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Underwritten by New York Life Insurance Company

ELIGIBILITY

Academy members under age 65 may request coverage for themselves, their lawful spouses under age 65 and all unmarried dependent children ages 14 days through 22 years (24 if a fulltime student). 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 and Puerto Rico.

Amounts of Insurance:

Members—$50,000 to $1,000,000 in $50,000 multiples.
Spouse—$50,000 to $1,000,000 in $50,000 multiples, not to exceed 100% of member’s coverage.
Child(ren)—$2,500 ($500 at ages 14 days through five months)

The total amount of coverage an individual may have under all group life insurance policies 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 Trustee of the Ophthalmologists Insurance Trust may not exceed the maximum benefit option for any insured person. In addition, a child may not be insured for more than one $2,500 benefit under all group policies issued by the New York Life Insurance Company to the Trustee of the Ophthalmologists Insurance Trust.

Pay Less If You're a Qualified Nonsmoker

Nonsmokers meeting the highest underwriting standards may qualify for “Preferred” (the best) rates. Other nonsmokers may qualify for “Select” (higher, but still specially negotiated) or “Standard” (the highest) rates. Smokers may only qualify for Standard rates.

Save with Volume Discounts on Higher Amounts of Insurance

If you or your spouse becomes insured for coverage amounts of $250,000 through $450,000, 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.

Continuing Insurance After the 10–Year Term Ends

Premiums are 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 of guaranteed rates 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 of guaranteed rates, or you do not apply for a subsequent 10–year term, coverage will continue in force on a non–guaranteed rate basis, under which premium contributions increase as the insured ages.

Help Keep Your Cost Manageable

Rates have been provided on an annual basis per $1,000 of coverage to make it easier for you to compare this coverage to other insurance on the market today. Two modes of payment are available to suit your budget: semiannual billing; and our semiannual or monthly Electronic Funds Transfer (EFT) option (your cost would be approximately one–half or one–twelfth, respectively, the amount you calculate from the rate chart.)

OTHER IMPORTANT INFORMATION

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 (24 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.

Exclusions

Benefits for a covered person death due to suicide, attempted suicide or intentionally self-inflicted injury during the first 24 months of coverage will be limited to a return of premium contributions, whether sane or insane.

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

Effective Date

Note: Residents of NC: Any reference to “performing normal activities” is replaced by the requirement that the health status of any proposed insured person remain the same as stated in your application.

Insurance will take effect on the first day of the month on or after 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 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 75 (23 for children, or 25 for children who are full–time students) or earlier if: (a) premium contributions are not paid when due, (b) the group policy is terminated or modified by the Policyholder to end insurance for the group of insureds to which the member belongs, and (c) if the insured requests to terminate insurance. In addition, dependent child coverage will terminate when the child ceases to be an eligible dependent. Upon your death, coverage for your insured dependents may continue as described in the Certificate of Insurance.

Renewal Payments and Claims

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.

YOUR COST

The cost of this life insurance is based upon the member or spouse's gender, amount of insurance requested, usage of tobacco/nicotine products, health status, and attained age on the date coverage is issued. Premium contributions will vary based on the options chosen.

Only non-smokers meeting the highest underwriting standards will qualify for the "Preferred" rates shown. Other non-smokers may qualify for the higher "Select" or "Standard" rates. (Note: Smokers may only qualify for Standard Rates.) Upon approval of your application, you will be notified of the rate classification for each approved person.

Current 2024 Annual Rates per $1,000 of Insurance † Amounts $100,000^*-$249,000 † †
	Male			Female^*
Issue Age	PREFERRED	SELECT	STANDARD	PREFERRED	SELECT	STANDARD
20-23	0.83	0.94	2.28	0.74	0.85	1.94
24-25	0.83	0.94	2.29	0.74	0.85	1.94
26-27	0.83	0.94	2.30	0.74	0.85	1.94
28	0.83	0.94	2.32	0.74	0.85	1.96
29	0.83	0.94	2.34	0.74	0.85	1.96
30-34	0.83	0.94	2.35	0.74	0.85	1.99
35	0.83	0.94	2.42	0.74	0.85	2.03
36	0.84	0.97	2.53	0.76	0.88	2.12
37	0.86	1.01	2.69	0.80	0.91	2.28
38	0.91	1.04	2.86	0.84	0.96	2.46
39	0.96	1.10	3.10	0.88	1.02	2.69
40	1.01	1.16	3.34	0.92	1.07	2.88
41	1.06	1.24	3.65	0.98	1.15	3.10
42	1.13	1.33	4.01	1.04	1.22	3.31
43	1.20	1.42	4.42	1.13	1.32	3.58
44	1.27	1.54	4.86	1.20	1.40	3.83
45	1.39	1.66	5.32	1.26	1.50	4.12
46	1.51	1.79	5.84	1.34	1.57	4.42
47	1.64	1.94	6.41	1.40	1.67	4.74
48	1.76	2.11	7.01	1.48	1.76	5.09
49	1.93	2.29	7.63	1.56	1.86	5.44
50	2.10	2.51	8.26	1.66	1.99	5.80
51	2.28	2.72	8.87	1.76	2.10	6.17
52	2.45	2.95	9.46	1.90	2.23	6.55
53	2.64	3.22	10.08	2.03	2.36	6.95
54	2.88	3.49	10.78	2.17	2.52	7.36
55	3.11	3.80	11.58	2.32	2.70	7.78
56	3.38	4.13	12.48	2.45	2.88	8.15
57	3.65	4.48	13.43	2.59	3.06	8.51
58	3.98	4.86	14.51	2.72	3.29	8.89
59	4.36	5.30	15.78	2.90	3.52	9.38
60	4.79	5.84	17.26	3.12	3.82	10.03
61	5.28	6.44	18.88	3.41	4.16	10.86
62	5.81	7.15	20.63	3.73	4.54	11.86
63	6.43	7.94	22.69	4.12	4.99	13.00
64	7.16	8.84	25.21	4.54	5.47	14.27

† Payable via periodic billing (quarterly, semi-annually) or via the Monthly Pre-Authorized Check Payment Policy as described previously.
† † As previously noted, member an spouse benefits under this Policy are available in $50,000 units.
^*Male rates apply to all coverage issued to Montana residents, regardless of a person's sex.
The current annual premium for all eligible children in $3.80 for $2,500 ($500 for children ages 14 days through five months) of life insurance.
Premiums are guaranteed to remain level for the first ten years of coverage. Then, if still eligible, you may reapply for the 10-year level term rates then in effect for a subsequent 10-year term. Rates for a subsequent term will be based on the insured 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 of guaranteed rates, or you do not apply for a subsequent term,coverage will continue in force on a non-guaranteed rate basis, under which premium contributions increase as you age.

YOUR COST

Only non-smokers meeting the highest underwriting standards will qualify for the "Prefered" rates shown. Other non-smokers may qualify for the higher "Select" or "Standard" rates. (Note: Smokers may only qualify for Standard Rates.) Upon approval of your application, you will be notified of the rate classification for each approved person.

Current 2024 Annual Rates per $1,000 of Insurance † Amounts $250,000^*-$499,000 † †
	Male			Female^*
Issue Age	PREFERRED	SELECT	STANDARD	PREFERRED	SELECT	STANDARD
20-23	0.55	0.66	1.98	0.48	0.58	1.67
24-25	0.55	0.66	2.00	0.48	0.58	1.67
26-27	0.55	0.66	2.02	0.48	0.58	1.67
28	0.55	0.66	2.03	0.48	0.58	1.68
29	0.55	0.66	2.04	0.48	0.58	1.68
30-34	0.55	0.66	2.06	0.48	0.58	1.69
35	0.55	0.66	2.14	0.48	0.58	1.74
36	0.56	0.70	2.23	0.49	0.61	1.84
37	0.58	0.72	2.38	0.52	0.64	1.98
38	0.61	0.77	2.56	0.56	0.68	2.17
39	0.64	0.83	2.78	0.61	0.73	2.38
40	0.68	0.89	3.04	0.65	0.79	2.57
41	0.73	0.96	3.34	0.71	0.86	2.78
42	0.83	1.04	3.68	0.77	0.94	3.00
43	0.91	1.13	4.08	0.84	1.03	3.25
44	1.00	1.25	4.51	0.91	1.12	3.52
45	1.10	1.36	4.97	0.98	1.20	3.79
46	1.20	1.49	5.47	1.06	1.28	4.08
47	1.31	1.66	6.04	1.12	1.38	4.39
48	1.40	1.81	6.61	1.19	1.48	4.73
49	1.54	1.98	7.22	1.26	1.56	5.08
50	1.68	2.18	7.84	1.34	1.68	5.42
51	1.86	2.41	8.44	1.45	1.80	5.78
52	2.06	2.64	9.01	1.58	1.93	6.17
53	2.28	2.88	9.62	1.70	2.06	6.56
54	2.52	3.16	10.32	1.86	2.22	6.95
55	2.78	3.47	11.09	2.00	2.38	7.37
56	3.05	3.79	11.96	2.14	2.56	7.74
57	3.32	4.09	12.90	2.26	2.74	8.09
58	3.64	4.49	13.97	2.41	2.96	8.46
59	4.01	4.92	15.20	2.58	3.19	8.94
60	4.43	5.44	16.66	2.80	3.43	9.58
61	4.92	6.05	18.23	3.08	3.82	10.39
62	5.48	6.77	19.94	3.42	4.19	11.36
63	6.11	7.55	21.96	3.82	4.63	12.47
64	6.82	8.45	24.48	4.22	5.09	13.72

YOUR COST

Current 2024 Annual Rates per $1,000 of Insurance † Amounts $500,000^*-$1,000,000 † †
	Male			Female^*
Issue Age	PREFERRED	SELECT	STANDARD	PREFERRED	SELECT	STANDARD
20-23	0.49	0.61	1.91	0.42	0.53	1.60
24-25	0.49	0.61	1.92	0.42	0.53	1.60
26-27	0.49	0.61	1.93	0.42	0.53	1.60
28	0.49	0.61	1.96	0.42	0.53	1.61
29	0.49	0.61	1.97	0.42	0.53	1.61
30-34	0.49	0.61	1.98	0.42	0.53	1.62
35	0.49	0.61	2.05	0.42	0.53	1.67
36	0.50	0.64	2.15	0.43	0.55	1.76
37	0.53	0.66	2.29	0.47	0.58	1.91
38	0.55	0.71	2.46	0.50	0.62	2.09
39	0.58	0.77	2.69	0.55	0.68	2.29
40	0.62	0.83	2.94	0.59	0.73	2.48
41	0.68	0.89	3.24	0.65	0.80	2.69
42	0.77	0.98	3.58	0.71	0.88	2.90
43	0.85	1.07	3.96	0.78	0.96	3.14
44	0.94	1.18	4.39	0.85	1.06	3.41
45	1.03	1.30	4.84	0.92	1.14	3.68
46	1.14	1.42	5.34	1.00	1.22	3.96
47	1.24	1.58	5.89	1.06	1.31	4.27
48	1.33	1.74	6.47	1.12	1.40	4.61
49	1.46	1.91	7.07	1.19	1.49	4.94
50	1.61	2.11	7.67	1.28	1.61	5.29
51	1.78	2.32	8.24	1.38	1.72	5.65
52	1.98	2.54	8.82	1.51	1.85	6.02
53	2.20	2.80	9.42	1.63	1.98	6.41
54	2.44	3.06	10.09	1.78	2.14	6.79
55	2.69	3.36	10.86	1.92	2.29	7.20
56	2.95	3.68	11.71	2.05	2.46	7.56
57	3.22	3.97	12.65	2.18	2.65	7.91
58	3.54	4.37	13.69	2.32	2.87	8.28
59	3.89	4.79	14.90	2.50	3.10	8.75
60	4.31	5.30	16.33	2.71	3.34	9.37
61	4.79	5.90	17.89	2.99	3.71	10.18
62	5.35	6.60	19.57	3.32	4.08	11.14
63	5.96	7.38	21.55	3.71	4.51	12.22
64	6.66	8.26	24.02	4.10	4.97	13.44

How New York Life Obtains Information and Underwrites Your Request For The

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 the 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 non-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 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 application 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 change 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 Credit Reporting Act procedures. If you question the accuracy to the information provided by the MIB, you may contact MIB and telephone 866-692-6901 (TTY 866 346-3642)

Information for consumers about MIB may be obtained on its Web site at http://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 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 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

8/12 ed.

About New York Life Insurance Company

Certificate Of Insurance

This information is only a brief description of the principal provisions and features of this coverage. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the Trustee of the Ophthalmologists Insurance Trust.

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

30-DAY FREE LOOK

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!

The Trustee of the Ophthalmologists Insurance Trust incurs costs in connection with this sponsored program. To provide and maintain this valuable membership benefit, it is reimbursed for these costs. The American Academy of Ophthalmology also receives a fee for the license of its name and logo for use in connection with this policy. This Group 10-Year Level Term Insurance is underwritten by New York Life Insurance Company, 51 Madison Ave., New York, NY 10010 under Group Policy G-29206 on Policy Form GRM-FACE/G-29206.

ID# 96271

Contact Us

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

Program Administrator

Address AAO Group Insurance Program PO Box 14533 Des Moines, IA 50306
Phone: 1-888-424-2308
Hours 7:30 am and 5:00 pm CT
Email [email protected]

Insurance Company

Address New York Life Insurance Company 51 Madison Avenue New York , NY 10010 SMRU #1785199

Group Level Term Life Insurance

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