How would you pay the mortgage, make the car payment, buy groceries, pay for electricity and water, or handle any of your monthly bills if your paychecks suddenly stopped?

For a brief explanation of the IEEE Group Disability Income Insurance Plan and how it can help protect you and your family, be sure to visit the Tell Me More section to learn more about the plan, then apply for coverage today!

• Helping Protect Your Livelihood and Lifestyle:
  Disability income insurance helps provide a substitute source of income if you are Totally Disabled and cannot work.
• Members under age 70 may apply
• Choice of Monthly Benefit Options up To $6,500
• Choice of Waiting Periods (30, 90, 180 or 365 days)
• Your Choice of How Long Benefits are Paid:
  (Career Plan, Inflation Fighter Career Plan, Five Year Plan)
• Preferred Definition of Disability helps protect you as a technology professional:
  "Totally Disabled" means you are prevented by illness or injury from performing the material and substantial duties of your usual occupation, provided you are not otherwise working for pay or profit.
• Premium Payments Waived during Disability
• Additional Benefits Included:
  Partial Disability Benefit, Rehabilitation Benefit, Survivor Benefit and Organ Transplant Benefit. 

Underwritten by New York Life Insurance Company

ELIGIBILITY

This Plan is available exclusively to IEEE members* under age 70 who are at FULL-TIME WORK, provided their gross annual income is at least $20,000. In order to become insured, satisfactory evidence of insurability must be provided and the required premium must be paid.

"FULL-TIME WORK" means the active performance of the regular duties of your normal occupation for pay or profit on the basis of at least 30 hours per week at the place such duties are normally performed.

This coverage is only available 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.

Important Notice For Self-Employed Members: Please be advised that if you are applying for this Plan and you have been self-employed for less than one year coverage is limited to a $1,040 Monthly Benefit Option, with a 90-day Waiting Period under the Five-Year Plan.

HOW THE PLAN WORKS

Choose From Three Plan Options
All three plans pay monthly benefits while you are Totally Disabled. "Totally Disabled" means you are prevented by illness or injury from performing the material and substantial duties of your usual occupation, provided you are not otherwise working for pay or profit. Benefits begin at the end of the waiting period, provided you are Totally Disabled.

Note: Benefits for disabilities due to Mental Disorders or Chemical Dependency are limited to a maximum of 36 monthly payments, regardless of Plan choice.

Choose Your Plan

Career Plan
If you are Totally Disabled before age 63, benefits are payable up to age 65. There is a two year maximum benefit for Total Disabilities starting at ages 63 through 74.

Five-Year Plan
Benefits are payable for up to five years for Total Disabilities commencing prior to age 60. For Total Disabilities starting at ages 60 through 62, benefits may continue up to age 65. For Total Disabilities starting at ages 63 through 74, benefits may continue for up to two years.

Inflation-Fighter Career Plan
This Plan offers disability coverage that, once benefits begin, can help keep pace with inflation. Monthly benefits will be adjusted annually from the date of disability if you are Totally Disabled prior to age 63. Adjustments may be made to the Monthly Benefit paid in the second and each succeeding year. The adjusted amount will be based on the Consumer Price Index for Urban Consumers (CPI-U), up to a maximum 5% increase per year and an overall maximum increase of one times the original benefit.*Once you are no longer disabled and the benefit payments stop, the Monthly Benefit returns to the original option amount.

Benefits are payable up to age 65 for Total Disabilities starting before age 63. After age 62, the inflation-fighter feature is no longer applicable and, for Total Disabilities starting at ages 63 through 74, benefits will be payable in accordance with the basic Career Plan (i.e., up to two years maximum).

*A "catch-up" feature allows disabled members to receive benefit increases in excess of the 5% annual maximum if the prior years' compounded rates of inflation were less then 5% annually. Contact the Administrator for additional details on this feature.

Choose Your Monthly Benefit
You have a choice of Monthly Benefit Options, from $260 to $6,500 (in $130 units). However, members age 65-69 may not request a monthly benefit option in excess of $3,250. The option you choose, together with any other disability income insurance you may have, cannot exceed 60% of your GROSS MONTHLY EARNED INCOME. Also, if you have been self-employed for less then one year, your Monthly Benefit Option is limited to $1,040. Depending on your state of residence, you may be eligible to receive disability benefits under a state plan. You should check to see if your state offers this type of benefit.

NOTE: On the November 1 anniversary date on or immediately after reaching age 65, coverage in excess of $3,250 reduces to $3,250. On the November 1 anniversary date on or immediately after reaching age 70, coverage in excess of $1,560 reduces to $1,560.

GROSS MONTHLY EARNED INCOME means 1/12th of your wages, salaries, commissions, fees and other amounts received for personal services — before deduction of income or social insurance taxes and after deduction of the normal business expenses which are deductible for income tax purposes —for the immediately preceding 12 month period. It does not include income from interest, dividends, rent, royalties, annuities, other insurance or other unearned income.

Your Choice of Waiting Periods
You also have a choice of four waiting periods before benefit payments begin: 30, 90,180 or 365 days. A waiting period is the number of consecutive days you must be Totally Disabled before benefit payments begin. You should choose one that will provide benefits when your employer-provided salary continuation plan runs out. Coverage with a longer waiting period is less expensive.

PLAN FEATURES

Survivor Benefit
If you die— from any cause— while receiving benefits for Total Disability, a death benefit equal to three times the Monthly Benefit Option in force on the date of your death will be paid to your surviving relatives in the following order of survival: your spouse; or your children, equally; or your brothers and sisters, equally; otherwise, if there is no surviving relative, to the executor or administrator of your estate.

Organ Transplant Benefit
If you have been insured under the Plan for at least six months and undergo a surgical procedure to donate an organ for transplant, you will be considered Totally Disabled. No waiting period will apply, and benefits will be payable from the first day of Total Disability. However, any portion of your Monthly Benefit Option which became effective in the six months immediately prior to such organ donation will not be payable for this Total Disability.

Rehabilitation Benefit
This benefit is designed to help certain disabled members return to the work force. Under this provision, a professional rehabilitation staff reviews case histories and identifies individuals who appear to have the greatest likelihood of rehabilitation. Individuals selected by New York Life Insurance Company are offered the option of participating in a rehabilitation program at no cost to them. Paricipation is voluntary and benefits are not reduced due to participation in this program.

Partial Disability Benefits
While you are recovering from a Total Disability, you may be eligible to receive a partial disability benefit even though you return to work. If you return to work immediately following a period of Total Disability for which benefits were payable, you may continue to receive your monthly disability benefit until the earlier of the end of the maximum benefit period for Total Disability, or 24 monthly payments. However, the amount of your Monthly Benefit Option, together with all other disability benefits and income you earn that month, cannot exceed 80% of your average GROSS MONTHLY EARNED INCOME for the 12 months before Total Disability started.

Waiver of Premium
After you have been Totally Disabled for six consecutive months and you begin to receive benefits for Total Disability, all future premium contributions under the Plan will be waived for as long as you receive benefits for that disability.

Benefits for Recurring Disability
Successive periods of disability that are due to the same or related causes will be considered a single period of disability unless separated by a return to FULL-TIME WORK for three consecutive months or more.

YOUR COST

The initial cost of insurance is based on your choice of Plan, Monthly Benefit, Waiting Period and your attained age when coverage becomes effective. The cost increases on the November 1 anniversary date on or immediately after the date you reach a higher age bracket. Premium contributions will vary depending upon the options and amount 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).

* For disabilities commencing on or after the November 1 on or immediately after reaching ages 60 and 63, the maximum benefit period is reduced as previously described.
† On the November 1 on or immediately after reaching age 65, coverage in excess of $3,250 reduces to $3,250, and on the November 1 on or immediately after reaching age 70, coverage in excess of $1,560 reduces to $1,560.
‡ Renewal only, coverage terminates at age 75.
¶ Inflation-fighter benefits apply only to disabilities beginning prior to age 63. Starting with age 63, benefits revert back to those provided by the basic Career Plan.

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 only change if they are changed for all others in the same class of insureds under this group policy. For example, a class of insureds is a group of people all with the same issue age, Waiting Period, and Plan. 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.

Note: If you wish to pay annually, the premium is four times the quarterly cost; if you prefer to pay semiannually, the premium is two times the quarterly cost. If you wish to pay monthly with the Electronic Funds Transfer (EFT) option, divide the quarterly cost by three.

ADDITIONAL PLAN PROVISIONS

Exclusions and Limitations
The Plan does not provide benefits for: any disability that occurs during or is due or related to intentionally self-inflicted injury while sane or insane [MO residents: the exclusion for intentionally self-inflicted injury is not applicable to injury caused by an attempted suicide while insane] declared or undeclared war or any act thereof, military service, or your incarceration or participation in an illegal occupation/activity or the commission of a crime; or any disability that is due or related to pregnancy or childbirth (except complications thereof), or any impairment or disease specifically excluded from your coverage.

The Plan limits benefits for disabilities due to Mental Disorders and Chemical Dependency to a maximum of 36 monthly payments.

No benefits will be paid unless the disability occurs while you are insured under the Plan and you are under the care of a licensed physician or surgeon other than yourself (or member of your immediate family or household) during the period of disability.

Effective Date
Note: Residents of MD and NC: Any reference to "performing normal activities" is replaced by the requirement that the health status of any proposed insured person remains the same as stated in your application.

You 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 are actively performing the normal activities of a person in good health of like age on that date. If you are not performing your normal activities as required, coverage will not become effective until the day you are performing such normal activities provided such date is within three months of the date insurance would have been effective and you are 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.

Note: There are instances where New York Life Insurance Company may be able to offer insurance, at the same cost, by eliminating coverage for a specific impairment or disease.

When Coverage Ends
Your insurance may remain inforce until the November 1 anniversary date on or immediately after you reach age 75, provided you: (a) do no cease FULL-TIME WORK other then for reasons of disability; (b)remain an IEEE member; (c) continue to pay premium contributions when due; (d) do not enter full-time active duty in the armed forces (coverage may be restored upon termination of active duty status, subject to policy guidelines); or (e) 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 to which you belong.

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 to the Trustee under Trust Agreement with the Institute of Electrical and Electronics Engineers.

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 receive a full refund?no questions asked!

IMPORTANT NOTICE – How New York Life Obtains and Underwrites Your Request for Group Disability Income Insurance

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 non-medical information (such as driving records, past convictions, hazardous sport or aviation activity, use of alcohol or drugs, and other applications for insurance). The information provided may include information that may predate the time frame stated on the medical questions section, if any, on the this application. This information may be used during the underwriting claims process, where permitted by law.

Your AUTHORIZATION may be used for a period of 24 months from the date you signed the application for insurance, 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 reliance on it, or to the extent that new York Life has a legal right to contest a claim under an insurance certificate of the certificate itself. The information New York Life obtains through your AUTHORIZATION may become subject to further disclosure. For example, New York Life may be required to provide 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 which you may apply for insurance, or to which 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 you request. Upon receipt of all requested information, we will make a determination as to whether your request can be approved.

MIB is a not-for-profit organization of 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 non-medical information may be given to the Bureau, which may then be furnished to member companies.

If we cannot provide the coverage you requested, 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 non-medical 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 Federal Fair Credit Reporting Act procedures. (Note: In certain jurisdictions, you may choose to receive medical information directly.) 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, 330 University Avenue, Suite 501, Toronto, Ontario, Canada MSG 1R7, telephone (416) 567-0590. Information for consumers about MIB may be obtained on its website at www.mib.com.

For NM Residents: PROTECTED PERSONS¹ have a right to access to certain CONFIDENTIAL ABUSE INFORMTION² 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 person or prospective insured person.

² CONFIDENTIAL ABUSE INFORMTION 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 application or insured as family member, employer or associate of a victim of domestic abuse or a person with whom an application or insured is known to have a direct, close, personal, family or abuse-related relationship.

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 the use in connection with this Plan.

Underwritten by New York Life Insurance Company, under Group Policy No. G-12150-2, on Policy Form GMR-FACE/IEEE-DI

About New York Life Insurance Company.