- Group Life, ADD & Accident and Health Beneficiary Designation Form (This works for all Provident policies)
- Group Life CLAIM FORM use for any covered member who has passed.
- 24 hr ADD Claim form (USE this along with Group Life claim form if passing is accidental for additional death benefit)
- FIRST NOTICE OF CLAIM for Accident and Health (WC Supplement) policy Claim form.
- Facility of Payment Affidavit (use this form in lieu of beneficiary form)
- Accident & Health Insurance Policy
Whenever emergency responders answer a call they risk more than their lives to selflessly serve others-they risk their economic livelihood due to hazards that can cause injury, illness, or even death. Even in states that have liberal Workers’ Compensation benefits, there are many shortcomings and loopholes that emergency responders may face. Disability limitations, waiting periods, and restrictions for heart attacks are just a few of the problems that emergency responders may encounter. These shortcomings can cripple a family’s financial stability. That’s where Provident’s Accident & Health coverage can make a real difference by filling in the gaps and providing benefits that Workers’ Compensation does not offer. Why choose Provident’s blanket Accident & Health policy?The Accident & Health policy helps make the insured person “whole” financially. It fills in the gaps for income replacement and provides many other benefits that pay independently of one another to ensure the financial security of the emergency responder and his or her family.This Accident & Health policy has innovative and groundbreaking benefits, such as a weekly disability benefit payable up to Lifetime.First Responder Assistance Program included with the ACH policy.The First Responder Assistance Program offers confidential support, resources and referrals any time day or night by phone or online for first responders and their families for issues regarding:
- Stress Management
- Family Conflict
- Grief and Loss
- Financial or Legal
- Problem Gambling
- Child and Elder Care
Don’t Suffer in Silence™. Take advantage of these confidential services whenever you need them.
For more information and to access the services available with the First Responder Assistance Program, call 855-207-1747.
Please watch Provident First Responder Assistance Program video.
Accidental Death & Dismemberment Policy
In the United States, accidents are the number once cause of death among people under the age 38, and the fifth leading cause of death overall. The Accidental Death & Dismemberment (AD&D) insurance benefits provide added protection in case of accidental death or dismemberment.
In order to provide a quote for Accidental Death & Dismemberment Insurance, we must know how many members the organization would like to cover, as well as the benefit limits that are being requested up to a maximum of $500,000.”
Seat Belt Benefit – an additional 10% of the AD&D benefit up to a maximum of $10,000 may be payable if an insured dies as the result of an accident in a private passenger vehicle while he or she was wearing a seat belt.
Emergency Service Workers are covered while performing any activity of their organization, as well as when they are off duty. Members are covered for injuries sustained anywhere in the world, and this includes riding as a passenger in any aircraft being used for the transportation of passengers.
Unum Life Insurance Company of America, a member of the Unum Corporation, issues the policy. The program is administered by Provident Agency, Inc. of Pittsburgh, PA.
- Group Term Life Insurance
Life is never predictable. The Group Term Life Insurance we offer through Provident can help protect the financial independence and strength of emergency responders’ families if the unexpected happens. The innovative features and services offer survivors much more than just a benefit check.In order to provide a quote for Group Term Life Insurance, the organization must supply a complete membership census including dates of birth of all members, as well as the benefit limits that are being requested up to a maximum of $20,000.The group term life insurance provides coverage to members 24 hours per day, and benefits are paid regardless of the cause of death-whether on or off duty.There are no medical questions. This group program is based on guaranteed issue with absolutely no medical examination questions concerning health.An emergency service organization can purchase up to $20,000 of coverage. The program is flexible in that it is possible to have different levels of benefits for different classes of membership. We are also able to retain full levels for all members, regardless of age.
- Accelerated Death Benefit available.Optional Accidental Death & Dismemberment rider available.After a death benefit is paid, Survivor Support Financial Counseling Service is available as an exclusive feature with Unum Life Plans. Provided by Ayco, the Survivor Support service offers objective financial guidance for survivors and terminally ill members at no additional cost.