Your Family's Passport to Financial Security
Life insurance is one of the cornerstones of financial planning. In the event of an unexpected or premature death, the Academy Group Term Life Insurance can help provide the financial security your family needs. This life insurance helps make sure they'll be able to meet current expenses & such as mortgage and car payments & as well as future expenses such as college tuition.
A very high percentage of American adults have life insurance. But just as important as having insurance is having coverage that's sufficient for your needs.
Valuable Benefits
WHO IS ELIGIBLE?
American Academy of Ophthalmology (ACADEMY) members under age 65 are eligible to apply for coverage for themselves, their lawful spouses under age 60, and unmarried dependent children ages 14 days through 22 years (24 if a full-time student). In order to become insured, satisfactory evidence of insurability must be provided and the required premium contribution must be paid.
A dependent who is a 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 and only one may insure any eligible children.
This coverage is available only for residents of the United States (excluding NC and territories) and Puerto Rico.
WHAT YOU CAN CHOOSE
FOR MEMBER
Options of $50,000 to $1,000,000 (in multiples of $10,000)*
FOR SPOUSE
Options of $50,000 to $1,000,000 (in multiples of $10,000)* May not exceed member’ coverage.
FOR EACH ELIGIBLE DEPENDENT CHILD
$2,500 ($500 at ages 14 days through 5 months)
*Coverage decreases starting at member’s age 65.
See “Amounts of Insurance at Member Ages 65 through 84.”
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.
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.
How Much Coverage Should You Consider?
Many independent insurance planners recommend anywhere from five to nine times your annual salary as an adequate amount of insurance. To estimate a coverage level that’s right for you, consider your present living expenses, your estate and the future plans of your family. Be sure to include educational plans, mortgage amounts, and daily expenses. Remember, the financial needs of your family will continue even after your death.
AMOUNTS OF INSURANCE AT MEMBER AGES 65 THROUGH 84
The amount of life insurance for you and your spouse is based on your age at last birthday and, depending upon the applicable option, may be reduced on the premium due date on or next following the day you attain a specified age, as follows:
All coverage terminates on the premium due date on or after a member turns 85. See the Group Conversion privilege.
Note: Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustees of the Ophthalmologists insurance Trust.
Volume Discounts for Member and Spouse
The more coverage you request, the more you can save! If you are insured for options $100,000 through $240,000, you’ll receive a discount based on volume. If you are insured for options of $250,000 through $1,000,000, you’ll receive another discount based on volume. If a program experience warrants, a premium credit or dividend maybe available. Premium credits cannot be promised or guaranteed.
The initial cost of insurance for you and your lawful spouse is based on your attained age when insurance becomes effective, the amount selected, and on the member's tobacco/nicotine use. The cost increases as you, the member, grow older. Premium contributions will vary depending upon the options chosen. The cost of coverage for all your eligible dependent children under the $2,500 option is $0.95.
| Member's Age | $100,000 Option | $250,000 Option | $500,000 Option | $750,000 Option |
|---|---|---|---|---|
| Under 30 | $11.00 | $25.00 | $50.00 | $75.00 |
| 30-34 | 14.00 | 30.00 | 60.00 | 90.00 |
| 35-39 | 18.00 | 42.50 | 85.00 | 127.50 |
| 40-44 | 30.00 | 70.00 | 140.00 | 210.00 |
| 45-49 | 51.00 | 115.00 | 230.00 | 345.00 |
| 50-54 | 90.00 | 202.50 | 405.00 | 607.50 |
| 55-59 | 151.00 | 340.00 | 680.00 | 1,020.00 |
| 60-64 | 269.00 | 605.00 | 1,210.00 | 1,815.00 |
| Member's Age | $100,000 Option | $250,000 Option | $500,000 Option | $750,000 Option |
|---|---|---|---|---|
| Under 30 | $9.00 | $20.00 | $40.00 | $60.00 |
| 30-34 | 11.00 | 22.50 | 45.00 | 67.50 |
| 35-39 | 15.00 | 35.00 | 70.00 | 105.00 |
| 40-44 | 24.00 | 55.00 | 110.00 | 165.00 |
| 45-49 | 41.00 | 92.50 | 185.00 | 277.50 |
| 50-54 | 72.00 | 162.50 | 325.00 | 487.50 |
| 55-59 | 121.00 | 272.50 | 545.00 | 817.50 |
| 60-64† | † | † | † | † |
†Call the Administrator for renewal rates(at ages 65-84 for member coverage, 60-84 for spouse coverage). See section titled "Amounts of Insurance At Member Ages 65 through 84" for applicable benefit decreases. Coverage terminates at member age 85. See group Conversion Privilege.
Note: If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To avoid this fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option.
The premium contributions shown reflect the current rates 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 option amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustee of the Ophthalmologists Insurance Trust.
The initial cost of insurance for you and your lawful spouse is based on your attained age when insurance becomes effective, the amount selected, and on the member's tobacco/nicotine use. The cost increases as you, the member, grow older. Premium contributions will vary depending upon the options chosen. The cost of coverage for all your eligible dependent children under the $2,500 option is $0.95.
| Member's Age | $100,000 Option | $250,000 Option | $500,000 Option | $750,000 Option |
|---|---|---|---|---|
| Under 30 | $14.00 | $30.00 | $60.00 | $90.00 |
| 30-34 | 18.00 | 40.00 | 80.00 | 120.00 |
| 35-39 | 25.00 | 57.50 | 115.00 | 172.50 |
| 40-44 | 43.00 | 97.50 | 195.00 | 292.50 |
| 45-49 | 76.00 | 170.00 | 340.00 | 510.00 |
| 50-54 | 135.00 | 305.00 | 610.00 | 915.00 |
| 55-59 | 224.00 | 505.00 | 1,010.00 | 1,515.00 |
| 60-64† | 385.00 | 865.00 | 1,730.00 | 2,595.00 |
| Member's Age | $100,000 Option | $250,000 Option | $500,000 Option | $750,000 Option |
|---|---|---|---|---|
| Under 30 | $11.00 | $22.50 | $45.00 | $67.50 |
| 30-34 | 14.00 | 32.50 | 65.00 | 97.50 |
| 35-39 | 20.00 | 45.00 | 90.00 | 135.00 |
| 40-44 | 35.00 | 77.50 | 155.00 | 232.50 |
| 45-49 | 60.00 | 137.50 | 275.00 | 412.50 |
| 50-54 | 108.00 | 245.00 | 490.00 | 735.00 |
| 55-59 | 179.00 | 402.50 | 805.00 | 1,207.50 |
| 60-64† | † | † | † | † |
†Call the Administrator for renewal rates(at ages 65-84 for member coverage, 60-84 for spouse coverage). See section titled "Amounts of Insurance At Member Ages 65 through 84" for applicable benefit decreases. Coverage terminates at member age 85. See group Conversion Privilege.
Note: If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To avoid this fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option.
The premium contributions shown reflect the current rates 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 option amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustee of the Ophthalmologists Insurance Trust.
How To Determine the Cost for Other Options
The rates shown are for qualified non-smokers requesting specified amounts of coverage. If you and/or your spouse do not qualify for non-smokers rates, or if you wish to apply for an amount not shown, please contact the Administrator for the applicable rates. If you wish to pay semi-annually or annually, multiply the rate shown by two or four, respectively.
Compare For Yourself the Value of Our Coverage
Life insurance policies are issued by insurance companies in varying amounts (e.g. $15,000, $25,000, $100,000). An easy way to compare premiums is to calculate the annual cost per $1,000 of coverage. What’s more, premium credits, when available, further reduce the cost of coverage.
Living Benefit Provision "Accelerated Death Benefit"
A Living Benefit or "accelerated death benefit" option is available to help terminally ill insureds and their families during a difficult, and often financially challenging time. Under this provision the member may request one advance payment equal to 50% of his or her (or an insured dependent’s) in force life insurance to be paid while that 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.) If a scheduled reduction in coverage will occur within one year of the date the Accelerated Death Benefit will be paid, the benefit payable will be 50 percent of the reduced coverage amount.
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 the 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.
Premiums Waived If You’re Disabled
If you become totally disabled before age 60 and the disability continues for at least nine months, your life insurance (and any dependent coverage) can be continued at no cost to you, subject to certain conditions. Please see the Certificate of Insurance for additional details.
Exclusions
Benefits for a covered person’s death due to suicide, attempted suicide or intentionally self-inflicted injury during the first 24 months of coverage, whether sane or insane, will be limited to a return of premium contributions. |
You Name Your Beneficiary
Your beneficiary is the person(s) last designated by you in writing, and recorded by or on behalf of New York Life Insurance Company. You are the automatic beneficiary for dependent insurance, as described in the Certificate of Insurance. If you wish to name a different beneficiary for spouse coverage, contact the administrator for the appropriate form.
Conversion Privilege
This policy provides conversion privileges under certain circumstances of involuntary termination as described in the Certificate of Insurance.
ADDITIONAL PROVISIONS
EFFECTIVE DATE
Note: Residents of NC: Any reference to "performing the normal activities of a person in good health" is replaced by the requirement that the health status of any proposed insured person remains the same as stated in your application.
You and your dependents will become insured on the date specified by New York Life Insurance Company provided the initial premium contribution is paid within 31 days after the date you are billed (send no money now), satisfactory evidence of insurability has been submitted, and you and your dependents are performing the normal activities of a person in good health of like age on that date. Coverage for any person who is not performing his or her normal activities on the date coverage would otherwise become effective will not become effective 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 for insurance. (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.)
When Coverage Ends
Your insurance can remain in force until you reach age 85, and for your insured dependents until they reach their termination age -- 85 for spouse, 23 for children, or 25 for children who are full-time students --, provided you continue to pay premium contributions when due, you remain a member of the Academy, and the group policy is not terminated or modified by the Trustees or New York Life Insurance Company to end insurance for the group of insureds to which you belong. Upon your death, coverage for your insured dependents may continue as described in the Certificate of Insurance. Coverage for your dependents will end when your coverage ends, or when the eligibility requirements are no longer being met.
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.
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 Trustees of the Ophthalmologists Insurance Trust.
When you become insured, you will be sent a Certificate of Insurance summarizing your benefits.
Underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010.
Want More Information?
Visit the Forms tab and download a no–obligation application and brochure containing detailed policy information and provisions, including costs, exclusions, limitations, and terms of coverage.
Consider Your Eligibility
Please wait until your application for membership is accepted before initiating your insurance requests.
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.
"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 receive a full refund– –no questions asked!
The Group Term Life Insurance 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 request 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 a professional paramedic to contact you to perform these simple tests at your convenience, free of charge.
To Apply:
Truthfully complete and sign the application. Be sure to indicate whether you are requesting coverage for your dependents.
Mail both your completed application and your check to:
Administrator,
Insurance Program
4050 114th Street
Urbandale, Iowa 50322
If you have questions about your eligibility or the features of this coverage, call a Customer Service Representative toll-free at 1-800-424-2308.
How New York Life Obtains Information and Underwrites Your Request For The Group 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.
This section is only a brief description of the principal provisions and features of the Policy. The complete terms and conditions are set forth in the group policy issued by New York Life to the Trustees of Ophthalmologists Insurance Trust.
The Academy incurs costs in connection with this sponsored program. To provide and maintain this valuable membership benefit, it is reimbursed for these costs. The Academy also receives a fee for the license of its name and logo for use in connection with this Policy.
Underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010, under Group Policy G-29077-0, on Policy Form GMR-FACE/G-29077-0.
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 |
|---|
Answers about the program, including eligibility, options, customer service and more.
How do I apply?
Do I have to meet with an insurance agent?
What if I have second thoughts after I apply?
How much insurance should I consider?
Are there any exclusions?
When is the coverage effective?
Insurance will take effect on the date your application is approved by New York Life Insurance Company provided the initial contribution has been paid within 31 days after the date you are billed 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. [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.]
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 does coverage end?