Overview

Request up to $1,000,000 Life Insurance Benefits

Lock in the same rate for 10 years.

Apply for high-value life coverage as an ACA Member, under age 65. Lock in the same rates for 10 full years and level amounts of insurance for the life of your coverage with the ACA Group 10-Year Level Term Life Insurance.

J. Christopher Burke CA Insurance License #0F709407. J. Christopher Burke AR Insurance License #8876308.

Underwritten by New York Life Insurance Company, 51 Madison Avenue, NY, NY 10010 under Policy Number G29183-0/FACE, Policy Form GMR. All details of this coverage will be available in the Certificate of Insurance including benefits, costs, eligibility, renewability, limitations, and exclusions.

Benefits

Eligibility

To qualify for coverage, you must be an active member of the ACA under age 65, a U.S. resident (not available in FL, NC, TX, VT, WA, and territories) and performing the normal activities of a person in good health of like age. Your lawful spouse (under age 65), may also apply. Dependent children between 15 days and 25 years (unmarried) may obtain coverage.

 

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. If both parents are insured as member, only one may request child coverage.

 

Level Premiums for 10 Years!

Premiums are guaranteed for an initial 10-Year period, with level amounts of insurance until termination at age 75. At the end of the 10-Year period, coverage will automatically be renewed without evidence of insurability. Renewal premiums are not guaranteed and will be based on your then attained age and will increase as you age. Or, if you are under age 65 you may apply for a subsequent 10-Year period of a guaranteed level rate, subject to full medical underwriting. Rates will be based on your then attained age.

 

An Accelerated Death Benefit Provision is included in your coverage 

Terminally ill insureds can collect Accelerated Death Benefits - up to 50% of your life insurance benefits if you are diagnosed with less than 12 months to live.

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 do not reduce.

To qualify, you must provide the insurance company with proof of terminal illness and anticipated life expectancy (12 months or less), as well as any other necessary medical information requested. Refer to the Certificate of Insurance for details.

Please note the 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.

 

You're Under No Obligation

If you decide your ACA 10-Year Level Group Term Life Insurance coverage isn't for you, return your Certificate within the first 30 days, without claim. We'll promptly refund your premium… no questions. No obligation.

 

 

J. Christopher Burke CA Insurance License #0F709407. J. Christopher Burke AR Insurance License #8876308.

Underwritten by New York Life Insurance Company, 51 Madison Avenue, NY, NY 10010 under Policy Number G29051-2/FACE, Policy Form GMR. All details of this coverage will be available in the Certificate of Insurance including benefits, costs, eligibility, renewability, limitations, and exclusions.

Rates

Take Advantage of ACA Group Rates!

As an ACA member, you may apply for these group rates for the 10-Year Level Group Term Life Insurance. You cannot be singled out for a rate increase. Rates can only change on a class wide basis. A class is a group of people with the same age and gender.

 

ACA GROUP 10-YEAR LEVEL TERM LIFE CURRENT 2023 QUARTERLY RATES* PER $10,000 BENEFIT

INSURED AMOUNTS $100,000-$249,000

Issue Age	MALE Preferred	MALE Select	MALE Standard	FEMALE Preferred	FEMALE Select	FEMALE Standard
20-23	2.03	2.33	5.98	1.80	2.10	5.08
24-25	2.03	2.33	6.00	1.80	2.10	5.08
26-27	2.03	2.33	6.05	1.80	2.10	5.08
28	2.03	2.33	6.08	1.80	2.10	5.10
2 9	2.03	2.33	6.13	1.80	2.10	5.10
30-34	2.03	2.33	6.15	1.80	2.10	5.18
35	2.03	2.33	6.35	1.80	2.10	5.28
36	2.05	2.40	6.65	1.85	2.15	5.55
37	2.13	2.50	7.05	1.95	2.28	5.98
38	2.28	2.63	7.53	2.05	2.38	6.48
3 9	2.38	2.80	8.18	2.15	2.55	7.05
40	2.50	2.93	8.85	2.30	2.68	7.58
41	2.65	3.15	9.68	2.45	2.90	8.18
42	2.83	3.38	10.68	2.63	3.10	8.78
43	3.03	3.63	11.75	2.83	3.35	9.48
44	3.25	3.95	12.98	3.03	3.60	10.18
45	3.55	4.25	14.20	3.20	3.85	10.95
46	3.88	4.65	15.63	3.43	4.05	11.75
47	4.23	5.08	17.18	3.60	4.30	12.63
48	4.58	5.53	18.78	3.78	4.58	13.58
49	5.03	6.00	20.50	4.03	4.83	14.53
50	5.48	6.58	22.18	4.25	5.18	15.50
51	5.98	7.18	23.85	4.58	5.48	16.50
52	6.43	7.80	25.43	4.93	5.83	17.55
53	6.95	8.50	27.13	5.28	6.18	18.65
54	7.58	9.28	29.00	5.65	6.60	19.73
55	8.23	10.10	31.20	6.08	7.10	20.88
56	8.95	10.98	33.63	6.43	7.58	21.90
57	9.68	11.93	36.23	6.83	8.08	22.88
58	10.60	12.98	39.15	7.18	8.70	23.90
59	11.60	14.18	42.58	7.65	9.33	25.23
60	12.78	15.63	46.60	8.25	10.15	27.00
61	14.10	17.28	50.98	9.03	11.08	29.25
62	15.53	19.18	55.75	9.90	12.10	31.95
63	17.25	21.35	61.35	10.95	13.33	35.03
64	19.20	23.80	68.18	12.10	14.63	38.50

 

INSURED AMOUNTS $250,000-$499,000

Issue Age	MALE Preferred	MALE Select	MALE Standard	FEMALE Preferred	FEMALE Select	FEMALE Standard
20-23	1.38	1.68	5.20	1.18	1.43	4.35
24-25	1.38	1.68	5.25	1.18	1.43	4.35
26-27	1.38	1.68	5.28	1.18	1.43	4.35
28	1.38	1.68	5.33	1.18	1.43	4.40
2 9	1.38	1.68	5.38	1.18	1.43	4.40
30-34	1.38	1.68	5.40	1.18	1.43	4.43
35	1.38	1.68	5.60	1.18	1.43	4.55
36	1.40	1.75	5.88	1.23	1.50	4.83
37	1.45	1.83	6.25	1.30	1.58	5.20
38	1.53	1.95	6.73	1.40	1.68	5.70
3 9	1.60	2.10	7.35	1.53	1.83	6.25
40	1.73	2.28	8.00	1.65	1.98	6.75
41	1.88	2.45	8.80	1.80	2.18	7.35
42	2.10	2.70	9.75	1.95	2.35	7.93
43	2.35	2.93	10.80	2.15	2.58	8.58
44	2.58	3.23	11.95	2.35	2.80	9.28
45	2.85	3.55	13.15	2.53	3.03	10.03
46	3.13	3.90	14.50	2.73	3.25	10.80
47	3.38	4.33	16.03	2.88	3.48	11.65
48	3.65	4.75	17.58	3.08	3.75	12.53
49	4.00	5.20	19.20	3.28	3.98	13.45
50	4.40	5.75	20.83	3.50	4.28	14.40
51	4.85	6.33	22.43	3.78	4.58	15.35
52	5.40	6.95	23.98	4.13	4.90	16.38
53	5.98	7.60	25.60	4.48	5.25	17.43
54	6.65	8.35	27.43	4.85	5.65	18.45
55	7.35	9.15	29.50	5.25	6.08	19.58
56	8.03	10.03	31.83	5.60	6.53	20.55
57	8.78	10.83	34.35	5.95	7.00	21.48
58	9.63	11.88	37.18	6.33	7.58	22.50
59	10.60	13.03	40.48	6.80	8.18	23.78
60	11.73	14.43	44.35	7.38	8.93	25.48
61	13.03	16.05	48.58	8.15	9.78	27.65
62	14.55	17.95	53.15	9.05	10.75	30.25
63	16.23	20.05	58.53	10.10	11.88	33.18
64	18.10	22.45	65.23	11.18	13.08	36.53

 

INSURED AMOUNTS $500,000-$1,000,000

Issue Age	MALE Preferred	MALE Select	MALE Standard	FEMALE Preferred	FEMALE Select	FEMALE Standard
20-23	1.23	1.55	5.00	1.03	1.30	4.15
24-25	1.23	1.55	5.03	1.03	1.30	4.15
26-27	1.23	1.55	5.05	1.03	1.30	4.15
28	1.23	1.55	5.13	1.03	1.30	4.20
2 9	1.23	1.55	5.18	1.03	1.30	4.20
30-34	1.23	1.55	5.18	1.03	1.30	4.23
35	1.23	1.55	5.38	1.03	1.30	4.35
36	1.25	1.60	5.65	1.08	1.35	4.63
37	1.33	1.68	6.03	1.18	1.43	5.00
38	1.38	1.80	6.48	1.25	1.53	5.48
3 9	1.45	1.95	7.10	1.38	1.70	6.03
40	1.58	2.13	7.75	1.50	1.83	6.53
41	1.75	2.28	8.55	1.65	2.03	7.10
42	1.95	2.55	9.48	1.80	2.20	7.68
43	2.20	2.78	10.48	2.00	2.40	8.30
44	2.43	3.05	11.63	2.20	2.65	9.00
45	2.68	3.40	12.80	2.38	2.88	9.75
46	2.98	3.70	14.15	2.58	3.10	10.48
47	3.20	4.13	15.65	2.73	3.30	11.33
48	3.48	4.55	17.20	2.90	3.58	12.20
49	3.83	5.00	18.78	3.10	3.80	13.10
50	4.20	5.55	20.38	3.35	4.10	14.05
51	4.63	6.08	21.93	3.60	4.35	15.00
52	5.18	6.70	23.48	3.95	4.68	16.00
53	5.75	7.38	25.05	4.28	5.03	17.00
54	6.43	8.10	26.83	4.63	5.43	18.03
55	7.10	8.88	28.90	5.03	5.85	19.13
56	7.78	9.75	31.15	5.38	6.28	20.08
57	8.50	10.50	33.68	5.75	6.78	21.00
58	9.38	11.55	36.45	6.08	7.33	22.03
59	10.28	12.68	39.68	6.58	7.93	23.28
60	11.40	14.08	43.48	7.15	8.55	24.93
61	12.68	15.68	47.68	7.90	9.50	27.08
62	14.20	17.50	52.15	8.80	10.48	29.65
63	15.85	19.60	57.45	9.83	11.58	32.50
64	17.68	21.95	64.00	10.85	12.78	35.80

 

* Male rates apply to all coverage issued to Montana residents regardless of sex.

All premiums are based on applicants attained age at the date of issue and on each premium due date. To cut overhead costs and keep rates member-exclusive, premiums are collected at quarterly intervals.

Volume Discounts

A volume discount for coverage amounts of $250,000 through $499,000 and even greater discount for amounts of $500,000 through $1,000,000. In addition, non-tobacco/nicotine users meeting the highest underwriting standards may qualify "Preferred" (the best) rates that follow. Other non-tobacco/nicotine users may qualify for the "Select" (higher) or "Standard" (the highest) rates. Tobacco/nicotine users may qualify for only the "Standard" (highest) rates.

New York Life's Right To Change Benefits, Rates or Terminate the coverage

Changes to the Group Policy are subject to agreement by New York Life and the Policyholder. The Policyholder or New York Life may terminate the coverage on any premium due date by giving 60 days advance notice. Rates after the first 10 years may be changed by New York Life on any premium due date and on any date on which benefits are changed.

J. Christopher Burke CA Insurance License #0F709407. J. Christopher Burke AR Insurance License #8876308.

Underwritten by New York Life Insurance Company, 51 Madison Avenue, NY, NY 10010 under Policy Number G29183-0/FACE, Policy Form GMR. All details of this coverage will be available in the Certificate of Insurance including benefits, costs, eligibility, renewability, limitations, and exclusions.

 

Terms

Exclusions and Limitations

Benefits are paid for death from any cause, at anytime, anywhere in the world (subject to the U.S. government regulations on restricted countries) except suicide which is not covered within 24 months of issue date of your coverage. 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 nonpayment of premiums.

Effective Date of Coverage

Residents of MD and NC: Any reference to "performing normal activities of a person in good health of like age" is replaced by the requirement that the heath status of any proposed insured person remains the same as stated in your application. Insurance will take effect on the first day of the month on or following the date your application is approved, provided the initial contribution is paid within 31 days after you are billed and any person to be insured is performing normal activities of a person in good health of like age on the day of approval. If any dependent proposed for coverage is not performing his/her normal activities as required, coverage will not take effect until he/she is performing such activities provided such date is within three months after 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 80 (25 for children) or earlier if: (a) the premiums are not paid when due, (b) ACA membership ends, (c) the group coverage is terminated or modified by the Policyholder to end insurance for the group of insureds to which the member belongs, and (d) if the insured requests to terminate insurance. In addition, dependent coverage will terminate when the dependent spouse or child ceases to be an eligible dependent.

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 can name any beneficiary you wish for member coverage. You may change this beneficiary at any time, by written request. You are the automatic beneficiary for dependent insurance, as described in the Certificate of Insurance. If you wish to name another beneficiary for dependent spouse or child insurance, contact the Administrator at 1-800-626-9226 for the applicable form.

Certificate of Insurance

This information is only a brief description of the principle provisions and features of the ACA 10-Year Level Group Term Life. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company Trustee of the American Chiropractic Association Insurance Trust.

IMPORTANT NOTICE:

How New York Life Obtains Information and Underwrites Your Request For 10-Year Level 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, 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). For Canadian residents, the address is: MIB Information Office, 330 University Avenue, Suite 501, Toronto, Ontario, Canada M5G 1R7, telephone 416-597-0590. Information for consumers about MIB may be obtained on its website at www.mib.com.

For NM Residents: Protected persons ¹ have a right of access to certain Confidential abuse information ² 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. ¹ Protected 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. 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 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 7.15 ed.

Sponsored by:

ACA incurs certain administrative expenses in connection with this sponsored program. To provide and maintain this valuable membership benefit it is reimbursed for such expenses.

Administered by:
A.G.I.A., Inc.
PO Box 9159
Phoenix, AZ. 85068-9918

A.G.I.A., Inc. is licensed/authorized to transact business in all 50 United States, and the District of Columbia. Their state of domicile is California. J. Christopher Burke CA Insurance License #0F709407. J. Christopher Burke AR Insurance License #8876308.

The 10-Year Level Group Term Life Insurance is underwritten by:
New York Life Insurance Company
51 Madison Avenue, New York, NY 10010
Under Group Policy G-29183-0, on
Policy Form G-29183-0/FACE

NEW YORK LIFE and the NEW YORK LIKE Box Logo are trademarks of New York Life Insurance Company

New York Life is licensed/authorized to transact business in all 50 united states, District of Columbia, Puerto Rico and Canada. However, not all group coverages it underwrites are available in all jurisdictions. Please check the coverage details for current availability.

New York Life Insurance Company's state of domicile is New York and their NAIC ID # is 55915.

 

AC-21382

Download, print and mail in your Application today!

1. Use the link below to download and print the form.
2. Please complete all fields on the Application.
3. Mail in your form to the ACA Member Benefit Program at PO Box 9159, Phoenix, AZ 85068

 

Questions? Call ACA's Customer Service and Claims Phone number at 1 (800) 626-9226.

Download Printable Application

 

Underwritten by New York Life Insurance Company, 51 Madison Avenue, NY, NY 10010 under Policy Number G29183-0/FACE, Policy Form GMR. All details of this coverage will be available in the Certificate of Insurance including benefits, costs, eligibility, renewability, limitations, and exclusions.