This coverage is available exclusively to IEEE members under age 70 who are at FULL-TIME WORK, provided their ANNUAL GROSS EARNED INCOME is at least $20,000 for the proceeding 12-month period. To become insured, satisfactory evidence of insurability must be provided and the required premium must be paid. You must also maintain active IEEE membership to remain insured.  Student members and members who are on active fulltime military duty are not eligible for this coverage.

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

This coverage is only available for residents of the U.S. (except VT and terrttories). Puerto Rico and Canada (except Quebec). AMBA does not act as broker with respect to Canadian residents and acts solely as an Administrator on behalf of New York Life. 

Choose From Three Options

This policy is designed to pay monthly benefits while you are totally disabled. "Totally disabled" means you are prevented by illness or injury from performing the material and substantial duties of your usual occupation, provided you are not otherwise working for pay or profit. Benefits begin at the end of the waiting period, provided you are totally disabled.

Note: Benefits for disabilities due to mental disorders or chemical dependency are limited to a maximum of 36 monthly payments, regardless of coverage choice.

Choose Your Coverage

1. Career Coverage

If you are totally disabled before age 63, benefits are payable up to age 65. There is a two-year maximum benefit for total disabilities starting at ages 63 through 74.

2. Five-Year Coverage

Benefits are payable for up to five years for total disabilities commencing prior to age 60. For total disabilities starting at ages 60 through 62, benefits may continue up to age 65. For total disabilities starting at ages 63 through 74, benefits may continue for up to two years.

3. Inflation-Fighter Career Coverage

This coverage offers disability coverage that, once benefits begin, can help keep pace with inflation. Monthly benefits will be adjusted annually from the date of disability if you are totally disabled prior to age 63. Adjustments may be made to the monthly benefit paid in the second and each succeeding year. The adjusted amount will be based on the Consumer Price Index for Urban Consumers (CPI-U), up to a maximum 5% increase per year and an overall maximum increase of one times the original benefit.^* Once you are no longer disabled and the benefit payments stop, the monthly benefit returns to the original option amount.

Benefits are payable up to age 65 for total disabilities starting before age 63. For total disabilities starting at ages 63 through 74, the inflation-fighter feature is no longer applicable, and benefits will be payable in accordance with the basic career coverage (i.e., up to two years maximum).

Choose Your Monthly Benefit

You have a choice of monthly benefit options, from $260 to $7,540 (in $130 units). However, members age 65-69 may not request a monthly benefit option of more than $3,250. The option you choose, together with any other disability income insurance you may have or for which you are applying, cannot exceed 60% of your AVERAGE MONTHLY INCOME. Depending on your state of residence, you may be eligible to receive disability benefits under a state plan. You should check to see if your state offers this type of benefit.

NOTE: On the November 1^st anniversary date on or immediately after reaching age 65, coverage of more than $3,250 reduces to $3,250. On the November 1^st anniversary date on or immediately after reaching age 70, coverage of more than $1,560 reduces to $1,560.

ANNUAL GROSS EARNED INCOME means your wages, salaries, commissions, fees and other amounts received for personal services — before deduction of income or social insurance taxes and after deduction of the normal business expenses that are deductible for income tax purposes — for any 12-month period. It does not include income from interest, dividends, rent, royalties, annuities, other insurance or other unearned income. AVERAGE MONTHLY INCOME means 1/12 of your ANNUAL GROSS EARNED INCOME.

Your Choice of Waiting Periods

You also have a choice of four waiting periods: 30, 90, 180 or 365 days. A waiting period is the number of consecutive days you must be totally disabled before benefit payments begin. You should choose one that will provide benefits when your employer-provided salary continuation policy runs out. Coverage with a longer waiting period is less expensive.

Future Purchase Option

You expect that your salary will increase with time, and that means you'll have more to protect. Reserve a coverage increase now, for future activation, without additional medical underwriting for your future need.

Eligible members, under age 47, may apply for this benefit when requesting initial coverage. You will be underwritten now for the full amount applied for, both your monthly benefit for immediate activation upon approval and the future amount to be activated (converted) as an increase to your monthly benefit in the future. No medical underwriting will ever be required in the future to activate (convert) an in-force FPO amount.

Any approved FPO amount, in $130 increments up to $2,600, even if not activated (converted), is subject to the Policy maximum and the 60% of AVERAGE MONTHLY INCOME limitation.

Whether you choose Policy 65 or Policy 5, the FPO amount is pended in that status until your decision to activate either a portion or the entire amount of the FPO to increase your monthly benefit. While pended with FPO status, you pay the very attractive FPO rate. Upon activation/conversion, the entire amount of the new, increased monthly benefit is subject to the full rate basis. The FPO is not available with the Inflation-Fighter Coverage.

You may request a conversion of an FPO amount to increase your monthly benefit only during the year of your even age, from age 24 to age 48. (Age is determined as attained age on the nearest November 1^st, except on the initial effective date, which recognizes attained age on that date.) You will need to contact the administrator to request this conversion/activation. An FPO amount that has not been converted to increase the monthly benefit is not eligible for claim payment consideration.

The FPO option will be terminated at age 50 and the eligibility to convert/activate the FPO amount ends.

^*A "catch-up" feature allows disabled members to receive benefit increases more than the 5% annual maximum if the prior years' compounded rates of inflation were less than 5% annually. Contact the administrator for additional details on this feature.

Review your cost for Group Disability Income Insurance.

Survivor Benefit

If you die—from any cause—while receiving benefits for total disability, a death benefit equal to three times the monthly benefit option in force on the date of your death will be paid to your surviving relatives in the following order of survival: your spouse; or your children, equally; or your brothers and sisters, equally; otherwise, if there is no surviving relative, to the executor or administrator of your estate.

Organ Donation Benefit

If you have been insured under the policy for at least six months and undergo a surgical procedure to donate an organ for transplant, you will be considered totally disabled. No waiting period will apply, and benefits will be payable from the first day of total disability. However, any portion of your monthly benefit option that became effective in the six months immediately prior to such organ donation will not be payable for this total disability.

Rehabilitation Benefit

This benefit is designed to help certain disabled members return to the work force. Under this provision, a professional rehabilitation staff reviews case histories and identifies individuals who appear to have the greatest likelihood of rehabilitation. Individuals selected by New York Life Insurance Company are offered the option of participating in a rehabilitation program at no cost to them. Participation is voluntary and benefits are not reduced due to participation in this program.

Residual Disability Benefit

An illness may leave you unable to perform some but not all your job functions. If you are under age 65 and a covered illness or organ donation results in an earnings loss of at least 20% you may receive a residual disability benefit. The benefit is payable after the elimination period and may be paid even if you never receive benefits for a covered total disability. The amount payable is based on a loss of earnings ratio as described in your certificate and ends the earlier of the date your earnings loss ratio is less than 20% or the maximum benefit period, including covered total disability benefits, if any, is reached.

Leave of Absence or Layoff Benefit

Many disability  policies end as soon as you stop work whether it’s time off to take care of a family member, to develop your career or worst yet because you are laid off. IEEE members can continue their coverage for up to 180 days to take a leave of absence or in the event of a layoff. Leaves must be authorized in writing and all other conditions of coverage must be met.

Premium Credit

Plus, a 30% premium credit, currently applies to all premium contributions due. If experience warrants, the trustee may grant future premium credits that can reduce your cost to renew coverage.

Waiver of Premium

After you have been totally disabled for six consecutive months and you begin to receive benefits for total disability, all future premium contributions under the  policy will be waived for as long as you receive benefits for that disability.

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.

Exclusions and Limitations

This policy does not provide benefits for: any disability that occurs during or is due or related to intentionally self-inflicted injury while sane or insane [Missouri Residents: This exclusion is not applicable to injury caused by an intentionally self-inflicted injury while insane], declared or undeclared war or any act thereof, military service, pre-existing condition (see below), or your incarceration for or participation (except as a victim) in an illegal occupation/activity or the commission of a crime; or any disability that is due or related to pregnancy or childbirth (except complications thereof), or any impairment or disease specifically excluded from your coverage.

This policy limits benefits for disabilities due to mental disorders and chemical dependency to a maximum of 36 monthly payments.

No benefits will be paid unless the disability occurs while you are insured under the policy and you are under the care of a licensed physician or surgeon other than yourself (or member of your immediate family or household) during the period of disability.

Preexisting Condition Limitation

A preexisting condition is an injury or sickness for which you consulted a doctor, received any medical services or supplies or took any medication during the 12 months immediately before becoming insured under this coverage. Benefits are not payable for a disability that is classified as a preexisting condition until the end of the earlier of 12 consecutive months during which you have not consulted a doctor, received medical services or supplies, or taken any medication for the condition; 24 consecutive months during which you have been insured under this policy.

Effective Date

Note: Residents of NC: Any reference to "performing normal activities" is replaced by the requirement that the health status of any proposed insured person remains the same as stated in your application.

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 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 may remain valid until the November 1 anniversary date on or immediately after you reach age 75, provided you:

• Do not cease FULL-TIME WORK other than for reasons of disability.
• Remain an IEEE member.
• Continue to pay premium contributions when due.
• Do not enter full-time active duty in the armed forces (coverage may be restored upon termination of active-duty status, subject to policy guidelines).
• You do not elect to terminate your coverage.
• The group plan is not terminated or modified by the policyholder or New York Life Insurance Company to end insurance for the group of insureds to which you belong.

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 Trustee under the Trust Agreement with the Institute of Electrical and Electronics Engineers.

When you become insured, you will be sent a Certificate of Insurance summarizing your benefits.

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 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, LLC. (“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 nonmedical 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 nonmedical 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 decide 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 nonmedical 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, LLC., 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 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                 

8/12 ed.

IEEE is compensated in connection with this sponsored group insurance to provide and maintain this valuable membership benefit.

Underwritten by New York Life Insurance Company, under Group Policy No. G-12150-2, on Policy Form GMR-FACE/G-12150-2

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