GrouptermLifeAD&D
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At A Glance

Term coverage is the purest kind of life insurance, with no costly savings features. Decreasing term life insurance is a type of term coverage in which the death benefit amount decreases as you age. This is typically because there is less need for higher coverage because, for example, children become more self-sufficient and/or your mortgage may be paid off. Accidental Death and Dismemberment (AD&D) is designed to provide additional coverage if you're seriously injured or killed due to an accident. This plan combines these two valuable types of insurance coverage in one plan. However, you also have the choice to only purchase the Decreasing Term Life coverage.

Consider Your Eligibility

Before you request coverage, you must be a member in good standing of ACP. Please wait until your application for membership is accepted before initiating your insurance requests. If you have any questions regarding membership, please call ACP directly at 1-800-523-1546.

Get Quicker, Easier Service When You Apply

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 Decreasing Term Life Insurance and Accidental Death & Dismemberment 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 Plan.

  1. Click on and print the applicable application located to the right
  2. If a Domestic Partner Form is required, please print and include with your application. The form can be located on the “forms” tab.
  3. Truthfully complete and sign the application. Be sure to indicate whether you are requesting coverage for your dependents.
  4. Do not send any money until New York Life Insurance Company has approved your application and notifies you of the premium contribution due, based on the information you have provided.
  5. Mail your completed application to:
    Administrator,
    ACP Group Insurance Program P.O. BOX 10374
    Des Moines, IA 50306

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

Certificate Of Insurance

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

30-Day FREE Look

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 be sent a full refund, no questions asked!

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

This plan is underwritten by New York Life Insurance Company, under Group Policy No. G-29102-0 on Policy Form GMR.

Some insurance experts suggest that you purchase life insurance equal to five to nine times your current income. In addition, you should consider how much your dependents will need to maintain their lifestyle.

Visit the Life Insurance Planning Center made available through a license agreement with KJE Computer Solutions, who is solely responsible for the content – for an objective, no–obligation analysis of life insurance needs.

All ACP Members, Associates, Medical Students, Fellows and Masters under age 60 may request coverage for themselves, their lawful spouse under age 60 and all unmarried dependent children ages 15 days through 25 years. In order to become insured, individuals must provide satisfactory evidence of insurability and the required premium must be paid.

A dependent who is also a member is eligible for either member or dependent coverage, but not both. If both the member and spouse are covered as members, neither may insure the other as spouse and only one may insure any eligible children.

This coverage is available only for residents of the United States (except territories) and Puerto Rico.

Members —$10,000 to $1,000,000 in $10,000 multiples.

Spouse — $10,000 to $500,000 in $10,000 multiples, not to exceed 50% of member’s coverage.

Child(ren) — $5,000 per eligible child - lesser amounts for children under age 6 months, as noted in Tell Me More.

Note: The total amount of coverage an individual may request under all group life insurance plans 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 Trustees of  ACP, Inc. Insurance Trust may not exceed the maximum benefit option for any insured person.

Double Your Life Benefit with Optional AD&D Coverage
The Accidental Death & Dismemberment Insurance option allows you to double your selected life benefit amount. Then if your loss is due to a covered accidental injury, the plan will pay your life benefit amount plus your AD&D benefit, which doubles your life benefit amount. It also pays a percentage of your amount if you are seriously injured and suffer a specified loss, as described below.

Covered Loss Percentage of Principal Sum
Loss of life 100%
Loss of two limbs 100%
Loss of sight of both eyes 100%
Loss of one limb and sight of one eye 100%
Loss of one limb 50%
Loss of sight of one eye 50%

The injury must be directly and independently caused by an accident while coverage is in force, and must result in a Covered Loss within 365 days.

Only one principal sum (the largest applicable) is payable for a loss to the same limb due to or related to any one accident. Loss of sight means total and permanent loss. Loss of limb means severance through or above the wrist or ankle joint.

Additional Seatbelt and Airbag Benefit and Waiver of Premium Benefits are also available. See Tell Me More for details.

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 [NC residents: a person of like age] on the date of 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 100 (26 for children) or earlier if: (a) premium contributions are not paid when due, (b) ACP 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 member coverage terminates or when the dependent eligibility requirements are no longer being met. Upon your death, coverage for your insured dependents may continue as described in the Certificate of Insurance.

Benefits are paid for death from any cause, at anytime, anywhere in the world (subject to U.S. government regulations on restricted countries) except suicide within 12 months from the issue date, whether sane or insane.

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 nonpayment of premium contributions.

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 one advance payment equal to 50% 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 at least 12 months prior to the insured person's scheduled coverage termination 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 (12 months or less), as well as any other necessary medical information requested. 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.

Note: The Accelerated Death Benefit is not available to residents of Massachusetts.
When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the Plan. If you are 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 be sent a full refund, no questions asked!

Eligibility

All ACP Members (including Associates, Medical Students, Physician Affiliates, Non-Physician Affiliates, Fellows and Masters) under age 60, may request coverage for themselves, their lawful spouse under age 60 and all unmarried dependent children ages 14 days through 25 years. In order to become insured, individuals must provide satisfactory evidence of insurability and pay the required premium.

A dependent, who is also a member, is eligible for either member or dependent coverage, but not both. If both the member and spouse are covered as members, neither may insure the other as spouse and only one may insure any eligible children.

This coverage is available only for residents of the United States (except territories) and Puerto Rico.

Non-Dependent Family Members:Any eligible nondependent family members may also apply for coverage as long as they join ACP as an Associate Member. For membership information, please call ACP directly at 1-800-523-1546.

APPLY FOR UP TO $1,000,000 OF COVERAGE

Choose the amount of Group Decreasing Term Life Insurance you need to help protect you and your family.

Amounts Of Life Insurance:

Members: $10,000 up to $1,000,000 in $10,000 multiples.
Spouse: $10,000 up to $500,000 in $10,000 multiples, not to exceed 50% of member’s coverage.
Child(ren): $5,000, for Children older than 6 months; $500 for children 15 days and older. (No coverage for children under 15 days)

Select the AD&D Insurance Plan option if you want to double your life benefit amount. This provides an added safety net should you be seriously injured or killed in a covered accident. (See Plan Features for more details.)

The total amount of coverage an individual may have under all group life insurance plans 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 policies issued by New York Life Insurance Company to the Trustees of the American College of Physicians, Inc. Insurance Trust may not exceed the maximum benefit option for any insured person.

DOUBLE YOUR COVERAGE WITH THE GROUP AD&D OPTION

If requesting the Group Term Life Insurance, you can also request an equal amount of Accidental Death & Dismemberment Insurance (AD&D) for yourself. This option allows you to double your selected life benefit amount. Then if your death is due to a covered accidental injury, the plan will pay your life benefit amount plus your AD&D benefit, which doubles your life benefit amount. It can also pay a percentage of your amount if you are seriously injured and suffer significant losses described below.

Covered Loss Percentage of Principal
Loss of life 100%
Loss of two limbs 100%
Loss of sight of both eyes 100%
Loss of one limb and sight of one eye 100%
Loss of one limb 50%
Loss of sight of one eye 50%

The injury must be directly and independently caused by an accident while coverage is in force, and must result in a Covered Loss within 365 days.

Only one principal sum (the largest applicable) is payable for a loss to the same limb due to or related to any one accident. Loss of sight means total and permanent loss thereof. Loss of limb means severance through or above the wrist or ankle joint.

Additional Seatbelt and Airbag Benefit

Under the AD&D option, your loved ones can collect an additional benefit amount up to $25,000 or 10% of your principal sum (whichever is less) if you suffer a covered loss of life as a result of injury sustained while riding in or operating an automobile and were found to be properly wearing a seatbelt.

An additional 5% will be paid if the automobile is equipped with an airbag. However, the total amount paid under the combined seatbelt and airbag benefit cannot exceed $25,000.

Exclusions and Limitations – AD&D

No benefit will be payable for: any loss that occurs during or is due or related to military service, your incarceration or your participation in (except as a victim) an illegal occupation/activity or the commission of a crime, your 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.

PLAN FEATURES

Amounts of Insurance at Age 65 and After

The amount of insurance for you and your spouse is based on the covered person’s age at last birthday, and decreases on the premium due date coinciding with or immediately after he/she enters a new age category. After age 64 (age 50 for spouse), coverage decreases for each $10,000 option of insurance as shown below.
Premium does not decrease.

Member's Age Each $10,000 Member Option Spouse’s Age Each $10,000 Member Option
Under 65 $10,000 Under 50 $10,000
65-69 6,600 50-59 4,500
70-74 4,300 60-69 2,000
75-79 2,900 70-74 1,000
80-84 1,950 75-79 675
85-89 1,350 80-84 475
90-99* 900 85-89 325
    90-99* 200

*Coverage terminates at age 100. See Group Conversion Privilege.
The amount of children’s insurance does not decrease.
Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustees of the ACP Life Insurance Trust.

Waiver of Premium Benefit

If you become Totally Disabled for at least six consecutive months before age 60, your premiums for this plan will be waived until you are no longer disabled.
Total Disability means an incapacity from an accidental injury or sickness which: completely and continuously prevents you from doing the material and substantial duties of any occupation for which you are reasonably qualified by education, training or experience, or; results in total and permanent loss in sight of both eyes; or the severance above the wrist or ankle of: (1) both hands; (2) both feet; or (3) one hand and one foot.
The amount continued will be based on the option under which you were insured at the time your disability began, subject to the age decrease previously described. You may be asked to provide proof of you Total Disability from time to time.

Valuable Living Benefit Provision
“Accelerated Death Benefit”

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 one advance payment equal to 50% 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 at least 12 months prior to the insured person's scheduled coverage termination 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 (12 months or less), as well as any other necessary medical information requested. 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.
Note: The Accelerated Death Benefit is not available to residents of Massachusetts.

OTHER IMPORTANT INFORMATION

Exclusions

For the Group Decreasing Term Life Insurance coverage, the only exclusion is suicide. Benefits are paid for death from any other cause, at any time, anywhere in the world except suicide, within 12 months from the issue date, whether sane or insane.
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 nonpayment of premium contributions.
For the Group Accidental Death & Dismemberment Insurance coverage, the exclusions and limitations are as previously stated.

Conversion Privilege

The Plan provides conversion privileges under certain circumstances of involuntary termination, as described in the Certificate of Insurance.

You Name Your 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.

Ownership of Insurance

“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, or if initial ownership is by other than the member according to the information provided on the application, references throughout this Plan Information to “you” or “member” will mean “owner,” as applicable.

Effective Date

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 [NC residents: a person of like age] on the date of 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.

When Coverage Ends

Coverage will end when the insured person reaches age 100 (26 for children) or earlier if: (a) premium contributions are not paid when due, (b) ACP 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) the insured requests to terminate insurance. In addition, dependent coverage will terminate when the member's coverage terminates, or when the dependent eligibility requirements are no longer being met. Upon your death, coverage for your insured dependents may continue as described in the Certificate of Insurance.

Renewal Payments And Claims

Once you are accepted into the Plan, 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.

Your Cost

The cost of the Group Decreasing Term Life Insurance is based on the insured person’s attained age on the date coverage is issued and increases as he/she grows older. Premium contributions will vary depending on the number of units chosen.

CURRENT 2017 SEMI-ANNUAL RATES

Rates per $10,000 Option - Member Only
Member's
Attained Age
Unit of
Insurance†
Decreasing
Term Life Premium
AD&D
Premium
Under 30 $10,000 $3.00 $3.00
30-34 10,000 4.00 $3.00
35-39 10,000 5.00 $3.00
40-44 10,000 8.10 $3.00
45-49 10,000 13.30 $ 3.00
50-54 10,000 22.70 $ 3.00
55-59* 10,000 44.60 $ 3.00

Rates per $10,000 Option - Spouse and Child(ren)**
Spouse's
Attained Age
Unit of
Insurance†
Decreasing
Term Life Premium
Under 30 $10,000 $8.00
30-39 10,000 10.00
40-49 10,000 18.00
50-59* 10,000 20.00

* Contact the Administrator for renewal rate at ages 60-99. Coverage terminates at age 100 – see “Conversion Privileges”.

**If Spouse/Child coverage is requested, each eligible child will be covered for $5,000

†Each $10,00 option begins to decrease at age 65 for member (age 50 for spouse) as previously stated.

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 insurance under this group policy. For example, a class of insureds is a group of people all with the same issue age. Benefit amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustees of the American College of Physicians, Inc. Insurance trust.

30-DAY FREE LOOK

When you become insured, you will be sent a Certificate of Insurance, summarizing your benefits under the Plan.

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 be sent a full refund, no questions asked!
This website is only a brief description of some of the plan’s principal provisions and features. The complete terms are set forth in the group policy issued by New York Life Insurance Company to the Trustees of the American College of Physicians, Inc. Insurance Trust.

IMPORTANT NOTICE
How New York Life Obtains Information and Underwrites Your Request for
Decreasing Term Life Insurance Plan

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, Inc. (“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, Inc. 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, Inc., 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 person 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 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 8/12ed.

The ACP Insurance Trust incurs costs in connection with this sponsored program. To provide and maintain this valuable membership, it is reimbursed for these costs. ACP also receives a fee for this 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-29102-0 on Policy Form GMR

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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

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