Underwritten by New York Life Insurance Company
ELIGIBILITY
Available exclusively to IEEE members* under age 70 who may request coverage for themselves, their lawful spouses under age 70, and all unmarried dependent children under age 25. In order to become insured, an application must be submitted 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, WA 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.
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. Coverage of $50,000 to $250,000 (in $50,000 units) is available for your spouse, but spouse coverage may not exceed your own member coverage. Each unmarried dependent child under age 25 may be covered for $10,000.
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
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.
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
The initial cost of insurance for you and your dependents is based upon the Principal Sums requested and your attained age when insurance becomes effective. The cost increases as you grow older.
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).
CURRENT 2010 ANNUAL*** PREMIUM CONTRIBUTIONS
| For Member |
| Principal Sum |
When Member is Under Age 70 |
When Member is Age 70 & Over** |
| $50,000 |
$26.00 |
$26.00 |
| 100,000 |
52.00 |
52.00 |
| 150,000 |
78.00 |
Not Available |
| 200,000 |
104.00 |
Not Available |
| 250,000 |
130.00 |
Not Available |
| 300,000 |
156.00 |
Not Available |
| 350,000 |
182.00 |
Not Available |
| 400,000 |
208.00 |
Not Available |
| 450,000 |
234.00 |
Not Available |
| 500,000 |
260.00 |
Not Available |
| For Spouse |
| Principal Sum |
When Member is Under
Age 70 |
When Member is Age 70 & Over** |
| $50,000 |
$26.00 |
$26.00 |
| 100,000 |
52.00 |
52.00 |
| 150,000 |
78.00 |
Not Available |
| 200,000 |
104.00 |
Not Available |
| 250,000 |
130.00 |
Not Available |
| For Children*** |
| Principal Sum |
When Member is Under
Age 70 |
When Member is Age 70 & Over** |
| $10,000 |
$10.50 |
$7.80 |
| each child |
|
|
*If you wish to pay semiannually with the Pre-Authorized Check Payment Option, divide the annual cost by two
**Renewal Only. On the premium due date coinciding with or next following the date the member reaches age 70, coverage converts to Common Carrier Travel Accident Coverage, and any Principle Sums in excess of $100,000 reduce to $100,000.
***One premium is for all children regardless of number.
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 insurance under this group policy. For example, a class of insureds is a group of people all with the same issue age. Benefit 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.
PLAN FEATURES
The Following Benefits Are Payable In Addition To Any Other Benefits Received Under the Plan
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, provided the member is under age 70 at the time of the accident.
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 you and your dependents return to your former productivity following an accident. Under this Plan, a rehabilitation benefit will 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 $5,000. The expense must be incurred within two years after the date of the accident. While you, the insured member, are receiving this benefit, you will not be required to pay premium contributions until the earlier of the date you return to work, or the $5,000 maximum has been reached.
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 90 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 the insured member dies as a result of a covered accident, his/her insured spouse 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 insured spouse’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 actual charges will be payable. However, this benefit will not exceed the lesser of 5% of the Principal Sum or $5,000. Please refer to the Certificate of Insurance for certain limitations and conditions on this benefit.
ADDITIONAL PLAN PROVISIONS
Exclusions and Limitations
No benefit will be payable for: any loss that occurs during or is due or related to military service, your incarceration or participation in an illegal occupation/activity or the commission of a crime, your voluntary intake of drugs, narcotics or alcohol (unless prescribed by a physician), any declared or undeclared war or act thereof, or operating, riding in or descending from any aircraft except when riding as a passenger; or for any loss that is due or related to: a physical or mental sickness or medical/surgical treatment thereof, or suicide or intentionally self-inflicted injury while sane or insane [MO Residents: Benefits will not be paid for losses resulting from suicide or self-inflicted injury within the first two years if New York Life can show that such act was intended at the time of application].
In addition, when you reach age 70, coverage converts to Common Carrier Travel Accident Insurance any Principle Sums in excess of $100,000 reduce to $100,000.
Beneficiary
The beneficiary is the person last designated by you in writing, and recorded as such by or on behalf of New York Life Insurance Company. Payments for losses other than for your loss of life will be made to you. The beneficiary for dependent(s) coverage is the member.
Effective Date
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 [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 day 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 can remain in force for you and your insured family members provided: (a) you remain an IEEE member; (b) you continue to pay premium contributions when due; (c) the insured person does not enter full-time active duty in the Armed Forces (coverage may be restored upon termination of active duty status, subject to policy guidelines); (d) the insured person does not request to terminate insurance; and (e) the 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. Dependent coverage will also terminate when your coverage terminates or when the dependent ceases to be your lawful spouse or an eligible 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 contains only a brief description of some 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 under Trust Agreement with the Institute of Electrical and Electronic 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 be sent a full refund - no questions asked!.
The IEEE insurance trust incurs costs in connection with providing oversight and administrative support for this sponsored plan. To provide and maintain this valuable membership benefit, its 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-18700-0, on Policy Form GMR-FACE /G-18700-0.
About New York Life Insurance Company.