Group Accidental Death and Dismemberment (AD&D) Insurance

Group Accidental Death and Dismemberment (AD&D) Insurance  


As an ROA Member in good standing under age 70, you are guaranteed acceptance for up to a $250,000 AD&D benefit, payable for a covered accident. Your spouse¹ and children can be covered for a percentage of your chosen benefit. The plan also provides benefits for education, child care assistance and seat belt usage. Double benefits (up to $300,000) will be paid if you die in a covered accident while a passenger in a licensed common carrier (such as a taxicab, train, bus or airplane).
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Family Coverage

Your spouse/domestic partner and dependent children (14 days to age 25) are also guaranteed coverage. Your spouse/domestic partner benefits are 40% of the benefit amount you choose and dependent child(ren)'s benefits are 10% of your benefit. If no spouse/domestic partner coverage is elected, each dependent child's coverage is 15% of your benefit. If no child coverage is elected, your spouse's/domestic partners benefits are 50% of your coverage.

Take a look at the enrollment form and brochure under the "Forms" tab for information on additional benefits such as:

  • Safe Driver Benefit
  • Education Benefits
  • Child Care Benefits Paid To Your Family
  • Coma Benefit
  • Common Carrier Benefit
  • Total And Permanent Disability
  • Training Benefit
  • Elder Care Benefit
  • Expose and Disappearance Benefit
  • Transportation Benefit
  • Burn Disfigurement Benefit
  • Rehabilitation Benefit
  • Common Disaster Benefit

Below is the plan's rate chart

Member's Benefit Amount Member Monthly Premium Contributions Member & Family Monthly Premium Contributions
$50,000 $2.70 $3.75
$75,000 $4.05 $5.63
$100,000 $5.40 $7.50
$125,000 $6.75 $9.38
$150,000 $8.10 $11.25
$175,000 $9.45 $13.13
$200,000 $10.80 $15.00
$225,000 $12.15 $16.88
$250,000 $13.50 $18.75
$275,000 $14.85 $20.63
$300,000 $16.20 $22.50
$325,000 $17.55 $24.38
$350,000 $18.90 $26.25
$375,000 $20.25 $28.13
$400,000 $21.60 $30.00
$425,000 $22.95 $31.88
$450,000 $24.30 $33.75
$475,000 $25.65 $35.63
$500,000 $27.00 $37.50

Rates do not increase with age. Rates shown are guaranteed until 7/1/2018. For your convenience, you will be billed annually. If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment options.

Group AD&D Insurance underwritten by ReliaStar Life Insurance Company, a member of the Voya® family of companies. Policy form HP010GP.

This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of coverage. All coverage is subject to the terms of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern.

This is a paid endorsement. The MSBA receives a fee from the insurance broker and/or the insurer for its endorsement of this plan.


These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.

Contact Us

We're here to help! Please contact us in whatever manner is most convenient for you.

4050 NW 114th Street
Urbandale, Iowa 50322
 M-F 7:30a-5p CT
[email protected]


Insurance Company:

ReliaStar Life Insurance Company
Minneapolis, MN