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Keywords:DECEMBER 13, 1972,H. TRACY HALL,PROVO,UTAH
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DECEMBER 13, 1972
INSTRUCTIONS
1.	Please type or print legibly.
2.	Include your ACS Membership Number where indicated. —
3.	If beneficiary is a married woman, indicate her first name, NOT husband's first name. Example: Mary Smith, NOT Mrs. John Smith.
4.	IMPORTANT - Plea«e sign in ink and include date signed.
5.	Make check payable to "ACS Group Insurance Plan."
6.	Send check with Enrollment Card to: ACS Group Insurance Plan
Connecticut General Life Insurance Company Hartford, Connecticut 06115
As a Member of the American Chemical Society you and your	Payment for loss of the Member's life will be made to the named
family are eligible January 1, 1973 to participate in the new	beneficiary. Payment for other losses including dependent losses
High Limit Accidental Death and Dismemberment Plan.	will be made to the insured Member.
The Accident Plan was especially designed by the Trustees to
meet the needs of all ACS Members and their dependents. It	WHAT IS THE COST?
covers Death, Dismemberment and Loss of Sight caused by an
accident.	Amount	Member	Member and
Selected	Only	Dependents
The ACS Trustees believe that by offering this new additional	$ 50,000	$ 8.50	$12.35
coverage each Member has the unique opportunity to strengthen	$100,000	$17.00	$24.70
his family's financial security at a minimum of cost.
The quarterly premiums shown pay your insurance from SCHEDULE OF BENEFITS	January 1, 1973 to April 1, 1973. On that date you will be
billed for a semi-annual or annual premium in accordance You may elect to purchase either the $50,000 or $100,000 Plan.	with your designation on the enrollment card.
You also have the option to insure your eligible dependents. If this election is made, your spouse will be insured for	NOTE: However, if you are a participant in the Life Insurance fifty percent (50%) of the principal amount selected by you. In plan you wil) be required to pay your Accidental addition, your children, who are between one year of age and age Death and Dismemberment premiums on the same 19, and unmarried, will be insured for five percent (5%) of your basis as your Life insurance premiums, total benefit.
Premiums are payable annually (April 1), or semi-annually WHO IS ELIGIBLE	(April 1 and October 1). If you choose to pay your premiums
annually, the amount due each April will be slightly less than Members or Associate Members who reside in the U. S. or Canada	four times the amount shown for the benefits you elect,
are eligible to participate if they are under age 65 as of January 1,	,
1973.	If y0U choose to pay your premiums semi-annually, the amount
due each April 1 and October 1 will be twice the amounts shown.
WHAT ARE THE BENEFITS?
When an insured individual has an accident either at or away from	HOW TO ENROLL
work and, as a direct result, suffers any of the losses shown below
within the following 120 days, benefits will be paid as shown	If you wish to participate in the new Accidental Death and
below:	Dismemberment Plan, complete the enrollment card. Check the
box next to the Plan amount that you are electing and be sure $ 50 000 or	As shown in the	t0 indicate where provided whether you wish to pay your pre-
^ "iioo ooo"—--	Schedule of Benefits	miums annually or semi-annually. If you are insured under the
N__'	Life Insurance Plan, please check the appropriate box. Make
Loss of Life	The entire amount	yoUr check payable to "ACS INSURANCE PLAN" and
return it in the self-addressed envelope along with your enrollment Loss of both hands, both feet, the sight of	card,
both eyes, or any combination of these The entire amount
Your application must be postmarked no later than January
Loss of one hand, one foot, or the sight of	1, 1973. As soon as it has been processed, a certificate verifying
one eye	One-half the amount	your benefits will be mailed to you.
DECEMEBER 13, 1972
H. TRACY HALL
PROVO,UTAH
NEW VOLUNTARY HIGH LIMIT ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PLAN
LIMITATIONS
No benefits will be paid for loss resulting from intentionally self-inflicted injury or suicide while sane or insane, disease, infection (except infection which occurs through or with an accidental cut or wound). Accidents as a result of war or act of war are not covered.
All benefits will terminate on the premium due date which next follows the attainment of age 65 by the insured member.
This brochure is intended to describe only the principal features of the ACS High Limit Accidental Death and Dismemberment Plan. The Master Policy issued to the Trustees contains all of the provisions relating to your insurance and they will govern in all cases.