Underwritten by New York Life Insurance Company
ELIGIBILITY
This plan is available exclusively to IEEE members ages 50 through 59 who may request coverage for themselves, their lawful spouses ages 50 through 59, and all unmarried dependent children ages 14 days through 22 years (24 if a full-time student). In order to become insured, satisfactory evidence of insurability must be provided and the required premium must be paid.
A dependent who is also an IEEE member is eligible for either member or dependent coverage, but not both. If both member and spouse are covered as members, neither may insure the other as spouse and only one may insure any eligible children.
This coverage is available only for residents of the U.S. (except VT and territories), Puerto Rico and Canada (not available to residents of Quebec and British Columbia). Note: This coverage is available to residents of Canada through Marsh Canada Limited. Stephen Fretwell, an employee of Marsh Canada Limited, acts as broker with respect to residents of Canada.
*Participation in the IEEE Group Insurance Program requires active IEEE membership status during the life of the plan.
Non-Dependent Family Members: Any eligible non-dependent family members may also apply for coverage if they first join the IEEE as an Associate member (for membership information, visit the IEEE home page or call IEEE directly at 1-800-678-IEEE).
APPLY FOR UP TO $1,000,000 OF COVERAGE
You can choose the amount you need. A member has options of $10,000 to $1,000,000 (in multiples of $10,000). A lawful spouse may be insured for $10,000 to $1,000,000 (in multiples of $10,000), not to exceed 100% of member's coverage. Each eligible dependent child may be insured for $10,000.
The total amount of coverage an individual may request under all group life insurance plans underwritten by New York Life Insurance Company cannot exceed $2,000,000.
In addition, the total amount of coverage for an individual insured under all group policies issued by New York Life Insurance Company to the Trustee of the IEEE Life Insurance Plan may not exceed the maximum benefit option for any insured person.
ATTRACTIVE RATES... MONEY-SAVING DISCOUNTS
Qualified Non-Smokers Pay Less
If you and/or your spouse have not used tobacco or nicotine in any form, including nicotine patches and nicotine chewing gum, during the past 12 months, you may qualify for non-smoker rates that will reduce your premium payments!
Volume Discounts for Member and Spouse
If you or your spouse becomes insured for options of $160,000 through $490,000, you'll receive a discount based on volume; and for options of $500,000 through $1,000,000 of coverage, you'll receive another volume discount.
Keep Your Cost Even More Manageable
You have the option to pay your premium contributions on a monthly basis via the Electronic Funds Transfer (EFT) option (your monthly cost would be approximately one-sixth of the amount you calculate from the rate chart.)
CURRENT 2010 SEMIANNUAL PREMIUM CONTRIBUTIONS
The cost of this coverage is based upon the member’s and spouse’s amount of insurance requested, usage of tobacco/nicotine products, and attained age when coverage becomes effective. Premium contributions will vary depending upon the options chosen.
IMPORTANT TAX INFORMATION FOR RESIDENTS OF ONTARIO, CANADA: Ontario has enacted a law requiring taxation of all group insurance purchased by individuals. An 8% tax will be added to the amount of any premium contributions due (in U.S. dollars).
Rates for Each $10,000 Option of Coverage
|
| |
Options less than $160,000 |
Options $160,000 but less than $500,000 |
Options $500,000 or higher |
|
Issue Age
|
Non-Smoker *
|
Smoker
|
Non-Smoker *
|
Smoker
|
Non-Smoker *
|
Smoker
|
|
50
|
11.46 |
20.82 |
9.72 |
17.76 |
9.36 |
17.22 |
|
51
|
11.52 |
21.36 |
9.78 |
18.24 |
9.42 |
17.70 |
|
52
|
11.58 |
21.96 |
9.84 |
18.66 |
9.48 |
18.18 |
|
53
|
11.88 |
22.74 |
10.08 |
19.32 |
9.78 |
18.78 |
|
54
|
12.72 |
24.48 |
10.80 |
20.40 |
10.50 |
20.22 |
|
55
|
13.98 |
26.88 |
11.88 |
22.86 |
11.52 |
22.14 |
|
56
|
15.60 |
30.36 |
13.32 |
25.86 |
12.84 |
25.08 |
|
57
|
17.76 |
34.40 |
15.12 |
29.34 |
14.70 |
28.50 |
|
58
|
20.40 |
39.54 |
17.34 |
33.60 |
16.86 |
32.64 |
|
59
|
22.98 |
44.46 |
19.50 |
37.80 |
18.90 |
36.66 |
The current semiannual premium contribution for all children is $3.00 for $10,000 of coverage for each child.
* To qualify as a non-smoker, the member/spouse must not have used tobacco or nicotine in any form, including nicotine patches and nicotine chewing gum, during the past 12 months.
The premium contributions shown reflect the current rate and benefit structure.
OTHER IMPORTANT INFORMATION
Proceeds Remain Liquid, Earn Interest
The Plan features a valuable Continued Interest Account which means death benefits to a beneficiary of $10,000 or more, if the IEEE member wishes, will be placed in an interest bearing account. Your beneficiaries can take their time evaluating their future financial plans, secure in the knowledge they may withdraw any or all of the death benefit proceeds at any time.
Valuable Living Benefit Provision "Accelerated Death Benefit"
The "Accelerated Death Benefit" option is available to help terminally ill insureds during a difficult, and often financially challenging time. Under this provision you may request one advance payment equal to 50% of a qualified terminally ill person's in force life insurance to be paid while that person is still alive.
The request must be made at least 12 months prior to the insured person's scheduled coverage termination age and the amount of insurance payable after the insured's death will be reduced by this payment. (Premium contributions will not be reduced.)
This money can be used to help cover high prescription drug costs...medical bills...outstanding debts...to help pay for experimental treatments...the cost of modifications to your home...or for a family vacation the choice is yours.
To qualify, a terminally ill insured must provide the New York Life Insurance Company with proof of terminal illness and anticipated life expectancy (12 months or less), as well as any other necessary medical information requested. For additional details and limitations, please see the Certificate of Insurance.
Please note that receipt of Accelerated Death Benefits may affect your eligibility for public assistance programs and may be taxable. Prior to applying to receive such benefits, you should consult with the appropriate social services agency and seek the advice of a qualified tax advisor.
Note: The Accelerated Death Benefit is not available to residents of Massachusetts.
No Exclusions
Benefits are paid for death from any cause, at any time, anywhere in the world. The validity of any amount of your life insurance which has been in force for two years during an insured's lifetime will not be contested except for insurance eligibility provisions and non-payment of premium contributions.
You Name Your Beneficiary
Your beneficiary is the person(s) last designated by you in writing, and recorded by or on behalf of New York Life Insurance Company. You may change this beneficiary designation, at any time, by written request. You are the automatic beneficiary for dependent insurance, as described in the Certificate of Insurance. If you wish to name a different beneficiary for spouse coverage, contact the Administrator for the appropriate form.
Group Conversion Privilege
The Plan provides conversion privileges under certain circumstances of involuntary termination as described in the Certificate of Insurance.
ADDITIONAL PLAN PROVISIONS
Effective Date
You and your eligible dependents will become insured on the date specified by New York Life Insurance Company provided the first premium contribution has been paid, satisfactory evidence of insurability has been submitted, and you and your dependents are alive on that date. Coverage for any dependent who is confined at home, in a hospital or other medical institution, or is incapacitated so as to be unable to perform his or her normal activities on the date coverage would otherwise become effective, will not become effective until the date he or she is no longer so confined or incapacitated provided you are insured on that date and the dependent is still eligible for insurance. (Payment of a premium contribution for insurance does not mean there is any coverage in force before the effective date as specified by New York Life Insurance Company.)
When Coverage Ends
Your insurance can remain in force until you reach age 65, provided: (a) you remain a member of IEEE; (b) you continue to pay premium contributions when due; and (c) the group plan is not terminated or modified by the Policyholder or New York Life Insurance Company to end insurance for the group of insureds in which you belong. Your dependent coverage will terminate when your member coverage terminates or, if earlier on the date: (a) your spouse reaches 65; (b) your child reaches age 23 (25 if a full-time student); (c) your spouse ceases to be your lawful spouse; or (d) your child ceases to be your unmarried dependent child. Upon your death, coverage for your insured dependents may continue as described in the Certificate of Insurance.
Renewal Payments And Claims
Once you are accepted into the Plan, you will have a 31-day grace period for your payment of renewal premium contributions. When you want to submit a claim, call or write the Administrator for claim forms.
Certificate Of Insurance
This information is only a brief description of the principal provisions and features of the Plan. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the Trustee of the Institute of Electrical and Electronics Engineers Life Insurance Plan.
When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the Plan.
"30-Day Free Look"
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 be sent a full refund no questions asked!
IMPORTANT NOTICE
How New York Life Obtains Information and Underwrites Your Request for Group Level Term Life Insurance To Age 65.
Information regarding insurability will be treated as confidential. In considering your request for insurance, we will rely on the medical information you provide, and on the information you authorize us to obtain from your physician, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB, Inc. (formerly known as Medical Information Bureau). MIB and other insurance companies may also furnish New York Life, its subsidiaries or the Plan Administrator with nonmedical information (such as driving records, past convictions, hazardous sport or aviation activity, use of alcohol or drugs, and other application for insurance). The information provided may include information that may predate the time frame stated on the medical questions section, if any, on this application. This information may be used during the underwriting and claims processes, where permitted by law.
Your AUTHORIZATION may be used for a period of 24 months from the date you signed the application, unless sooner revoked. The AUTHORIZATION may be revoked at any time by notifying the Administrator in writing at the address provided. Your revocation will not be effective to the extent New York Life or any other person already has disclosed or collected information or taken other action in certificate or the certificate itself. The information New York Life obtains through your AUTHORIZATION may be come subject to further disclosure. For example, New York Life may be required to provided it to insurance, regulatory or other government agencies. In this case, the information may no longer be protected by the rules governing your AUTHORIZATION.
New York Life may release this information to the Plan Administrator, MIB, other insurance companies to whom you may apply for insurance, or to whom a claim for benefits may be submitted and to others whom you authorize in writing. However, this will not be done in connection with information concerning Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV).
New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. We may make a brief report to MIB; however, we will not disclose our underwriting decision. Information in our files may be seen by New York Life and Plan Administrator employees, but only on a “need to know” basis in considering your request. Upon receipt of all requested information, we will make a determination as to whether your request for insurance can be approved.
MIB is a not-for-profit organization of life insurance companies, which operates an information exchange on behalf of its members. When you apply for insurance or submit a claim for benefits to a MIB member company, medical or nonmedical information may be given to the Bureau, which may then be furnished to member companies.
If we cannot provide the coverage you request, we will tell you why. If you feel our information is inaccurate, you will be given a chance to correct or complete the information in our files. Upon written request to New York Life or MIB, you will be provided with nonmedical information. Generally, medical information will be given either directly to the proposed insured or to a medical professional designated by the proposed insured. Your request is handled in accordance with the Fair Credit Reporting Act procedures. If you question the accuracy of the information provided by MIB, you may contact MIB and seek a correction. MIB’s information office is: MIB, Inc. 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734, telephone (866) 692-6901 (TTY 866 346-3642). For Canadian residents the address is: MIB Information Office, 3300 University Avenue, Suite 501, Toronto, Ontario, Canada M5G 1R7, telephone (416) 597-0590. Information for consumers about MIB, Inc., may be obtained on its Web site at www.mib.com.
For NM Residents: PROTECTED PERSONS 1 have a right of access to certain CONFIDENTIAL ABUSE INFORMATION 2 we maintain in our files and they may choose to receive such information directly. You have the right to register as a PROTECTED PERSON by sending a signed request to the Administrator at the address listed on the application. Please include your full name, date of birth and address.
1 PROTECTED PERSON means a victim of domestic abuse; who has notified us that he/she is or has been a victim of domestic abuse; and who is an insured or prospective insured person.
2 CONFIDENTIAL ABUSE INFORMATION means information about: acts of domestic abuse or abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant or insured family member, employer or associate of a victim of domestic abuse or a person with whom the applicant or insured is known to have a direct, close, personal, family or abuse-related relationship.
If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage be effective prior to this date. Payment of a premium contribution with your application does not mean that there is any insurance in force before the effective date as determined by New York Life Insurance Company.
| New York Life Insurance Company |
2/09 ed. |
The IEEE insurance trust incurs costs in connection with this sponsored plan. To provide and maintain this valuable membership benefit, it is reimbursed for these costs. IEEE also receives a fee for the license of its name and logo for use in connection with this plan.
Underwritten by New York Life Insurance Company, under Group Policy No. G-8100-1, on Policy Form GMR-FACE/ G-8100-1.
About New York Life Insurance Company