Accidental Death and Dismemberment Insurance
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At a Glance

$100,000 to $500,000 Member coverage! Accidents. Television and newspapers report them every day. But what if one happened to you? Would your family have the financial resources to survive the crisis? If you travel a great deal in your work ... or if you are subject to possible injury on the job ... you may need the ACP Group Accidental Death & Dismemberment (AD&D) Insurance Plan. It helps protect you and your insured family members by providing accident protection that covers you year round ... anywhere in the world.

How To Apply

  1. Click on and print the applicable application located to the right.
  2. Select your Principal Sum and read the rate chart to find the premium for each individual to be covered under the amount of coverage desired.
  3. Complete, sign and date the Application.
  4. Make your premium check payable to:
    Administrator,
    ACP Group Insurance Program
    If you choose the convenient Electronic Funds Transfer (EFT) option, be sure to include a voided check, as applicable, in addition to the check for the first payment due.
  5. Mail the Application together with your check to:

    Administrator
    ACP Group Insurance Program
    P.O. Box 10374
    Des Moines, IA 50306-8812

    Residents of Puerto Rico:
    Please send your completed application and check for the initial premium to:
    Global Insurance Agency, Inc.
    P.O. Box 9023918
    San Juan, PR 00902-3918

30-Day FREE Look

When you receive your Certificate of Insurance, read it carefully. If you’ re not completely satisfied with the terms of your new insurance plan, simply return your Certificate, without claim, within 30 days and your premium will be promptly refunded, and your insurance will then be invalidated.

How To File A Claim

To file a claim, write the Administrator for claim forms.

Who Is Eligible?

As a member or affiliate member of ACP under age 70 and a resident of the U.S. (excluding VT, WA and territories) or Puerto Rico, you are eligible to apply for this Group Accidental Death & Dismemberment (AD&D) coverage for yourself, your lawful spouse under age 70, and unmarried dependent children under age 19 or 26 if a full–time student. To become insured, a completed form must be submitted and the required premium contribution must be paid when due.

What You Can Choose

You may select a Principal Sum ranging from $100,000 to $500,000 (in units of $100,000) for yourself — at competitive group rates.

When you reach age 70, the Principal Sum reduces to $25,000.

Your insured spouse and children will qualify for a percentage of your Principal Sum. If you choose to insure your spouse only, your spouse’s coverage amount will be 50% of your amount. If you choose to insure your family, your spouse will be insured for 40% of your amount and each eligible dependent child will be insured for 10% of your amount. If you choose coverage for member and child(ren) only, each child will be covered by 15% of your amount.

An individual may not be insured under one or more AD&D Group Policies underwritten by New York Life Insurance for a total amount of AD&D coverage that exceeds current over-insurance standards.

How The Plan Works

Schedule of Benefits
For an injury directly and independently caused by an accident while coverage is in force for you, your covered spouse or your child, the benefits specified below will be paid if such resulting loss (es) occur within 365 days of that accident.

Benefits are payable for the following losses:

  • FULL PRINCIPAL SUM for loss of: life; two limbs; movement of both upper and lower limbs (quadriplegia); sight of both eyes; both speech and hearing; or one limb and sight of one eye.
  • THREE–QUARTERS OF PRINCIPAL SUM for loss of: movement of three limbs (triplegia).
  • ONE–HALF OF PRINCIPAL SUM for loss of: one limb; movement of both upper and lower limbs on one side of the body (hemiplegia); movement of both lower limbs (paraplegia); sight of one eye; or speech; or hearing.
  • ONE–QUARTER OF PRINCIPAL SUM for loss of the thumb and index finger of either hand; or loss of movement of one limb (uniplegia).

    Loss means: with reference to limbs, actual severance through or above the wrist or ankle joints; with reference to thumb and index finger, actual severance through or above metacarpophalangeal joints; with reference to sight, speech or hearing, total and permanent loss thereof; and with reference to movement, total and permanent paralysis of such limbs.

    The total benefit payable for all losses due to a single accident will not be more than the Principal Sum. Only one of the sums, the largest, will be paid for all injuries to the same limb resulting from one accident.

Your Cost

Current 2018 Annual Premium Contributions

For Member
Principal Sum Annual Premium
$25,000* $30.00
100,000 60.00
200,000 120.00
300,000 180.00
400,000 240.00
500,000 300.00

Member and Family
Principal Sum Annual Premium
Member Spouse Each Child Premium
$25,000* $10,000 $2,500 $40.00
100,000 40,000 10,000 79.00
200,000 80,000 20,000 158.00
300,000 120,000 30,000 237.00
400,000 160,000 40,000 316.00
500,000 200,000 50,000 395.00

Member and Children
Principal Sum Annual Premium
Member Each Child
$25,000* $3,750 $40.00
100,000 15,000 75.00
200,000 30,000 150.00
300,000 45,000 225.00
400,000 60,000 300.00
500,000 75,000 375.00

*Renewal Only — Age 70 and Over all amounts reduce to a maximum of $25,000.

The premium contributions shown reflect the current rate and benefit structure. Premium contributions may be changed by New York Life Insurance Company on any premium due date and any date on which benefits are changed. However, your rates may change only if they are changed for all others in the same class of insureds. For example, a class of insureds is all others with the same issue age. Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustees of American College of Physicians, Inc. Insurance Trust.

Plan Features

The Following Benefits Are Payable In Addition To Any Other Benefits Received Under the Plan

Common Carrier Benefit

If a covered loss occurs as a result of an accident while a passenger on a licensed common carrier (train, bus, etc.), an additional 25% of the member’s Principal Sum will be payable.

Repatriation Benefit

If a covered accidental death occurs outside of the insured person’s state of residence,and said accident occurs before the covered person reaches age 70, an additional benefit of up to $25,000 of the actual expenses incurred will be paid for the preparation and transportation of the body to the place of burial or cremation.

Rehabilitation Benefit

Rehabilitation training can help an insured person return to former productivity following a covered accident, other than loss of life. If approved, the amount paid will equal the actual expenses incurred for rehabilitation training up to a maximum of $5,000. The expense must be incurred within two years after the date of the accident. You will not be required to pay premium contributions while you, the insured member, are receiving this benefit, until the earlier of the date you return to work, or the $5,000 maximum has been reached.

Seat Belt Benefit

If an insured person is involved in an automobile accident in which he/she was properly wearing a seatbelt and dies within 90 days as a result of that accident, the beneficiary can receive an additional amount which is the lesser of $25,000 or 10% of the Principal Sum payable. Please refer to the Certificate of Insurance for certain limitations and conditions on this benefit.

Education Benefit

If the benefit for loss of life is payable with respect to the insured member, and his/her children are covered by this Plan on the date of the accident, this Plan will pay an education benefit equal to the lesser of: 5% of the member’s Principal Sum in force at the time of death, or; $5,000. This benefit will be payable annually up to four years, for each insured dependent child who is enrolled (or enrolls within 365 days of the accident) as a full–time student at an institution of higher learning (college, university or trade school). The benefit will end before four years if the dependent child ceases to be a Full-Time student. In addition, if no insured child qualifies for this benefit following the covered loss of the member’s life, a lump sum benefit of $2,500 will be payable.

Surviving Spouse Benefit

If both the member and spouse are insured under the policy and one spouse dies as a result of an accident, the plan will pay the surviving spouse an additional benefit equal to 1% of the deceased person’s Principal Sum. The benefit is payable monthly to the surviving spouse for up to 12 months or until the spouse dies, whichever occurs first.

Exclusions and Limitations

No benefit will be payable for any loss that occurs during or is due or related to: military service; the insured person’s incarceration for participation in (except as a victim) an illegal occupation/activity or the commission of a crime; the insured person’s voluntary intake of drugs, narcotics or alcohol (unless prescribed by a physician); any declared or undeclared war or act thereof; or operating, riding in or descending from any aircraft except when riding as a passenger; or for any loss that is due or related to: a physical or mental sickness or medical/surgical treatment thereof, or suicide or intentionally self–inflicted injury while sane or insane. In addition, when you reach age 70, coverage reduces to $25,000.

Beneficiary

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. The member is the beneficiary for spouse's and children's coverage. If you wish to designate a different beneficiary, simply contact the Plan Administrator at 1-888-643-0323 for a Beneficiary Form.

When Coverage Ends

Your insurance remains in force unless you cease to be an ACP member, fail to pay premium contributions when due, the insured person enters full–time active duty in the Armed Forces, or the Plan is terminated or modified by the Policyholder or New York Life Insurance Company to end insurance for the group of insureds to which you belong. Dependent coverage will terminate when member coverage terminates or when the dependent ceases to be a lawful spouse or eligible dependent child. A member’s surviving spouse and children may continue coverage if it was in force at the time of the member’s death as described in the Certificate of Insurance.

Effective Date

You and your dependents will become insured on the date specified by New York Life Insurance Company provided the initial premium contribution is paid when due, and you and your dependents are performing the normal activities of a person in good health of like age (NC Residents: a person of like age) on that date. Dependent insurance will not take effect unless your insurance is in effect on a premium paying basis, and any person who is not performing his or her normal activities as required will not become insured until the date he or 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. (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.)

Certificate of Insurance

When you become insured, you will be sent a Certificate of Insurance summarizing your coverage. This brochure contains only a brief description of some of the Plan’s principal provisions and features. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the Trustees of American College of Physicians, Inc. Insurance Trust.

The ACP insurance trust incurs costs in connection with this sponsored Plan. To provide and maintain this valuable membership benefit, it is reimbursed for these costs. ACP may also receive a fee for the license of its name and logo for use in connection with this Plan.

Underwritten by New York Life Insurance Company, under Group Policy No. G–29182–0 on Policy Form GMR–FACE/G–29182–0.

Answers about the plan, including eligibility, options, enrollment, customer service and more.

Premium contributions for both the member and spouse are based on the member's age. Premiums may be periodically increased on plans to reflect plan utilization and help ensure their financial stability.
No, not under normal circumstances. A surviving spouse can, however, maintain coverage under certain circumstances.

This coverage is underwritten by New York Life Insurance Company, under Group Policy G-29182-0

About New York Life Insurance Company.
Mercer Consumer is the company contracted to manage the Group Insurance Program. Mercer Consumer is not affiliated with the insurance companies that underwrite each plan.

These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.

Insurance Application and Brochure



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We're here to help! Please contact us in whatever manner is most convenient for you.

Program Administrator, ACP Group Insurance Program

Mercer Consumer
P.O. Box 10374
Des Moines, IA 50306
Phone: 1-888-643-0323
Email: ACPgroupins.service@mercer.com

Insurance Company

New York Life Insurance Company
51 Madison Avenue
New York, NY 10010

Insurance Application and Brochure Download

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