Group 10-Year Level Term Life Insurance can provide important financial security for loved ones with a premium that is not expected to increase for a set period: 10 years (see Features under Tell Me More). During the initial 10-year period, your premiums is expected (but not guaranteed) to remain the same. It can be ideal for families with younger or older children who need protection but don’t want to worry about the possibility of annual coverage increases impacting their budget.
Term coverage is the purest kind of life insurance, with no costly savings features. Here is term life insurance you can depend on for premiums that are expected (but not guaranteed) to remain the same for 10 years and benefit options that will not go down while you are insured. You can renew coverage up to age 75, subject to all termination of coverage provisions. Available to ACM members and spouses under age 65, Group 10-Year Level Term Life Insurance can help you protect your family from the financial burdens of your or your spouse’s premature death.
Your renewal is guaranteed until age 75, provided you pay premiums when due, remain a member of ACM, and the group policy remains in force. ACM Members can select a coverage amount from $100,000 up to $1,000,000 (in $1,000 units). Your spouse can select from $100,000 to $1,000,000 (in $1,000 units), not to exceed 100% of the member's coverage. This insurance features "Preferred" and "Standard" Rates, and you can benefit from volume discounts when you apply for higher amounts of insurance. Plus, send no money until you are approved.
These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.
ELIGIBILITY
ACM members under age 65 may request coverage for themselves and their lawful spouses under age 65. In order to become insured, individuals must provide satisfactory evidence of insurability, the required premium must be paid when due and you and their lawful spouses if proposed for coverage, are at Full-Time Work. Full-Time Work means the active performance for pay or profit of the regular duties of your occupation on a basis of at least 30 hours per week where such duties are normally performed. You must be an insured member for spouse coverage to take effect.
If both the member and spouse are covered as members, neither may insure the other as spouse.
Coverage is not available in all States.
AMOUNTS OF INSURANCE
Members—$100,000 to $1,000,000 in $1,000 multiples.
Spouse—$100,000 to $1,000,000 in $1,000 multiples, not to exceed 100 percent of member’s coverage.
The total amount of coverage an individual may have under all group life insurance underwritten by New York Life Insurance Company may not exceed $2,000,000. In addition, the total amount of coverage an individual may have under all group policies issued by New York Life Insurance Company to the Policyholder may not exceed the maximum benefit option for any insured person.
FEATURES
Nonsmokers meeting the highest underwriting standards may qualify for Preferred (the Policy’s best) rates. Other nonsmokers may qualify for higher rates.
If you or your spouse becomes insured for coverage amounts of $201,000 through $499,000, you’ll receive a volume discount; and for amounts of $500,000 through $1,000,000 of coverage, you’ll receive an even bigger discount.
Premiums are expected but not guaranteed to remain level for the first ten years of coverage. At the end of the 10-year period, you may reapply for 10-year level term rates then in effect for a subsequent 10-year period, provided the insured person is under age 65 and otherwise eligible. If your application for a subsequent 10-year term is approved, your premium contribution will be based on the insured’s person’s age, health and tobacco/nicotine use at the time coverage becomes effective and will be guaranteed for a new 10-year term. If you and your spouse are not approved for a subsequent 10-year term or you do not apply for a subsequent expected but not guaranteed 10-year term, coverage will continue in force on a non-guaranteed rate basis, under which premium contributions increase as the insured ages.
Rates have been provided on an annual basis per $1,000 of coverage to make it easier for you to compare this Policy to others on the market today. You can pay your premiums via direct bill on a semiannual basis or you can pay your premiums via Electronic Funds Transfer (EFT) on a monthly or semiannual basis. The choice is yours. Your cost would be approximately one half or one twelfth, respectively, the amount you calculate from the rate chart.
OTHER IMPORTANT INFORMATION
The Accelerated Death Benefit option is available to help terminally ill insureds during a difficult and often financially challenging time. Under this provision you may request to accelerate up to the lesser of 25% or $50,0000 and a maximum up to 50 percent of your (or an insured dependent’s) in force life insurance to be paid while the terminally ill person is still alive. The request must be made before the covered person turns 70 and the amount of insurance payable after the insured’s death will be reduced by this payment. (Premium contributions will not be reduced.)
This money can be used to help cover prescription drug costs…medical bills…outstanding debts…to help pay for experimental treatments…the cost of modifications to your home…or for a family vacation—the choice is yours.
To qualify, a terminally ill insured must provide New York Life Insurance Company with proof of terminal illness and anticipated life expectancy (24 months or less), as well as any other necessary medical information requested. Terminal illness does not include any condition resulting from attempted suicide or intentionally self-inflicted injury. For additional details and limitations, please see the Certificate of Insurance.
Please note that receipt of Accelerated Death Benefits may affect your eligibility for public assistance programs and may be taxable. Prior to applying to receive such benefits, you should consult with the appropriate social services agency and seek the advice of a qualified tax advisor.
Coverage is payable for death by any cause except death from suicide during the first two years of coverage, whether sane or insane, for which the only benefit payable is the return of applicable premium contributions. The validity of any amount of your life insurance which has been in force for two years during an insured's lifetime will not be contested except for insurance eligibility provisions and non-payment 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.
Owner means the person or entity with rights of ownership of this insurance as described in the Certificate of Insurance. If a transfer of ownership has been recorded by or on behalf of New York Life Insurance Company, or if initial ownership is by other than the member according to the information provided on the application, references throughout this Information to you or member will mean owner, as applicable.
Insurance will take effect on the date your application is approved, by New York Life Insurance Company provided the initial contribution is paid within 31 days after the date you are billed (send no money now) and any person to be insured is actively performing the normal activities of a person in good health of like age [Note: Residents of NC: a person of like age] on the date after approval. Any person who is not performing his/her normal daily activities as required will not become insured until the day he/she is performing such activities, provided such date is within three months of the date insurance would have been effective and the person is still eligible.
Coverage will end when the insured person reaches age 75 or earlier if: (a) premium contributions are not paid when due, (b) ACM membership ends, (c) the group program 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. Spouse coverage ends when your coverage ends (for reason other than your attainment of age 75) or when he/she ceases to be your lawful spouse. Upon your death, coverage for your insured spouse may continue as described in the Certificate of Insurance.
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.
HOW TO APPLY
Be sure to review all of the life insurance information on the website before applying.
Before you request coverage, you must be a member in good standing of ACM. Please wait until your application for membership is accepted before initiating your insurance requests. If you have any questions regarding membership, please the association directly at 1-800-342-6626.
The information provided when you fill out your application can make the medical underwriting process quicker and easier. By providing complete and accurate information, you avoid delays that may occur while we wait for missing information to be received and shorten the time needed for underwriting decisions and approvals.
New York Life Insurance Company relies on your answers and statements. Misstatements or failures to report information on your application may be used as the basis for rescinding your insurance.
The Group 10-Year Level Term Life Insurance Plan is medically underwritten based on the information provided by you on the application. It is important that you complete the form truthfully and completely. Your application is subject to New York Life Insurance Company’s approval and more medical information may be requested. A physical exam, EKG, blood test or other information may be required. If so, we will arrange for an independent professional paramedic to contact you to perform these simple tests at your convenience. The exam and blood test will be paid for by the program.
Please send your completed application to:
Global Insurance Agency, Inc.
P.O. Box 9023918
San Juan, PR 00902-3918
IMPORTANT NOTICE
How New York Life Obtains Information and Underwrites Your Request for Group 10 Year Level 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 applications 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). 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.
7/15 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.
This information is only a brief description of the principal provisions. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the Trustee of the Association and Society Group Insurance Trust.
When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the coverage.
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 receive a full refund, no questions asked!
The Association for Computing Machinery incurs cost in connection with this program. To provide and maintain this valuable membership benefit, it is reimbursed for these costs.
Underwritten by New York Life Insurance Company, under Group Policy No. G-30720-0 on Policy Form GMR-FACE/G-30720-0.
About New York Life Insurance Company
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Answers about the program, including eligibility, options, customer service and more.
When is the coverage effective?
Who is eligible for this insurance?
ACM members under age 65 may request coverage for themselves and their lawful spouses under age 65. In order to become insured, satisfactory evidence of insurability must be provided and the required premium must be paid when due and you and their lawful spouses if proposed for coverage, are at Full-Time Work. Full-Time Work means the active performance for pay or profit of the regular duties of your occupation on a basis of at least 30 hours per week where such duties are normally performed. You must be an insured member for spouse coverage to take effect.
A dependent who is also an ACM 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.
Coverage is not available in all States.
How much life insurance should I consider?
Who is this program underwritten by?
This program is underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010, under Group Policy No. G-30720-0 on Policy Form GMR-FACE/G-30720-0.
What if I have second thoughts after I apply?
How does the Accelerated Life Benefit work?
The "Accelerated Death Benefit" option is available to help terminally ill insureds during a difficult, and often financially challenging time. Under this provision you may request to accelerate up to the lesser of 25% or $50,0000 and a maximum up to 50 percent of your (or an insured dependent's) in force life insurance to be paid while the terminally ill person is still alive. The request must be before the covered person turns 70 age and the amount of insurance payable after the insured's death will be reduced by this payment. (Premium contributions will not be reduced.)
This money can be used to help cover high prescription drug costs...medical bills...outstanding debts...to help pay for experimental treatments...the cost of modifications to your home...or for a family vacation--the choice is yours.
To qualify, a terminally ill insured must provide New York Life Insurance Company with proof of terminal illness and anticipated life expectancy (24 months or less), as well as any other necessary medical information requested. Terminal illness does not include any condition resulting from attempted suicide or intentionally self-inflicted injury. For additional details and limitations, please see the Certificate of Insurance.
Please note that receipt of Accelerated Death Benefits may affect your eligibility for public assistance programs and may be taxable. Prior to applying to receive such benefits, you should consult with the appropriate social services agency and seek the advice of a qualified tax advisor.
Are there any exclusions?
When does coverage end?
Will I meet with a salesperson?
Are there any discounts available?
Two discounts may be available:
How much insurance can I request?
Members—$100,000 to $1,000,000 in $1,000 multiples.
Spouse—$100,000 to $1,000,000 in $1,000 multiples, not to exceed 100 percent of member's coverage.
Note: The total amount of coverage an individual may request under all group life insurance policies underwritten by New York Life Insurance Company may not exceed $2,000,000.
We're here to help! Please contact us in whatever manner is most convenient for you.
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Application Mailing Address
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Payment Mailing Address
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