This insurance is available exclusively to ACM members* under age 60 who are at FULL-TIME WORK, provided their ANNUAL NET EARNED INCOME is at least $20,000 for the proceeding 12 month period. In order to become insured, satisfactory evidence of insurability must be provided and the required premium must be paid.
 

"FULL-TIME WORK" means the active performance of the regular duties of your normal occupation on the basis of at least 30 hours per week at the place such duties are normally performed.
 

This coverage is only available for residents of AZ, GA, HI, IN, IA, MA, MI, NE, NJ, OK, PA, RI, TN and the District of Columbia.
 

*Participation in the ACM Group Insurance Program requires active ACM membership status.

This Policy pays you monthly benefits (after your waiting period is over) for disabilities caused by a covered injury or sickness, as long as you remain totally disabled, up to age 65, if total disability begins prior to age 63. Benefits are payable for 2 years, but not beyond age 70 if total disability begins on or after age 63 but prior to age 70. Benefits for disabilities resulting from mental disorder are reduced as noted in "Exclusions".

If the monthly benefit plus income benefits you receive from other sources (as described in the Certificate of Insurance) exceeds 70% of your basic monthly pay, then the monthly benefits to be paid will be reduced by the amount by which the total income benefit exceeds 70%.

Monthly benefits will end on the date you fail to give required proof of continuing total disability; your total disability ends; the maximum benefit period ends; or you die.

Choose Your Monthly Benefit

Only you know the amount of monthly insurance protection you would need should you become totally disabled...and the amount of protection you can afford to purchase. With this coverage, you can select from $100 to $3,000 (not to exceed 70% of your basic monthly pay) in monthly benefit increments of $100. Choose a monthly benefit package that fits your needs as well as your budget.

Definition of Basic Monthly Pay: Basic Monthly Pay is the montly average of your ANNUAL NET EARNED INCOME, using the immediately preceding period that produces the highest figure: preceding tax year; preceding two tax years; or the entire period, if less than 12 months.

Your Choice of Waiting Periods

You also have a choice of three waiting periods before benefit payments begin: 30, 90 or 180 days. A waiting period is the number of consecutive days you must be disabled before benefit payments begin. Coverage with a longer waiting period is less expensive.

Waiver of Premium

After you have been Totally Disabled and have been receiving benefit payments for six consecutive months, all future premium contributions will be waived for as long as you receive benefits for that disability. Payment of premiums resumes when you stop receiving monthly benefits.
 

Benefits for Recurring Disability

Successive periods of disability that are due to the same or related causes will be considered a single period of disability unless separated by a return to FULL-TIME WORK for three consecutive months or more.

Click here to review YOUR COST

EXCLUSIONS AND LIMITATIONS

No benefits will be paid for any disability due to: intentionally self-inflicted injury, whether sane or insane; normal pregnancy, normal childbirth or voluntary abortion (complications of pregnancy are covered); war or an act of war; incarceration for or participation in (except as a victim) an illegal occupation/activity or the commission of a crime; military service; or pre-existing condition, except as noted below.

Moreover, no benefits are payable for any disability for which you are not under the regular care of a licensed physician other than yourself or a member of your immediate family.

Benefits for Mental, Nervous, or Emotional Disorders are limited to a maximum of 12 monthly benefits that will be paid while such disability continues. This limitation does not apply while you are institutionalized.

Preexisting Condition Limitation

Pre-Existing Condition means an injury or sickness for which the insured person: incurred charges, received medical treatment, consulted a physician, or took prescribed drugs within 12 months before the effective date of insurance. If total disability is due to a pre-existing condition, and the disability begins within 24 months of the effective date of insurance, no benefits will be paid unless the insured person has not: incurred charges, received medical treatment, consulted a physician, or taken prescribed drugs, for such condition, or any complication of it, for 12 continuous months, while insured.

Effective Date

You will become insured on the date specified by New York Life Insurance Company provided the first premium contribution has been paid, satisfactory evidence of insurability has been submitted, and you are actively performing the normal activities of a person in good health of like age [NC: a person of like age] on that date. If you are not performing your normal activities as required, coverage will not become effective until the day you are performing such normal activities provided such date is within three months of the date insurance would have been effective and you are 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.
 

Note: There are instances where New York Life Insurance Company may be able to offer insurance, at the same cost, by eliminating coverage for a specific impairment or disease.
 

When Coverage Ends

Your insurance will end at the earliest of: the date the group policy ends or is amended to end coverage for your class; the end of the policy period for which the last premium was paid by the insured; the date you cease at FULL-TIME WORK, as defined, for reasons other than total disability; the date you begin full-time active military duty; the premium due date coinciding with or next following the date you attain age 70.

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 the policy. The complete terms and conditions are set forth in the group policy issued by New York Life to the Qualified Association and Organization 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 receive a full refund—no questions asked

How New York Life Obtains Information and Underwrites Your Request For ACM Group Disability Income 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 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, 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, 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 website 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 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 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.
 

The Association for Computing Machinery incurs cost in connection with this coverage. To provide and maintain this valuable membership benefit, it is reimbursed for these costs.