This coverage is available exclusively to IEEE members under age 70. You must maintain active IEEE membership status during the life of your coverage.

You can request coverage for yourself, your spouse under age 70 and unmarried dependent children ages 14 days through 22 years (24 if a full-time student). To become insured, you must provide evidence of insurability and pay the required premium.

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. Only one may insure any eligible children.

This coverage is available to residents of Canada (except Quebec).

AMBA does not act as broker with respect to Canadian residents and acts solely as an Administrator on behalf of New York Life.

Any eligible non-dependent family members can apply for coverage if they join IEEE as an associate member. Call us at 1-800-493-IEEE (4333) for more details.

As an IEEE member, you can choose the coverage you need:

• Member: $10,000 to $1 million, in multiples of $10,000.
• Spouse: $5,000 to $1 million, in multiples of $5,000. Coverage may not exceed 100% of member’s coverage.
• Each eligible dependent child: $10,000.

Member and spouse coverage decreases as shown under "Amounts of Insurance at Member Ages 69 through 99."

The total amount of coverage an individual may have under all group life insurance policies underwritten by New York Life Insurance Company may not exceed $2 million.

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-Sponsored Life Insurance Program may not exceed the maximum benefit option for any insured person.

Our group term life insurance offers many valuable benefits. Learn more about them.

Volume Credits

The more coverage you apply for, the more you can save. You’ll receive a volume credit if you become insured for options of $160,000 through $490,000. Another volume credit applies for options of $500,000 through $1 million. These credits are continued for members age 69 and older as long as the minimum number of coverage units is maintained.

Premium Credit

Now through 2/28/25, a 10% premium credit will apply to all premium contributions due. If policy experience warrants, the Trustee may grant premium credits that can reduce your cost to renew coverage. Although not promised or guaranteed, premium credits and/or credits have been granted every year since 1963.

Non-Tobacco/Nicotine Use Credit

If you and/or your spouse qualify, you can take advantage of nonsmoker rates to reduce your premiums even further.

Monthly Payment Option

You have the option to pay your premium contributions via monthly Electronic Funds Transfer (EFT). Your monthly cost would be approximately one-sixth of the amount you calculate from the rate chart.

Premiums Waived If You're Totally Disabled

If you become totally disabled before age 60, and remain disabled for nine months or longer, your insurance will be continued as long as you remain totally disabled—for both you and your insured family members—without additional premium contributions until coverage terminates when you reach age 100. The amount continued will be based on the options under which you and your dependents were insured at the time your disability began, subject to the scheduled decreases. You may be asked to provide evidence of your continued total disability from time to time.

IMPORTANT NOTICE TO RESIDENTS OF MANITOBA AND ONTARIO, CANADA: Manitoba and Ontario, Canada have enacted laws requiring taxation (Manitoba 7% and Ontario 8%) of all group insurance purchased by individuals. This tax will be added to the amount of any premium contributions due (in U.S. dollars), which is then reported and remitted to the province.

The amount of life insurance for you and your spouse is based on your age at your last birthday. After age 68, coverage decreases for each $10,000 member and spouse option of insurance on the premium due date on or immediately after you enter a new age category. Premiums do not reduce. And the amount of children’s insurance doesn’t decrease. 

*Coverage terminates at member's age 100. Group Conversion Privilege.

Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustee of IEEE-Sponsored Life Insurance.

Learn more about important provisions and notices for your Group Term Life Insurance Program.

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, is incapacitated or 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 100, and for your insured family members if they remain eligible, provided:(a) you remain a member of IEEE;(b) you continue to pay premium contributions when due; and (c) the group insurance 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. Upon your death, coverage for your insured dependents may continue as described in the Certificate of Insurance.

Renewal Payments and Claims

Once your application is approved, 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 policy. The complete terms and conditions are set forth in the group policy issued by New York Life to the Trustee of the Institute of Electrical and Electronics Engineers Life Insurance.

When you become insured, you will be sent a Certificate of Insurance summarizing your benefits.

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!

How New York Life Obtains Information and Underwrites Your Request for Group Term Life 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 LLC (“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 LLC 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 INFORMATION² 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.

²CONFIDENTIAL 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 insurance to provide and maintain this valuable membership benefit.

Underwritten by New York Life Insurance Company, under Group Policy No. G-8100-1, on Policy Form GMR-FACE /G-8100-1.

80765

Insurance Application & Brochure

Change of Beneficiary

Nonsmoker Declaration

EFT Authorization Form

Demystifying the Application Process

Demystifying the Life Insurance Medical Exam