When Coverage Begins: Your coverage will begin on the first of the month on or following the day your application for coverage is approved by New York Life, provided you are actively-at-work full time on the date, meet required evidence of insurability requirements and the premium is paid.
When Coverage Ends: Your coverage will end when you are no longer a dues paying member or Allied member of AIA, you are no longer at full-time work, you reach age 65, you stop paying your premiums when due, you receive covered total disability benefits for the maximum benefit period, when you begin active duty in the armed forces, or the date the group policy ends.
Exclusions: Any of the following in which a disability occurs during, is due to or related to: Air Travel in, travel on, fall from or descent from any aircraft while such aircraft is in flight, unless the insured is traveling: (a) solely as a fare-paying passenger on a licensed, commercial, regularly scheduled, nonmilitary aircraft; or (b) in a civil aircraft having a current and valid “Standard Federal Aviation Agency Airworthiness Certificate” and piloted by a person with a current and valid pilot’s certificate with proper ratings for the type of flight and aircraft involved; Drugs—use of drugs, intoxicants, narcotics, barbiturates or hallucinogenic agents, unless such use is prescribed or administered by a doctor other than the insured, or accidental; impairment restriction; military service in the naval or air force of any country, alliance or international organization or in a civilian unit which serves such force; war, declared or undeclared, an act of war or an armed conflict that involves the armed forces of one or more countries; regular care that does not require a doctor's regular care of, or attendance to, the insured; or for any period of disability for which the insured is not under the regular care and attendance of a doctor, except that: This requirement will not apply if such care is no longer required for prudent medical management of the injury, sickness or organ donation. For the purpose of satisfying the requirement that the insured be under the “regular care” of a doctor, doctor does not include the insured or a member of his or her immediate family; intentional self-inflicted injury or an attempt at suicide or occurs while intentionally injuring oneself; whether the insured is sane or insane; engagement in any of the following in a role other than as a victim: (a) in war, (b) an act of war, or (c) an armed conflict which involves the armed forces of one or more countries; pre-existing conditions; pregnancy, childbirth or related medical condition.
Excluded expenses include:
- Employees Salaries: The salaries of individuals hired after the insured’s total disability began. This exclusion does not apply to an employee(s) hired as a temporary replacement(s) for the insured.
- Personal Expenses: The personal expenses of the insured, including but not limited to any of the following: (a) the insured’s salary, fees, income taxes, drawing account or any other remuneration; or (b) charitable contributions.
- Professional Services: The salaries of or fees paid to other individuals in the same occupation as the insured for professional services.
- Purchases: The cost of: (a) office equipment, goods, wares or merchandise of any nature; or (b) any and every item used by the insured in his or her normal occupation.
- Repayment Of Loan Principal: The repayment of the principal on a loan and/or mortgage.
Important Definitions
Total Disability means one that begins while insured and continuously disables you so that you are unable to perform all the substantial and material duties of any occupation. Also, you must be under a doctor’s regular care and not working at any gainful occupation for wage or profit.
Successive Periods of Disability will be considered one period of disability if such disabilities are due to the same or related causes, and which are separated by less than six months of return to continuous full-time work during which you are not totally disabled or different or unrelated causes are not separated by return to full-time work.
Full-time work means the active performance for pay or profit of the regular duties of one’s normal occupation on a basis of 20 hours per week at a place where such duties are normally performed or other location to which travel is required.
Preexisting Condition means an injury or sickness or any condition related to such injury or sickness for which a person consults a doctor, receives medical services or supplies or takes any medication during the 12 month period immediately before the insured’s initial insurance date, if such injury or sickness condition is not fully disclosed when a request for insurance is made under the Policy. Preexisting Condition does not include: (a) any such injury or sickness or condition for which such person has not consulted a doctor, received medical services or supplies or taken any medication for a continuous period of 12 consecutive months after the date he or she first becomes an insured; or (b) any such injury or sickness or condition after such person has been continuously insured under the Policy for 24 months.
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.
How New York Life Insurance Company Underwrites
Your Request For Business Overhead Disability Insurance
Information regarding insurability will be treated as confidential. In considering your request for coverage, 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 Insurance Company 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 Insurance Company 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.
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 non-medical 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 Insurance Company 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 the 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 at 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734. For Canadian residents, the address is 330 University Avenue, Suite 501, Toronto, Canada M5G 1R7. You may call MIB at 866-692-6901 (TTY 866-346-3462).
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 PERSON1 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(S) 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 |
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 Insurance Company.
Questions? Call toll-free 1-866-768-1075
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.
This information is only a brief description of the principal provisions and features of the AIA Trust Group Business Overhead Disability Plan. The complete terms, conditions, exclusions and limitations are set forth in the group policy issued by New York Life Insurance Company to the Trustee of 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 Business Overhead Disability Program is underwritten by:
New York Life Insurance Company
51 Madison Avenue, New York, NY 10010
under Group Policy G-29059-2 on
Policy Form GMR-FACE/ G-29059-2
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.