefit, you may change part or all of your life insurance coverage under the Plan into a personal life insurance policy. You do not need to pass a medical examination to qualify.

If you have been insured under the Life Insurance Benefit for at least five years when it ends, you may change your Life Insurance Benefit amount to the smaller of:

  • the amount of your insurance under the Plan when it ended less any amount for which you become eligible under any other group life policy within 31 days; or
  • $5,000.

To receive your individual policy you must:

  • apply for it in writing; and
  • make your first premium payment within 31 days after the date your Plan Life Insurance Benefit ends.

You do not need to provide evidence of insurability or evidence of your good health. You may contact the Fund Office for conversion application forms.

The individual policy that is issued may be of any type customarily being offered by the insurance company, except term insurance. The policy will not include disability or other supplementary benefits. The premium is based on the current rate used by the insurance company according to the type and amount of the policy and your age on the date the policy is issued. The individual policy will be effective on the 32nd day following the date your group insurance ended.

Written notice of your conversion privilege will be given to you or mailed to your last known address. If you are not given written notice of your conversion privilege at least 15 days before the end of the 31-day conversion period, you will have:

  • 15 days after the date notice is given to you; or
  • 91 days after your life insurance coverage ends

to make your application.

If you die within 31 days after your Life Insurance Benefit coverage ends, we will pay the amount that could have been converted.

Accidental Dealth and Dismemberment (AD&D) Benefit

AD&D benefits are payable if you (the employee-member) sustain an accidental injury resulting in the loss of your life, a limb, or your eyesight within 90 days after the accident.

If you suffer more than one of the losses listed below in any one accident, payment will be made only for the loss for which the largest benefit is payable. Loss of hand or foot means that the limb is severed at or above the wrist or ankle joint, respectively. Loss of sight mneans the total and irrecoverable loss of sight.

Type of Loss Benefit Amount
Life $7,500
Both hands or both feet or sight of both eyes $7,500
One hand and one foot $7,500
One hand and the sight of one eye $7,500
One foot and the sight of one eye $7,500
One hand or one foot $3,750
Sight of one eye $3,750

Upon notification that your death or dismemberment has occurred, the Fund Office will send the proper forms for completion. Benefits for loss of your life are payable to your Life Insurance Benefit beneficiary. Benefits for any other loss are payable to you.

No benefit is payable under the AD&D benefit if death or any loss is caused directly or indirectly by:

  • bodily or mental illness, infirmity or disease of any kind
  • ptomaine or bacterial infections (except infections caused by pyogenic organisms which occur with and through an accidental cut or wound) or hernia
  • suicide or intentional self-destruction or self-inflicted injury
  • participation in the commission of a felony
  • war or an act of war
  • operating or riding in any aircraft, except as a (1) passenger in a commercial aircraft that is on a regularly scheduled passenger flight; (2) passenger or pilot of a chartered flight; (3) passenger or pilot of a licensed aircraft operated by a licensed pilot, including student licensees.


(Updated 04/09/12)