ACA Group Term Life Insurance Plan - aca
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Group Term Life Insurance
Would your family have enough if you were gone? Apply for up to $500,000 of ACA Group Term Life Insurance Coverage.
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Group Term Life
You probably have life insurance. But is it what your family needs? As an ACA member, you're eligible to apply for exclusively priced coverage - designed for Doctors of Chiropractic Medicine.
Nested Applications
Group Term Life Tabbed Product Details
Overview
Caring for your patients and meeting your family's day-to-day demands takes time. When do you plan for your long-term needs such as life insurance?
Some experts believe...Your life insurance should equal 5 to 10 times your annual income. You could need even more coverage if you have financial commitments, special needs or a young family.
As an ACA member under age 65, you can apply for coverage to the ACA Group Term Life:
- Benefits up to $500,000.
- Apply to cover your eligible spouse, dependent children (under age 21 or 25 if full time student) and even your eligible employees who work at least 30 hours a week
- Member-only rates
- 30 Day FREE Look
- Pays benefits early for terminal illnesses
- Keep coverage up to age 80
- Waives premiums if you're disabled
J. Christopher Burke California Insurance License #0F70947. J. Christopher Burke, Arkansas Insurance License #62442.
Underwritten by New York Life Insurance Company, 51 Madison Avenue, NY, NY 10010 under Policy Number G29051-1/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.
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Benefits
Request ACA Group Term Life Insurance TODAY.
Eligibility
To qualify for coverage, you must be an active member of the ACA or an employee of a member (working 30 or more hours per week) 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), unmarried dependent children between 15 days and 25 years are also eligible.
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.
Amounts Of Insurance Available:
ACA Term Life coverage is also available when you enroll your lawful spouse under age 65 and your dependent children under age 20 (25 if full-time students).
When you choose family coverage, benefits for all covered family members are based on the amount of coverage you select as follows:
- Members - $10,000 to $500,000 in $10,000 increments.
- Spouse - $5,000 to $250,000 in $10,000 increments, not to exceed 50% of member's coverage.
- Each Unmarried Dependent Child - Between 6 months and 25 years are eligible for benefit amounts from $1,000 to $5,000. Children between 15 days and up to 6 months of age are eligible for $100 in coverage.
You May Be Able To Collect Benefits Early
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.
- You're paid this benefit while you are alive and paying premiums.
- Pays the remainder of your death benefit to your family or designated beneficiary after your death.
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 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 a qualified tax adviser.
Benefits Automatically Increase
ACA Term Life member benefits increase each year on March 1 to help make sure coverage keeps pace with rising costs.
- Benefits increase a percent equal to the previous year's Consumer Price Index (CPI); as of the previous, September 30.
- Rounds to the nearest $500 but not to exceed more than 50% of your original insurance amount.
To be eligible for this benefit increase, you must be under age 65, not totally disabled on the date it would otherwise take effect, pay the premium due for the increased amount and be alive when the premium contribution payment is made. This option will be offered on the member's coverage with each March 1 premium notice. You can make a request to not have your coverage automatically increase in the future, but once you do you cannot restart them.
Group Conversion Option
Your ACA Group Term Life Insurance provides privileges to convert to an individual policy from New York Life Insurance Company under certain circumstance of involuntary termination as described in the Certificate of Insurance.
You're Under No Obligation
If you decide your ACA Term Life 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 California Insurance License #0F70947. J. Christopher Burke, Arkansas Insurance License #62442.
Underwritten by New York Life Insurance Company, 51 Madison Avenue, NY, NY 10010 under Policy Number G29051-1/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.
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Take advantage of ACA Group Rates!
As an ACA Member, you may apply for these group rates. All premiums are based on the applicant's attained age at the age of issue and on each premium due date. Premiums will increase as the applicant enters a new age bracket.
ACA GROUP TERM LIFE CURRENT 2023 SEMIANNUAL RATES* PER $10,000 of Insurance
| UNDER $100,000 | $100,000-$199,000 | $200,000-$500,000 | ||||
| MEMBER'S/ SPOUSE'S AGE | SMOKER | NON SMOKER | SMOKER | NON SMOKER | SMOKER | NON SMOKER |
| Under 25 | $7.76 | $6.90 | $7.34 | $6.04 | $6.90 | $5.75 |
| 25-29 | $8.63 | $7.76 | $8.20 | $6.90 | $7.76 | $6.61 |
| 30-34 | $9.49 | $7.76 | $8.91 | $7.48 | $8.34 | $7.19 |
| 35-39 | $12.94 | $11.21 | $12.08 | $10.35 | $11.21 | $10.06 |
| 40-44 | $19.84 | $18.11 | $18.98 | $17.25 | $18.11 | $16.39 |
| 45-49 | $30.19 | $26.74 | $29.76 | $25.88 | $29.33 | $25.01 |
| 50-54 | $47.44 | $41.40 | $46.58 | $39.68 | $45.71 | $38.81 |
| 55-59 | $74.18 | $63.83 | $72.45 | $62.10 | $70.73 | $60.38 |
| 60-64 | $113.85 | $98.33 | $110.40 | $94.88 | $107.81 | $92.29 |
| 65-69 | $186.30 | $159.56 | $178.54 | $153.53 | $174.23 | $149.21 |
| 70-74 | $462.30 | $384.39 | N/A | N/A | N/A | N/A |
| 75-79 | $675.34 | $578.74 | N/A | N/A | N/A | N/A |
Child Coverage: Semiannually $2.30 per $1,000, on rate covers all dependent children
The current rates shown above reflect the current rates and benefit structure.
Changes to the Group Policy are subject to agreement between 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 may be changed by New York Life on any premium due date and on any date on which benefits are changed. 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.
At age 70, the coverage reduces to a maximum of $25,000 and your spouse's reduces to a maximum of $12,500. Premiums remain the same. Coverage ends at age 80.
To cut overhead costs, premiums are collected on a semi annual basis.
J. Christopher Burke California Insurance License #0F70947. J. Christopher Burke, Arkansas Insurance License #62442.
Underwritten by New York Life Insurance Company, 51 Madison Avenue, NY, NY 10010 under Policy Number G29051-1/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.
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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. In the case of death due to suicide within 24 months of coverage, the benefit will be limited to the return of premiums paid.
Accelerated Benefits are not payable if there is an absolute assignment; there is an irrevocable beneficiary who does not give written consent; there is a court decree involving the life insurance in connection with a divorce agreement; or the illness is due to intentionally self-inflicted injury or attempted suicide. Receipt of Accelerated Benefits may be taxable. Consult your personal tax advisor for specific details.
Effective Date of Coverage
Insurance will take effect on 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 (or 25 for children) or earlier if: the premiums are not paid when due and 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 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 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, 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.
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 7.15 ed.
Endorsed 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.
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 California Insurance License #0F70947. J. Christopher Burke, Arkansas Insurance License #62442.
Underwritten by:
New York Life Insurance Company, 51 Madison Avenue, NY, NY 10010 under Policy Number G29051-1/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.
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.
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Download, print and mail in your Application today!
- Use the link below to download and print the form.
- Please complete all fields on the Application.
- 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 G29051-1/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.
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