Group Accidental Death and Dismemberment Insurance Plan

Accidents can happen. In fact, they are the fourth leading cause of death in the United States.* That is why we offer AUSA members an Accidental Death and Dismemberment Insurance plan, designed to help provide financial relief that you or your family might need during difficult and trying times.

*FastStats—Accidents or Unintentional Injuries." Centers for Disease Control and Prevention, September 2022.

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Plan Highlights

  • Guaranteed issue--no required physical exam or health questions for members under age 70
  • Up to $500,000* in accident coverage
  • Cash benefits to use as you and your family see fit—education, medical bills, end-of-life expenses, etc.
  • Spouse and dependent education benefit as payment of tuition to an institution of higher learning
  • Seat Belt Benefit—you and your dependents qualify for an additional benefit if a covered injury is sustained when wearing a seat belt at the time of the accident**
  • Common Carrier Benefit—you and your dependents can receive double the principal sum paid if a covered injury occurs while on a conveyance operated for transporting passengers for hire, like a taxi or Uber

*At age 70 all coverage is reduced by 50% and will be further reduced by 50% at age 75. **If sustained while 1) a passenger or licensed operator of a properly registered vehicle and 2) wearing a seat belt at the time of the accident, as verified on the police report.

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For trusted protection backed by AUSA, choose your state to download the appropriate application.

Download, print, and mail your completed application to the address listed in the application.

This insurance product may not be available in all states and U.S. territories, including AK, ID, ME, NM, OR, PR, UT, WA, WV, and Guam.


Group Accidental Death & Dismemberment Insurance Brochure

Claim Forms

To submit a claim, download and complete the applicable form and mail it to the address shown at the bottom of this page or fax it to (866) 817-9009.

Accidental Death Claim Form
Accidental Dismemberment: Loss of Sight, Hearing, or Speech Claim Form

Beneficiary Forms

To update your beneficiary, download the applicable form and mail it to the address shown at the bottom of this page.

Beneficiary Form
Beneficiary Form (VA)

This website explains the general purpose of the insurance described, but in no way changes or affects the Master Policy ADD-13268 as actually issued. In the event of a discrepancy between this website and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

The Hartford Financial Services Group, Inc., (NYSE: HIG) operates through its subsidiaries, including underwriting company Hartford Life and Accident Insurance Company, under the brand name, The Hartford®, and is headquartered at One Hartford Plaza, Hartford, CT 06155. For additional details, please read The Hartford’s legal notice at

Accident Form Series includes GBD-1000, GBD-1300, or state equivalent.