IEEE members under age 65 are eligible to apply for coverage for themselves and for their lawful spouses under age 65. In order to become insured, satisfactory evidence of insurability must be provided and the required premium contribution must be paid.

 

A spouse who is also a member is eligible for either member or spouse coverage, but not both. If both member and spouse are covered as members, neither may insure the other as spouse.

 

Non-Dependent Family Members: Any eligible “non-dependent” family members may also apply for coverage as long as they join IEEE as an Associate Member. For membership information, please call IEEE directly at 1-800-678-IEEE (4333).

 

This coverage is available only for residents of the United States (excluding CA, CT, FL, MA, MT, NJ, NY, OR, SD, UT, WA and territories), Puerto Rico and Canada (except Quebec).

 

This coverage is available to residents of Canada (except Quebec). Mercer (Canada) Limited, represented by its employees Nicole Swift and Pauline Tremblay, acts as broker with respect to residents of Canada.

FOR MEMBER $50,000 or $100,000

FOR SPOUSE $50,000 or $100,000 (may not exceed 100% of member coverage)

 

The total amount of coverage an individual may have under all other group life insurance plans underwritten by New York Life Insurance Company may not exceed $2,000,000. However, coverage under this plan is not subject to this maximum and can be in addition to the $2,000,000 aggregate maximum.

 

In addition, the total amount of coverage an individual may have under all group policies issued by New York Life Insurance Company to the Trustee of the IEEE Member Group Life Insurance Plan may not exceed the maximum benefit option for any insured person.

Schedule of Benefits:	Member or Spouse Benefit
	$50,000	$100,000
	Benefit Amount Payable+
Death Benefit	$50,000	$100,000

 

The Death Benefit will be reduced by the amount of any Accelerated Benefits paid for the insured person.

 

Accelerated Benefits
For Qualifying Event:

Terminal Illness*	$25,000	$50,000
Critical Illness**	$12,500	$25,000
Permanent Critical Condition***	$12,500	$25,000

 

*Terminal Illness is a condition for which the patient has a life expectancy of 12 months or less.

**Critical Illness means any one of these conditions, as defined below: Major Stroke, Major Heart Attack, Malignant Cancer, Major Organ Transplant, Paralysis or Renal Failure.

***Permanent Critical Condition means a medical condition that usually requires continuous confinement in a Convalescent Care Facility, Hospice, Nursing Home or at home, if the insured is expected to remain confined for the rest of his or her life.

 

+Maximum Benefit Payable: No more than one Accelerated Benefit is payable for any one: Terminal Illness; Critical Illness; or Permanent Critical Condition. The minimum Death Benefit payable is 25% of the benefit in force and no more than 75% of that benefit amount is payable for Qualifying Events on each insured person. (In order to preserve the 25% payable minimum death benefit, the amount payable for any Qualifying Event may be reduced so that, when combined with any Accelerated Benefit already paid, no more than 75% of the insured’s benefit is paid.)

 

NOTE: If the Death Benefit is reduced by a payment of an accelerated benefit, premiums due are based on the reduced level of death benefit.

 

Qualifying Events Defined: For any benefit to be paid, New York Life must receive a written request and written satisfactory medical proof of the Qualifying Event.

 

Terminal Illness: A condition where the patient has a life expectancy of 12 months or less.

 

Critical Illness:

• Major Heart Attack—death of a portion of the heart muscle as a result of a myocardial infarction; evidence of the following must be present: electrocardiographic evidence of a myocardial infarction occurring prior to the effective date of this insurance; and elevated levels of cardiac enzymes consistent with myocardial infarction. (Your Certificate of Insurance will provide details on the measurement of certain cardiac enzyme levels.)
• Major Stroke—a cerebrovascular incident or accident which produces: (a) neurological sequel that lasts more than 24 hours; and (b) evidence of permanent neurological defect. Included in the definition of a stroke are infarction of brain tissue, hemorrhage and embolism from an extracranial source, but Transient Ischemic Attacks (TIAs) and attacks of Vertebrobasilar Ischemia are not included.
• Malignant Cancer—a disease manifested by the presence of malignant tumors characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue. Included in the definition of cancer are leukemia, Hodgkin’s disease, Kaposi’s sarcoma and malignant melanomas. It does not include Carcinoma in Situ or Skin Cancer/Pre-Malignant Conditions. Your Certificate provides more detail on the definitions of “in situ” cancers and pre-malignant conditions.
• Major Organ Transplant—undergoing as a recipient the transplant of a heart, lung, liver, pancreas, kidney or bone marrow. Transplantation means the replacement of malfunctioning organs(s) or tissue with the organ(s) or tissue of a donor suitable under generally accepted medical procedures.
• Paralysis—the complete and permanent loss of functional use of two or more limbs, as a result of medically documented physical paralysis. Loss of functional use resulting from psychosomatic causes is not included in the definition. New York Life must receive satisfactory written medical proof of a continuous period of at least 90 days of paralysis.
• Renal Failure—end stage renal disease due to chronic irreversible failure of both kidneys to function, requiring regular peritoneal dialysis, hemodialysis or renal transplantation. New York Life must receive satisfactory written medical proof of a continuous period of at least 90 days of persistent renal failure.

 

Permanent Critical Condition: a medical condition that usually requires continuous confinement in a Convalescent Care Facility, Hospice, Nursing Home or at home, if the insured is expected to remain confined for the rest of his or her life. New York Life will consider an insured to have suffered a Permanent Critical Condition if he or she cannot perform any two of these Activities of Daily Living for a continuous period of 180 days: bathing, dressing, toileting, transferring, eating or continence.

• Convalescent Care Facility means a licensed institution which provides post-hospital care or rehabilitation services; room and board, 24-hour-a-day nursing service by registered professional nurses (on duty or call with at least one fulltime nurse) and a doctor on duty or call. It does not include a rest home, a place for care of the aged, alcoholics, mentally ill or drug addicts and/or a place for custodial care.
• Hospice means a facility providing a coordinated program of home and inpatient care for terminally ill patients, meeting the standards of the National Hospice Organization and any State licensing requirements.
• Nursing Home means an institution or a distinct part of a hospital, that is primarily engaged in providing skilled nursing services for sick or injured inpatients and has continuous nursing services under the supervision of a doctor, with the services of a doctor and clinical records available, and is certified as a skilled nursing facility.

Click here to review YOUR COST

Benefits will be paid in the event of death, anywhere in the world regardless of cause. The validity of any amount of your insurance which has been in force for two years during your lifetime will not be contested except for insurance eligibility provisions or nonpayment of premium contributions.

You may select any person, persons, trust or other legal entity as your beneficiary. If, at the time of your death, there are no surviving beneficiaries, benefits will be paid to the executor or administrator of your estate, or at the option of New York Life, to the surviving relatives in the following order of survival: spouse; children equally; parents equally; or brothers and sisters equally.

If you're 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!

Once you are accepted into the Plan, you will have a 31-day grace period for your payment of renewal premium contribution. When you want to submit a claim, call or write the Administrator for claim forms.

You and your spouse will become insured on the date specified by New York Life Insurance Company provided the initial premium contribution is received within 31 days after you are billed, satisfactory evidence of insurability has been submitted, and you and your spouse are performing the normal activities of a person in good health of like age [NC residents: a person of like age] on the date of approval. For any proposed insured who is not performing such normal activities on the date insurance would otherwise have taken effect, insurance will not take effect until the day he/she is performing such normal activities, provided such day is within three months of the date insurance would otherwise have taken effect and the person is still eligible. Spouse coverage will not take effect prior to member insurance. Payment of a premium contribution for insurance does not mean there is any coverage in force before the effective date as determined by New York Life Insurance Company.

Insurance can remain in force to age 75, provided: (a) you continue to pay premium contributions when due (Note: The Office of Foreign Assets Control (OFAC), an agency of the U.S. Department of Treasury, ensures economic and trade sanctions based on the U.S. foreign policy against targeted foreign countries and specially designated individuals and organizations. New York Life may not be able to accept premium originating from an OFAC-targeted country or provide insurance services to an individual who is located in a targeted country.); (b) you remain a member of IEEE; 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 to which you belong; and for an insured spouse provided member coverage remains in force and he/she remains the lawful spouse of the member. Insurance will not terminate if you change employment or retire. Upon your death, coverage for your insured spouse may continue as described in the Certificate of Insurance.

IMPORTANT NOTICE:

 

How New York Life Obtains Information and Underwrites
Your Request for
Group Term Life with Living Benefits Insurance

 

In this notice, references to “you” and “your” include any person proposed for insurance. Information regarding insurability will be treated as confidential. In considering whether the person(s) in your request for insurance qualify 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. (“MIB”). MIB is a not-for-profit organization of insurance companies, which operates an information exchange on behalf of its members. If you apply for life or health insurance coverage or a claim for benefits is submitted to an MIB member company, medical or non-medical information may be given to MIB and such information may then be furnished by MIB, upon request, to a member company.

 

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 New York Life 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 or 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.

 

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 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.

 

New York Life may release this information to the Plan Administrator, other insurance companies to which you may apply for life and health 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 test results concerning Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV). We may also make a brief report of your protected health information to MIB, but we will not disclose our underwriting decision.

 

New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. 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.

 

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 the Federal 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, 330 University Avenue, Suite 501, Toronto, Ontario, Canada M5G 1R7, telephone (416) 597-0590. Information for consumers about MIB may be obtained on its Web site at www.mib.com.

 

For NM Residents: PROTECTED PERSONS¹ 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.

 

¹PROTECTED 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.

 

New York Life Insurance Company
8/12 ed.

 

IEEE is compensated in connection with this sponsored group plan to provide and maintain this valuable membership benefit.

Underwritten by New York Life Insurance Company,

under Group Policy No. G-8100-2 on Policy Form GMR-FACE/G-8100-2

This plan is underwritten by New York Life Insurance Company, under Group Policy No. G-8100-2 on Policy Form GMR-FACE/G-8100-2

About New York Life Insurance Company

Rating Agencies Disclaimer

When approved, you will be sent a Certificate of Insurance summarizing your benefits under the Plan. 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!

Issuance of this coverage is handled over the Internet and the mail. You can review the materials in the privacy of your home and purchase your insurance directly through the mail without meeting with a salesman. You can, of course, talk to customer service representative if you'd like. Please see the Contact Us section for the Program Administrator's toll-free number.

IEEE members under age 65 are eligible to apply for coverage for themselves, and for their lawful spouses under age 65. In order to become insured, satisfactory evidence of insurability must be provided and the required premium contribution must be paid.

 

A spouse who is also a member is eligible for either member or spouse coverage, but not both. If both member and spouse are covered as members, neither may insure the other as spouse.

 

Non-Dependent Family Members: Any eligible “non-dependent” family members may also apply for coverage as long as they join IEEE as an Associate Member. For membership information, please call IEEE directly at 1-800-493-IEEE (4333).

You and your spouse will become insured on the date specified by New York Life Insurance Company provided the initial premium contribution has been paid, satisfactory evidence of insurability has been submitted, and you and your spouse are performing the normal activities of a person in good health of like age. [MD and NC residents: a person of like age] on the date of approval. For any proposed insured who is not performing such normal activities on the date insurance would otherwise have taken effect, insurance will not take effect until the day he/she is performing such normal activities, provided such as is within three months of the date insurance would otherwise have taken effect and the person is still eligible. Spouse coverage will not take effect prior to member 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.

Insurance can remain in force to age 75, provided: (a) you continue to pay premium contributions when due (Note: The Office of Foreign Assets Control (OFAC), an agency of the U.S. Department of Treasury, ensures economic and trade sanctions based on the U.S. foreign policy against targeted foreign countries and specially designated individuals and organizations. New York Life may not be able to accept premium originating from an OFAC-targeted country or provide insurance services to an individual who is located in a targeted country); (b) you remain a member of IEEE; (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 to which you belong; and, for an insured spouse, provided member coverage remains in force and he/she remains the lawful married spouse to the member. Insurance will not terminate if you change employment or retire. Upon your death, coverage for your insured spouse may continue as described in the Certificate of Insurance.

Benefits will be paid in the event of death, anywhere in the world regardless of cause. The validity of any amount of your insurance which has been in force for two years during your lifetime will not be contested except for insurance eligibility provisions or nonpayment of premium contributions.