Accidental Death & Dismemberment

You can’t always prevent an accident…but you can prepare for one with our AD&D program.

  • Coverage amounts up to $250,000.
  • Lump-sum payment in the event of your accidental death or covered accidental dismemberment injury.
  • Coverage for you, your spouse and children.
  • Acceptance is guaranteed for members and employees under age 60.
  • Round the clock protection on or off the job.

Make a Payment Brochure Enrollment Form Privacy and MIB Notice

Who is Eligible For Coverage?

All PICPA members and employees of PICPA members are eligible to enroll. Members and employees must be under age 60, reside in the United States and be actively at work on a full-time basis.

Plans Available

Member or Employee Only

Elect coverage for just yourself. Select a benefit amount that’s right for you ( minimum of $10,000 to a maximum of $250,000 in increments of $10,000).

Family Plan

Select a family plan which covers yourself, your spouse and children.

  • Percent of Member/Employee Principal Sum if loss occurs
    • Member/Employee: 100%
    • Dependent Spouse: 50% (if no dependent children); 40% (if there are dependent children)
    • Dependent Child(ren) 15% (if there is no spouse); 10% (if a spouse is covered)

Return completed forms to Gallagher Affinity at:

Gallagher Affinity
GGB.AffinityPHL@ajg.com or Fax to 215-925-0161
P.O. Box 4111, Clinton, IA 52733
Questions call: 800-952-4050 Ext. 4765
Email: Irene_Walton@ajg.com