Underwritten by New York Life Insurance Company
ELIGIBILITY
As a member of IEEE under age 70, you are eligible to apply for coverage for yourself, your lawful spouse under age 70, and unmarried dependent children under age 19 (26 if a full-time student). To become insured, an application must be submitted and the required premium contribution must be paid.
This coverage is available to residents of the United States (except VT and territories), Puerto Rico and Canada (excluding Quebec and British Columbia).
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.
WHAT YOU CAN CHOOSE
You may select a Principal Sum ranging from $50,000 to $500,000 (in units of $50,000) for yourself—at economical group rates. You have a choice of two Plans—the Member Only Plan or the Family Plan. The Member Only Plan pays benefits for covered accidental death or injury for you alone. The Family Plan is designed to cover all of your eligible dependents for benefit amounts based on a percentage of your Principal Sum.
An individual may not be insured under one or more AD&D Group Policies underwritten by New York Life for a total amount of AD&D coverage that exceeds current over-insurance standards.
When you reach age 70, coverage converts to Common Carrier Travel Accident Insurance and any Principal Sum in excess of $100,000 reduces to $100,000. Common Carrier coverage protects against accidents that occur while riding on a public conveyance—airplane, bus, train, or taxi.
HOW THE PLAN WORKS
Schedule of Benefits
Except as stated in the description of the Disappearance benefit below, for an injury directly and independently caused by an accident while coverage is in force for you, your spouse or your child, the benefits specified below will be paid if such resulting loss(es) occur within 365 days of that accident.
Benefits are payable for the following losses:
FULL PRINCIPAL SUM for loss of: life; or two limbs; or movement of both upper and lower limbs (quadriplegia); or sight of both eyes; or both speech and hearing; or one limb and sight of one eye.
THREE-QUARTERS OF PRINCIPAL SUM for loss of: movement of both lower limbs (paraplegia).
ONE-HALF OF PRINCIPAL SUM for loss of: one limb; or movement of both upper and lower limbs on one side of the body (hemiplegia); or sight of one eye; or speech; or hearing.
ONE-QUARTER OF PRINCIPAL SUM for loss of the thumb and index finger of either hand.
Loss means: with reference to limbs, actual severance through or above the wrist or ankle joints; with reference to thumb and index finger, actual severance through or above metacarpophalangeal joints; with reference to sight, speech or hearing, entire and irrevocable loss thereof; and with reference to movement, complete and irreversible paralysis of such limbs.
Disappearance – If an insured is riding in a conveyance and such conveyance either disappears or sinks as a result of an accident and the insured's body is not found within one year after that accident, the insured will be presumed dead, as a result of accidental injury, and the benefit in effect will be payable.
The total benefit payable for all losses due to a single accident will not be more than the Principal Sum. Only one of the sums, the largest, will be paid for all injuries to the same limb resulting from one accident.
YOUR COST
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).
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CURRENT 2010 ANNUAL MEMBER ONLY PLAN PREMIUM CONTRIBUTIONS
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Member's Principal Sum
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When Member is Under Age 70
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When Member is Age 70 & Over*
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$50,000
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$24.00
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$24.00
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100,000
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48.00
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48.00
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150,000
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72.00
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Not Available
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200,000
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96.00
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Not Available
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250,000
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120.00
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Not Available
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300,000
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144.00
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Not Available
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350,000
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168.00
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Not Available
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400,000
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192.00
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Not Available
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450,000
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216.00
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Not Available
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500,000
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240.00
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Not Available
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Family Plan**
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Principal Sums
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Annual Premium Contributions When Member is
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Member
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Spouse
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Each Child
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Under Age 70
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Age 70 & Over*
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$50,000
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$25,000
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$5,000
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$36.00
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$36.00
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100,000
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50,000
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10,000
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72.00
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72.00
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150,000
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75,000
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15,000
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108.00
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N/A
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200,000
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100,000
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20,000
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144.00
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N/A
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250,000
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125,000
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25,000
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180.00
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N/A
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300,000
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150,000
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30,000
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216.00
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N/A
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350,000
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175,000
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35,000
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252.00
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N/A
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400,000
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200,000
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40,000
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288.00
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N/A
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450,000
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225,000
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45,000
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324.00
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N/A
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500,000
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250,000
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50,000
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360.00
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N/A
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*Renewal Only. On the premium due date on or immediately after the date the member reaches age 70, the member may not carry more than $100,000 Principal Sum and all coverage converts to Common Carrier Travel Accident.
**Under the Family Plan, if on the date of the accident no dependent spouse is covered, dependent child coverage increases to 15% (instead of 10%). Under the Family Plan, if on the date of the accident spouse only is covered, the percentage is 60%.
Ontario, Canada Residents: Please see tax notice under HOW TO APPLY SECTION.
The premium contributions shown reflect the current rate and benefit structure. Premium contributions may be changed by New York Life Insurance Company on any premium due date and any date on which benefits are changed. However, your rates may change only if they are changed for all others in the same class of insureds. For example, a class of insureds is a group of people all with the same issue age. Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustee under Trust Agreement with the IEEE, Inc.
PLAN FEATURES
The Following Benefits Are Payable In Addition To Any Other Benefits Received Under the Plan Provided the Member is Under Age 70
Common Carrier Benefit
If a covered loss occurs as a result of an accident while a passenger on a licensed common carrier (train, bus, etc.), an additional $25,000 benefit will be payable.
Repatriation Benefit
If a covered accidental death occurs outside of the insured person’s state of residence, an additional benefit of up to $25,000 of the actual expenses incurred will be paid for the preparation and transportation of the body to the place of burial or cremation.
Rehabilitation Benefit
Rehabilitation training can help an insured person return to former productivity following an accident. This benefit may be paid for a covered loss other than loss of life. The amount paid will equal the actual expenses incurred for rehabilitation training up to a maximum of $10,000. The expense must be incurred within two years after the date of the accident.
Seat Belt Benefit
If an insured person is involved in an automobile accident in which he/she was properly wearing a seatbelt, and dies within 365 days as a result of that accident, the beneficiary can receive an additional amount which is the lesser of $50,000 or 50% of the Principal Sum payable. Please refer to the Certificate of Insurance for certain limitations and conditions on this benefit.
Education Benefit
If the benefit for loss of life is payable with respect to the insured member, and his/her dependents are covered by this Plan on the date of the accident, this Plan will pay an education benefit equal to the lesser of 2% of the member's Principal Sum payable or $2,500 per year. This benefit will be payable up to four years, for each insured dependent who is enrolled (or enrolls within 365 days of the accident) as a full-time student at an institution of higher learning (college, university or trade school). In addition, if no insured spouse or child qualifies for this benefit following the covered loss of the member's life, a lump sum benefit equal to 4% of the member's principal amount will be payable.
Spouse Critical Period
If either the insured member or insured spouse dies as a result of a covered accident, the survivor will receive additional monthly payments equal to 1% of the member's Principal Sum. These payments will be made until the earlier of six months or the survivor's death.
Adaptive Home/Auto Benefit
If a covered loss (other than loss of life) results in a physical disability, and, because of that disability, an insured person incurs expenses necessary to modify his/her home and/or car, a benefit amount equal to the lesser of 5% of the Principal Sum or $5,000 is payable. Please refer to the Certificate of Insurance for certain limitations and conditions on this benefit.
Burn Disfigurement
If a covered loss causes an insured to suffer a disfigurement due to burns, covering at least 5% of the body, an additional benefit equal to the lesser of 10% of the Principal Sum or $30,000 will be payable.
Day Care Benefit
If the insured Member's death results from a covered loss and his or her children, under age 13, are enrolled in a Day Care program at the time of the loss (proof of enrollment is required; details will be found in your Certificate of Insurance), a benefit equal to the lesser of 5% of the Member's Principal Sum, or $2,500, or the actual Day Care costs for one year, is payable. The benefit is paid each year for each child who qualifies, except that no more than four Day Care Benefits will be paid for each such child. If the insured Member has no child eligible for this benefit at the time of the covered loss, a benefit of $500 will be paid.
Elder Care
If an insured's death is the result of a covered accident and that insured's elderly relative (other than a spouse) was dependent on the insured for support and maintenance, a benefit equal to the lesser of 5% of the Principal Sum or $5,000 will be payable.
Common Disaster
If both the insured member and spouse die within one year of same or separate accidents that occurred within the same 24-hour period, in addition to the benefit payable for loss of life for each, the insured spouse benefit amount for loss of life will be increased to 100% of the member's Principal Sum if the member and spouse are survived by one or more eligible children and the combined member and spouse Principal Sums do not exceed $500,000.
Only The Following Benefit Is Payable At Member Age 70 and After
Common Carrier Travel Accident Benefit
When the insured Member reaches Age 70, coverage is converted to Common Carrier Travel Accident Insurance only. A benefit is payable for a covered loss which is the result of an accident while traveling as a passenger in a common carrier (such as a train, bus, aircraft) properly licensed and operated for that purpose. Any Principal sum in excess of $100,000 will be reduced to $100,000.
ADDITIONAL PLAN PROVISIONS
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Exclusions and Limitations
No benefit will be payable for any loss that occurs during or is due or related to or resulting from: participation in or incarceration resulting from, in a role other than as victim, commission of a felony, or illegal occupation/activity; voluntary intake of drugs, narcotics or intoxicants, unless prescribed by a physician, illegal use of drugs or intoxicants, or legal intoxication; any declared or undeclared war or act thereof; operating, riding in or descending from any aircraft except when riding as a passenger; physical or mental sickness or medical/surgical treatment thereof; suicide or intentionally self-inflicted injury while sane or insane.
In addition, when you reach age 70, coverage converts to Common Carrier Travel Accident Insurance, and any Principal Sums in excess of $100,000 reduce to $100,000.
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Beneficiary
The beneficiary is the person last designated by you in writing, and recorded as such by or on behalf of New York Life. Payments for losses other than for your loss of life will be made to you. The beneficiary for dependent(s) coverage is you, the member.
Effective Date
Insurance for you and your eligible dependents will become effective on the date specified by New York Life Insurance Company provided the initial contribution has been paid and you and your approved dependents are actively performing the normal activities of a person in good health of like age (For MD and NC residents: a person of like age) on that date. Dependent insurance will not take effect unless your insurance is in effect on a premium paying basis, and any person who is not performing his/her normal activities as required will not become insured until the date he/she is performing such activities, provided such date is within three months of the date insurance would have been effective and the person is still eligible. (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
Insurance will terminate on the occurrence of the earliest of these conditions: if premium contributions due are not paid; if the Group Policy is terminated or modified by the Policyholder or New York Life Insurance Company to end insurance for the group of insureds to which the insured belongs; for any insured person, if the Principal Sum for that insured has been paid; for dependent spouse and/or child coverage, if member coverage ends, except that such dependent coverage may be continued if the member’s Principal Sum has been paid; for a dependent spouse, when he/she is no longer a lawful married spouse; for a dependent child, upon reaching age 19 (26 if a full-time student). A member’s surviving spouse and children may continue coverage if it was in force at the time of the member’s death, 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
When you become insured you will be sent a Certificate of Insurance summarizing your coverage. This brochure contains only a brief description of some of the Plan's principal provisions and features. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the Trustee under Trust agreement with the IEEE, Inc.
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!
The IEEE incurs certain costs in connection with this sponsored group 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 the Plan.
Underwritten by New York Life Insurance Company, under Group Policy No. G-18700-1, on Policy Form GMR-FACE/G-18700-1.
About New York Life Insurance Company.