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Group Accidental Death & Dismemberment Insurance

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Yes, Supervisors are eligible to apply.
Retired Coverage Starting Monthly at $1.60.

CCPOA Retired Chapter dues paying members are eligible to enroll, also your spouse under age 75, and unmarried dependent children under age 21.

Unmarried children who are full time students and primarily dependent on you for support are also eligible to age 23.


No claim form available.
Contact the Trust for help with a claim.


Application - Active

Application - Retired

What Is It?

AD&D helps bridge the financial gap that occurs when a breadwinner meets accidental death, or an accident results in loss of sight or loss of limbs. In addition, it provides financial assistance to train or retrain you or a loved one for a new career.

Who Can Apply?

Rank & File; Supervisor; Retired

What Does It Cover?

AD&D pays a dollar amount on accidental death or loss of limbs.

Additional benefits include an education benefit for a surviving spouse, funds to help with day-care for young children and funds for adaptive home and vehicle alterations.

How Does It Work?

You pick an amount of coverage to buy (Principle Sum.) Your monthly payment remains constant, but the amount of coverage does reduce as you age. When a claim is paid-out it is based on a percentage of the Principle Sum, the type of injury, and your age.

If you are not completely satisfied with the terms of your Certificate of Insurance you may return it, without claim, within 30 days. Your coverage will be invalidated and you will receive a full refund - no questions asked.

Extended Coverage
Includes additional benefits like Day Care, Adaptive Vehicle and Spouse Education.

Rates Current: January 2020

rank & file supervisor retired
Principle Sum Member Only Family Plan Member Only Family Plan
$25,000 $1.25 $1.50 $1.60 $2.13
$50,000 $2.50 $3.00 $3.16 $4.25
$75,000 $3.75 $4.50 $4.79 $6.38
$100,000 $5.00 $6.00 $6.38 $8.50
$125,000 $6.25 $7.50
$150,000 $7.50 $9.00
$175,000 $8.75 $10.50
$200,000 $10.00 $12.00
$225,000 $11.25 $13.50
$250,000 $12.50 $15.00

Underwritten by: New York Life Insurance Company
51 Madison Avenue, NY NY 10010

Bates #: 1710192

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Main Office: (916) 779-6355
Claims Dept: (916) 779-6356

Toll Free: 1-800-In-Unit-6

Visit Us

CCPOA Benefit Trust Fund
2515 Venture Oaks Way
Suite 200
Sacramento, CA 95833

© 2020 CCPOA Benefit Trust Fund
TWO TOWERS logo is a registered trademark of CCPOA Benefit Trust Fund

All the information on this website is published in good faith and for general information purpose only. Benefit Trust Fund does not make any warranties about the completeness, reliability and accuracy of this information. This website explains the general purpose of the insurance described, but in no way changes or affects any policy 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.