Overview

Secure up to $250,000 of Benefits — GUARANTEED!

Accidents are the third leading causes of death in our nation, according to the National Safety Council.¹ And as a doctor of Chiropractic Medicine, you see from your patients how emotionally and financially hard it can be to recover from an accident.

Today, you can help protect your family with the valuable ACA Accident Coverage:

¹Injury Facts 2023, National Safety Council

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

 

Benefits

Apply for ACA Group Accident Protection Insurance TODAY.

 

24-hour, Worldwide Coverage — benefits up to $250,000

You're guaranteed benefits as an ACA member under age 65. No physical exam or health questions. You must be a resident of the U.S. or Puerto Rico. You're covered anytime, anywhere!¹ You have protection 24 hours a day ... at home, at work, on vacation ... on top of any other insurance you may already have.

¹Subject to U.S. government regulations or restricted countries.

 

Helps to Protect Your Family, too.

ACA protection is also available when you enroll your lawful spouse under age 65 and your dependent children under age 20 (25 if full-time students) – guaranteed regardless of health.

When you choose family coverage, benefits for all covered family members are based on the amount of coverage you select as follows:

 

Pays you directly!

Because accidental deaths and disabling injuries result in special needs and high medical bills, the ACA Group Coverage provides you with valuable benefits to cover these expenses. You or your family member will collect the following benefits based on your loss:

 

LOSS OF:	% OF PRINCIPAL SUM:
Life	100%
Two hands or two feet*	100%
Sight of both eyes*	100%
One hand and one foot*	100%
One hand and one eye or one foot and one eye*	100%
Speech and hearing*	100%
One hand or one arm*	100%
Quadriplegia (total paralysis of upper and lower limbs)	100%
One leg or one foot or sight of one eye or speech or hearing	50%
Paraplegia‡ or Hemiplegia§	50%
Thumb and index finger of same hand*	50%

 

*Benefits for these loses will be payable only when such double loss occurs as a results of a single accident.
‡"Paraplegia" means total paralysis of both lower limbs.
§"Hemiplegia" means total paralysis of upper and lower limbs on one side of the body.

Loss of hand or hands, or foot or feet, means severance at or above the wrist joint or ankle joint respectively. Loss of one eye or eyes means the total and irrecoverable loss thereof. Loss of speech or hearing means the total and irrecoverable loss thereof. Loss of hearing which can be corrected by the use of any hearing aid or device shall not be considered an irrecoverable loss. Loss of thumb and index finger of the same hand means severance of two or more entire phalanges of both the thumb and index finger. To receive benefits, loss must be independent of sickness and all causes other than the accident.

Increased Insured Child Benefit: Except for loss of life, the benefit payable will two times the in-force child benefit amount, up to a maximum of $50,000 for an insured child's injuries which result in a loss specified above. In the event that the insured child dies within 90 days of the same accident, the amount payable will be limited to the in force child benefit amount, up to the maximum of $25,000.

 

You're Under No Obligation.

If you decide the ACA Group Accidental Death and Dismemberment Protection 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.

 

Rates

Take advantage of ACA Group Accidental Death and Dismemberment Insurance Rates!

Your membership in ACA entitles you to group rates.

ACA GROUP ACCIDENTAL DEATH & DISMEMBERMENT
CURRENT 2023 QUARTERLY RATES

Benefit Amount	Member Only	Member & Spouse	Member & Child	Member & Family
$25,000	$4.50	$9.00	$5.12	$9.62
$50,000	$9.00	$18.00	$10.24	$19.24
$100,000	$18.00	$36.00	$20.48	$38.48
$150,000	$27.00	$54.00	$30.72	$57.72
$200,000	$36.00	$72.00	$40.96	$76.96
$250,000	$45.00	$90.00	$51.20	$96.20

Rates do not increase with age. Plus, you cannot be singled out for a rate increase. Benefit options are not guaranteed and are subject to change by agreement between the Trustee Policyholder and New York Life. Premium contributions may be changed by New York Life on any premium due date and on any day on which benefits are changed. However, your rates may change only if they are changed for all others in the same class of insureds under this Group Policy. For example, a class of insureds is a group of people all with the same issue age.

Quarterly Rate: $25,000 to $250,000 in $25,000 units.

G-29051-2

 

ACA Group Accidental Death & Dismemberment Insurance Coverage Terms

If both you and your spouse are ACA members, you may both select the member coverage. In that case, neither of you may insure the other as a spouse and you must carry all dependent children under only one certificate. If dependent child coverage is not already in force on a premium-paying basis, coverage on a newborn will continue for 31 days from the date of birth. Coverage for such newborn will end unless a request to continue coverage is made in writing and payment of dependent child premiums is received by the end of that 31-day period. If dependent child coverage is already in force on a premium-paying basis, coverage on a newborn is effective on the date of birth and will continue, subject to the terms stated in the Termination section. No physical exam is ever required. Coverage will be effective on the first of the month following receipt of your Enrollment Form and first monthly premium payment.

Termination

You may maintain your ACA Accidental Death and Dismemberment Insurance as long as you pay your premiums on time and the Group Policy is not terminated by the Trustee, Policyholder or New York Life. Coverage for your dependents terminates when yours does, or for your spouse when he/she becomes an insured member or ceases to be your lawful spouse. Child coverage can continue as long as the child is eligible or until termination age 20 (26 if full-time student). Coverage for any insured will terminate when active duty in the armed forces begins.

Exclusions

This ACA program is Accidental Death and Dismemberment protection. The exclusions are:

This information is only a brief description of Group Policy terms, conditions and limitations. Complete provisions are found in the Group Policy issued to the Trustee under Trust Agreement with the ACA.

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.
P.O. 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 Group Accidental Death & Dismemberment coverage is underwritten by:
New York Life Insurance Company
51 Madison Avenue, New York, NY 10010
Under Group Policy G-29051-2, on
Policy Form GMR/FACE/G-29051-2

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 Activation Application today!

1. Use the link below to download and print the application.
2. Please complete all fields on the Activation Application.
3. Mail in your application 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 Activation Application