Life insurance can be one of the cornerstones of financial planning. In the event of an unexpected or premature death, the ACM 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.
Before you request coverage, you must be a member in good standing of ACM. Please wait until your application for membership is accepted before initiating your insurance requests. If you have any questions regarding membership, please call ACM directly.
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.
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, New York Life Insurance Company 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 Policy.
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 policy. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the Association for Computing Machinery. When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the policy.
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!
All ACM members and their spouses or domestic partners who reside in the U.S* or Puerto Rico and are under age 65 are eligible to apply for up to $500,000 of Term Life Insurance coverage. Your children ages 6 months to 23 years (25 if a full-time student) are each eligible for $5,000 of life insurance. Children 15 days to 6 months may be insured for $1,000 each.
*Coverage is not available in all states at this time. Contact the plan administrator for availability in your state. Coverage is not available to residents of Canada.
APPLY FOR UP TO $500,000 OF COVERAGE
Choose the amount of Group Term Life Insurance you need to help protect you and your family.
Amounts Of Life Insurance:
Members: Up to $500,000 in $10,000 multiples.
Spouse: Up to $500,000 in $10,000 multiples; may not exceed member coverage.
Child(ren): $5,000, $1,000 for ages 15 days to 6 months.
You are automatically the beneficiary of your dependents’ coverage. (The amount of dependents’ coverage is subject to mandated limitations in certain states.)
The total amount of coverage an individual may have under this group life insurance underwritten by New York Life Insurance Company may not exceed $1,000,000. In addition, the total amount of coverage an individual may have under all policies issued by New York Life Insurance Company may not exceed $2,000,000
Valuable Living Benefit Provision
“Accelerated Death Benefit”.
The Living Benefit or "accelerated death benefit" is designed to provide members with the option to have a portion of a terminally ill insured's life insurance benefit paid while he/she is still alive.
The money received under this feature can be used however you see fit. For example, it can help pay medical bills and other outstanding debts and financial obligations. It can help you keep your savings and assets intact. It can help you maintain your quality of living.
To qualify for this benefit, a person must be insured under this Policy and diagnosed as having a life expectancy of 12 months or less. Proof of terminal illness will consist of a statement from a doctor and any other medical information New York Life Insurance Company believes necessary to confirm the person's status.
You can request payment equal to 60% (to a Maximum of $250,000) of a qualified terminally ill person's in force coverage. The request must be made at least 12 months prior to that person's scheduled coverage termination age, and the amount payable after the insured's death will be reduced by this payment. (Premium contributions will not be reduced.)
If a scheduled reduction will occur within 6 months of the date the advance payment is approved, the benefit payable will be 60% of the reduced coverage. Note: An insured will be eligible for only one terminal illness benefit during his/her lifetime.
Please note that the receipt of this benefit may affect your eligibility for public assistance programs and may be taxable. You may wish to consult the appropriate social services agency and a qualified tax advisor about how this may affect your personal situation.
OTHER IMPORTANT INFORMATION
Exclusions
Your ACM Group Term Life Insurance provides benefits for death from any cause (except suicide during the two years your coverage is in force) … at any time … in any place throughout the world. If a person commits suicide, whether sane or insane, within 2 years from the date insurance takes effect, the Insurance Company’s liability will be limited to the premiums paid. The validity of any amount of 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.
Conversion Privilege
The Policy 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.
Effective Date
You and your dependents will become insured on the date specified by New York Life Insurance Company provided the initial premium contribution is paid when due, 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 (NC residents: a person of like age) on the date coverage is to become effective. (This doesn't apply to dependent children.) Coverage for any person who is unable to perform his or her normal activities on the date coverage would otherwise become effective will not become effective until the date he or she is no longer confined or incapacitated, provided he/she 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 will continue automatically until the premium due date coinciding with or next following your 80th birthday, as long as you pay your premium when due, remain an ACM member, the Group Policy remains in force and insurance is not modified to end for your class. Dependent’s insurance will continue until your insurance ends under the group policy, the group policy is changed to end dependents’ life insurance, the person ceases to be a dependent or premium is not paid for the dependent when due. If you die, your spouse and dependent children who were insured under the group policy immediately prior to your death may continue to be insured, subject to the terms and conditions of the group policy.
Renewal Payments And Claims
Once you are 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 the Group 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 amounts chosen. All eligible children can be insured under the $5,000 option for $10.00 semiannually.
CURRENT 2023 ACM GROUP TERM LIFE INSURANCE MONTHLY RATES
| Under $250,000 Coverage | ||||||
| Member’s Age | Male Non-Smoker | Female Non-Smoker | Male-Smoker | Female-Smoker | ||
| Under 30 | $0.66 | $0.52 | $0.75 | $0.60 | ||
| 30-34 | 0.76 | 0.57 | 0.88 | 0.66 | ||
| 35-39 | 1.04 | 0.73 | 1.20 | 0.84 | ||
| 40-44 | 1.63 | 1.08 | 1.88 | 1.25 | ||
| 45-49 | 2.64 | 1.66 | 3.04 | 1.92 | ||
| 50-54 | 4.10 | 2.58 | 4.73 | 2.98 | ||
| 55-59 | 6.34 | 3.99 | 7.32 | 4.60 | ||
| 60-79* | 6.83 | 4.76 | 7.88 | 5.50 | ||
| $250,000 Coverage or More | ||||||
| Member’s Age | Male Non-Smoker | Female Non-Smoker | Male-Smoker | Female-Smoker | ||
| Under 30 | $0.59 | $0.46 | $0.68 | $0.57 | ||
| 30-34 | 0.69 | 0.51 | 0.79 | 0.62 | ||
| 35-39 | 0.94 | 0.66 | 1.08 | 0.79 | ||
| 40-44 | 1.47 | 0.97 | 1.69 | 1.15 | ||
| 45-49 | 2.37 | 1.50 | 2.74 | 1.75 | ||
| 50-54 | 3.69 | 2.32 | 4.26 | 2.71 | ||
| 55-59 | 5.71 | 3.59 | 6.58 | 4.17 | ||
| 60-79* | 6.15 | 4.29 | 7.09 | 4.98 | ||
For rates for additional amounts not shown, please contact the Plan Administrator.
If applicable, an additional $2 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option.
Renewal only. Only those under age 65 may apply. All premiums are based on member's attained age at the date of issue and on renewal dates. Premiums will increase as the member enters a new age bracket. Coverage reduces by 50% at ages 65, 70 and 75. Coverage terminates at age 80.
Child(ren): Just add $10.00 to your total premium to insure all your children. Each child 15 days to 6 months is eligible for $1,000 in life insurance. Children 6 months to age 23 (25 if a full-time student) may be insured for $5,000 each. Children's coverage does not include an accelerated benefits provision.
The premium contributions shown reflect the current rates and benefit structure. Premium contributions may be changes by New York Life Insurance Company on any premium due date, but not more than once in any 12-month period, 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 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.
Important Notice
How New York Life Obtains Information and Underwrites Your Request for 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 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 1-866-692-6901 (TTY 1-866-346-3642). 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 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. |
We're here to help! Please contact us in whatever manner is most convenient for you.
Administered by:
| Address Association Member Benefits Advisors P.O. Box 10374 Des Moines, IA 50306 |
|---|
| Phone 1-800-482-2852 |
| Email [email protected] |
Underwritten by:
| Address New York Life Insurance Company 51 Madison Avenue New York, NY 10010 |
|---|
Answers about the program, including eligibility, options, customer service and more.
By whom is this coverage underwritten?
Underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010 under Group Policy No. G-30722-0 on Policy Form GMR-FACE/G-30722-0.
New York Life is licensed/authorized to transact business in all of the 50 United States, the District of Columbia and Puerto Rico. However, not all group policies it underwrites are available in all jurisdictions. Please check the applicable insurance brochures for current availability.
New York Life’s state of domicile is New York, and NAIC ID # is 66915.
How much insurance should I consider?
Who is eligible for this insurance?
All ACM members and their spouses or domestic partners who reside in the U.S* or Puerto Rico and are under age 65 are eligible to apply for up to $500,000 of Term Life Insurance coverage. Your children ages 6 months to 23 years (25 if a full-time student) are each eligible for $5,000 of life insurance. Children 15 days to 6 months may be insured for $1,000 each.
*Coverage is not available in all states at this time. Contact the plan administrator for availability in your state. Coverage is not available to residents of Canada.
How much insurance can I request?
Members —Up to $500,000 in $10,000 multiples.
Spouse — Up to $500,000 in $10,000 multiples; may not exceed member coverage.
Child(ren) — $5,000 ($1,000 for ages 15 days to 6 months)
Note: The total amount of coverage for an individual insured under this Policy issued by New York Life Insurance Company to the Group Insurance Trust may not exceed $1,000,000. You are automatically the beneficiary of your dependents’ coverage. (The amount of dependents’ coverage is subject to mandated limitations in certain states.)
The total amount of coverage for an individual may have under all group life insurance policies underwritten by New York Life Insurance Company may not exceed $2,000,000.
When is the coverage effective?
When does coverage end?
Are there any exclusions?
How does the Accelerated Death Benefit work?
The Living Benefit or "accelerated death benefit" is designed to provide members with the option to have a portion of a terminally ill insured's life insurance benefit paid while he/she is still alive. The money received under this feature can be used however you see fit. For example, it can help pay medical bills and other outstanding debts and financial obligations.it can help you keep your savings and assets intact.it can help you maintain your quality of living.
To qualify for this benefit, a person must be insured under this policy and diagnosed as having a life expectancy of 12 months or less. Proof of terminal illness will consist of a statement from a doctor and any other medical information New York Life Insurance Company believes necessary to confirm the person's status.
You can request payment equal to 60% (to a Maximum of $250,000) of a qualified terminally ill person's in force coverage. The request must be made at least 12 months prior to that person's scheduled coverage termination age, and the amount payable after the insured's death will be reduced by this payment. (Premium contributions will not be reduced.)
What if I have second thoughts after I apply?