APPLY FOR UP TO $500,000 OF COVERAGE
Choose the amount of Group 10-Year Level Term Life Insurance you need to help protect you and your family for the next ten years – without the worry of premiums that could go up or benefits that could go down.
Amounts Of Insurance:
Member: $100,000 to $500,000 in $10,000 units.
Spouse: $100,000 to $250,000 in $10,000 units.
Child(ren): $5,000 ($500 for ages 14 days to 6 months).
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 AFA may not exceed
the maximum benefit option for any insured person.
Members of AFA under age 65 may request coverage for themselves, their lawful spouse under age 65 and all unmarried dependent children ages 14 days through 18
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.
Coverage may not be available in all states. Contact the administrator for details. This coverage is available only for residents of the United States (except territories).
Pay Less If You’re a Qualified Non-Smoker
Non-smokers meeting the highest underwriting standards may qualify for “Preferred” (the Plan’s best) rates. Other nonsmokers may qualify for “Select” (higher, but still very competitive) or “Standard” (the Plan’s highest) rates. All smokers receive the “Standard” rate.
Save with Volume Discounts on Higher Amounts of Insurance
If you or your spouse becomes insured for coverage amounts of $250,000 through $500,000, you’ll receive a volume 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 Plan to other insurance plans on the market today. Two
modes of payment are available to suit your budget: direct billing (quarterly, semiannually, annually); and our monthly, quarterly, semiannual and annual Electronic
Funds Transfer (EFT) option.
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 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.
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 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.
Note: Residents of NC: Any reference to “performing 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.
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 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 (19 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 plan is terminated or modified by the Policyholder or New York Life to end insurance for the group of insureds to which the member
belongs, and (c) if the insured requests to terminate insurance. Dependent coverage will end when the member's coverage ends (for reason other than attainment of age
75). In addition, dependent coverage will terminate when the eligibility requirements are no longer being met. Upon your death, coverage for your insured dependents
may continue as described in the Certificate of Insurance.
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 Trustee of the Air Force Association Insurance Plan.
When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the Plan.
How New York Life Obtains Information and Underwrites Your Request for Group 10-Year Level 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 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 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 INFORMATION2we 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.
2 CONFIDENTIAL 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.
New York Life Insurance Company
How to Apply
Download and print the Application Form for this plan.
- Send the completed Application and initial payment to:
Mercer Consumer AFA Plan Administrator P.O. Box 14464 Des Moines, IA 50306
This plan is underwritten by New York Life Insurance Company, under Group Policy No. G-30293-0, on Policy Form G-30293-0 GMR-FACE.