Effective Date of Coverage: Insurance will take effect on the first of the month on or following the date your application is approved by New York Life Insurance Company, provided the initial contribution is paid within 31 days after you are billed and any person to be insured is performing normal activities of a person in good health of like age on the day of approval. If any dependent proposed for coverage is not performing his/her normal activities as required, coverage will not take effect until he/she is performing such activities provided such date is within three months after the date insurance would have been effective and the person is still eligible.
When Coverage Ends: Coverage will end when the insured person reaches age 70, (25 for children who are unmarried dependents) or earlier if: (a) the premiums are not paid when due, (b) AIA membership ends, (c) the group plan is terminated or modified by the policyholder to end insurance for the group of insureds to which the member belongs, and (d) if the insured requests to terminate insurance. In addition, dependent coverage will terminate when the dependent spouse or child ceases to be an eligible dependent.
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.
Beneficiary Designation: You can name any beneficiary you wish for member coverage. You may change this beneficiary at any time, by written request. Your beneficiary is the person(s) last designated by you in writing, and recorded by or on behalf of New York Life Insurance Company. You are the automatic beneficiary for dependent insurance, as described in the Certificate of Insurance. If you wish to name another beneficiary for dependent spouse or child insurance, contact the administrator at 1-866-768-0884 for the applicable form.
Exclusions and Limitations: In the case of death due to suicide within 12 months of coverage, the benefit will be limited to the return of premiums paid.
Important Information from New York Life Insurance Company
New York Life Insurance Company reserves the right to request medical information to determine applicant’s medical eligibility for coverage. Based on the age of the person proposed for insurance and the amount of coverage requested, a physical examination, EKG, blood test or other information may be required. Not all applicants will have to supply additional information. However, if it is required, New York Life will arrange for an independent professional paramedic to contact you to perform these simple tests at your convenience. The exam and blood test are free-of-charge.
IMPORTANT NOTICE:
How New York Life Underwrites Your Request
for AIA Trust Group Term Life 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 doctor, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB (Medical Information Bureau). 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 your request. Upon receipt of all requested information, we will make a determination as to whether request for insurance can be approved.
MIB is a nonprofit organization of life 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 nonmedical 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 the 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, Ste. 400, Braintree, MA 02184-8734, Telephone: (781) 751-6000. For Canadian Residents, the address is MIB Information Office, 330 University Ave., Ste. 500, Toronto, Canada, M5G 1R7, Telephone: (416) 597-0590. (TTY 1-866-346-3642 for hearing impaired.)
For NM Residents: PROTECTED PERSONS (1) 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.
(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 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 as family member, employer or associate of a victim of domestic abuse or a person with whom an applicant or insured is known to have a direct, close, personal, family or abuse-related relationship.
| New York Life Insurance Company |
08/08 ed. |
If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage be effective prior to this date. Payment of a premium contribution with your application does not mean that there is any insurance in force before the effective date as determined by New York Life.
Questions? Call toll-free 1-866-768-1075
The AIA Trust incurs certain administrative expenses in connection with this sponsored program to provide and maintain this valuable membership benefit. It is reimbursed for such expenses. This information is only a brief description of Group Policy terms, conditions, and limitations. Complete provisions are found in the Group Policy issued to the Trustee under Trust Agreement with the AIA Trust.
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 Term Life Insurance is underwritten by:
New York Life Insurance Company
51 Madison Avenue, New York, NY 10010
under Group Policy G-11105-0 on
Policy Form GMR-FACE/ G-11105-0
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 not available in all states.
New York Life Insurance Company’s state of domicile is New York and their NAIC ID # is 55915.