When Coverage Begins: Coverage starts on the first day of the month coinciding with or next following the date the application(s) is approved by New York Life, as long as the premium is paid within 30 days of the effective date. To be insured, an employee must be working full-time at least 20 hours a week on the effective date or the date the premium is paid, whichever is later. Insurance for a proposed INSURED EMPLOYEE not ACTIVELY-AT-WORK on the date insurance would otherwise have taken effect, will take effect on the day the proposed INSURED EMPLOYEE is ACTIVELY-AT-WORK, if the proposed INSURED EMPLOYEE is still eligible to obtain the insurance on that day.
When Coverage Ends: Your firm insurance can remain in force and for your employees as long as they remain eligible, provided:(a) you remain a member of AIA; (b) you continue to pay premium contributions when due; and (c) the group plan is not terminated or modified by the Policyholder, the AIA Trust, or New York Life Insurance Company to end insurance for the group of insureds to which you belong.
Definitions:
Total Disability means an incapacity from an injury or sickness which completely and continuously prevents an insured member from doing the material and substantial duties of any occupation for which he or she is reasonably qualified by education, training or experience; results in total and permanent loss of sight of both eyes; or results in severance, above the wrist or ankle of both hands, both feet or one hand and one foot.
Covered Loss in relation to AD&D is a loss that:
1. an INSURED EMPLOYEE suffers, but only if such loss results from an accidental injury and such: (a) loss occurs within 90 days of such injury; (b) injury occurs while he or she is insured under the Policy; and (c) injury is the direct result of the accident and is independent of all other causes. Termination of the Policy or of an INSURED EMPLOYEE’S insurance will not prejudice the payment of benefits for a Covered Loss which resulted from an accidental injury that occurred before the date of such termination. 2. is listed on the Table Of Benefits on the Schedule page(s); and 3. is not excluded in the Exclusions section.
Exclusions: Benefits are payable in the event of an insured’s death from any cause except suicide during the first 12 months of coverage. However, if suicide is committed during the first 12 months, we will refund the premiums paid to the date of death.
Accident benefits will not be paid for any loss which is due to one of the following exclusions:
- Suicide, attempted suicide or intentionally self inflicted injury, while sane or insane. Benefits will not be paid for suicide within the first 12 months of coverage if New York Life can show that suicide was intended at the time of application;
- War Conditions — Engagement in war, an act of war or an armed conflict which involves the armed forces of one or more countries.
- Military Service — A loss that is related to an Insured members duty in the military, naval or air service of any country;
- Occupational Injury — A loss that is due to or related to an on the job accidental injury, even if the loss is not covered under a Workers' Compensation Act or similar act;
- Air Travel — A loss that occurs while Operating, riding or descending from any aircraft except when riding as a passenger in a regularly scheduled flight in a licensed, commercial, non-military aircraft;
- Treatment — A loss that occurs during, is due to or is related to the insured’s medical, dental or surgical treatment unrelated to the accident which would otherwise entitle the insured to benefits.
- Disease/Infirmity — A loss that is due to or related to disease or bodily infirmity of mind or body, medical or surgical treatment of such disease or bodily infirmity, or bacterial infections, except infections which occur as a result of an: (1) accidental cut or wound, or (2) accidental ingestion of contaminated material.
If you are an individual architect practicing alone, you aren't eligible for this plan. You may apply for an AIA Trust Group Life Insurance Plan for sole practitioners. Please call 1-800-399-8060 for details.
Questions? Call toll-free 1-800-399-8060
This information is only a brief description of the principal provisions and features of the AIA Trust Group Firm Term Life and Accidental Death and Dismemberment (AD&D) Insurance Plan. The complete terms and conditions including features, costs, eligibility, renewability, limitations and exclusions are contained in the Certificate of Insurance issued to each insured.
The AIA Trust incurs certain administrative expenses in connection with this sponsored plan. To provide and maintain this valuable AIA membership benefit, the Trust is reimbursed for these expenses.
Endorsed by:
Administered by:
AGIA Insurance Services, Inc.
P.O. Box 22859
Santa Barbara, CA 93121
A.G.I.A., Inc., is licensed/authorized to transact business in all 50 United States, and the District of Columbia. Their state of domicile is California. John Wigle California Agent license number is 0482924.
The Group Firm Term Life and Accidental Death and Dismemberment Plan is underwritten by:
New York Life Insurance Company
51 Madison Avenue, New York, NY 10010
under Policy Form GMR-ER, Group Policy G-11108-0/FACE
New York Life is licensed/authorized to transact business in all the 50 states, and the District of Columbia.
Please note that this plan is currently not available to residents of Vermont , Washington, US territories, Puerto Rico, and Canada.
New York Life Insurance Company’s state of domicile is New York and their NAIC ID # is 55915.