This coverage is available exclusively to IEEE members under age 55. You must maintain active IEEE membership status during the life of the policy.

You can request coverage for yourself, your spouse under age 55 and unmarried dependent children ages 14 days through 22 years (24 if a full-time student). To become insured, you must provide evidence of insurability and pay the required premium.

A dependent who is also an IEEE member is eligible for either member or dependent coverage, but not both. If both member and spouse are covered as members, neither may insure the other as spouse. Only one may insure any eligible children.

This coverage is available only for residents of the United States (except territories), 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.

Any eligible non-dependent family members can apply for coverage if they join IEEE as an associate member. Call us at 1-800-493-IEEE (4333) for more details.

Choose the amount of Group 20-Year Level Term Life insurance you need to help protect you and your loved ones without the worry of premiums increasing for 20 years or benefit amount reductions.

Amounts of Insurance:

• Members: $100,000 to $2 million, in $10,000 multiples.
• Spouse: $100,000 to $2 million, in $10,000 multiples. Coverage may not exceed 100% of member’s coverage.
• Each eligible dependent child: $10,000 per eligible child.

The total amount of coverage an individual may request under all group life insurance policies underwritten by New York Life Insurance Company may not exceed $2 million. In addition, the total amount of coverage an individual may have under all group policies issued by New York Life Insurance Company to the Trustee of the IEEE-Sponsored Life Insurance coverage may not exceed the maximum benefit option for any insured person.

Our group 20-year level term life insurance offers many valuable benefits. Learn more about them.

Pay Less if You’re a Qualified Nonsmoker

Nonsmokers meeting the highest underwriting standards may qualify for the preferred (the policy’s best) rates that follow. Other nonsmokers may qualify for "select" (a bit higher) or standard (the policy’s highest) rates.

Save With Volume Discounts on Higher Amounts of Insurance

If you or your spouse becomes insured for coverage amounts of $250,000 through $490,000, you’ll receive a volume discount. For amounts of $500,000 through $2 million of coverage, you’ll receive an even bigger discount.

Continuing Insurance After the 20-Year Term Ends

Premiums are guaranteed to remain level for the first 20 years of coverage. At the end of the 20-year period, you may reapply for 20-year level term rates then in effect for a subsequent 20-year period, provided the insured person is under age 55 and otherwise eligible. If your application for a subsequent 20-year term of guaranteed rates is approved, your premium contribution will be based on the insured person's age, health and tobacco/nicotine use at the time coverage becomes effective and will be guaranteed for a new 20-year term.

If you and your spouse are not approved for a subsequent 20-year term of guaranteed rates, or you do not apply for a subsequent 20-year term, coverage will continue in force on a non-guaranteed rate basis, under which premium contributions increase as the insured ages.

Keep Your Cost Manageable

Rates have been provided on an annual basis per $1,000 of coverage to make it easier for you to compare this covergae to other insurance policies on the market today. Two payment methods are available to suit your budget: semiannual billing; and semiannual or monthly Electronic Funds Transfer (EFT) option (your cost would be approximately one-half or one-twelfth, respectively, the amount you calculate from the rate chart.)

IMPORTANT NOTICE TO RESIDENTS OF MANITOBA AND ONTARIO, CANADA: Manitoba and Ontario, Canada, have enacted laws requiring taxation (Manitoba 7% and Ontario 8%) of all group insurance purchased by individuals. This tax will be added to the amount of any premium contributions due (in U.S. dollars), which is then reported and remitted to the province.

Valuable Living Benefit Provision "Accelerated Death Benefit"

The accelerated death benefit option is available to help terminally ill people who are insured during a difficult and often financially challenging time. Under this provision you may request one advance payment equal to 50% of qualified terminally ill person's in-force life insurance to be paid while that person is still alive.

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 person’s death will be reduced by this payment. (Premium contributions will not be reduced.)

You can choose how you want to use the money:

• High prescription drug costs
• Medical bills
• Outstanding debts
• Experimental treatments
• Modifying your home
• A family vacation

To qualify, a terminally ill person who is insured must provide New York Life Insurance Company with proof of terminal illness and anticipated life expectancy (12 months or less), as well as any other necessary medical information requested. For additional details and limitations, please see the certificate of insurance.

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 of a qualified tax advisor.

No Exclusions

Benefits are paid for death from any cause, at any time, anywhere in the world. The validity of any amount of your life insurance that has been in force for two years during an insured’s lifetime will not be contested except for insurance eligibility provisions and nonpayment of premium contributions.

Your Choice of 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.

Ownership of Insurance

Owner means the person or entity with rights of ownership of this insurance as described in the Certificate of Insurance. If a transfer of ownership has been recorded by or on behalf of New York Life Insurance Company, or if initial ownership is by anyone other than the member according to the information provided on the application, references throughout this Policy Information to you or member will mean owner, as applicable.

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.

Insurance will take effect on the date your application is approved by New York Life Insurance Company, provided the initial contribution is paid within 31 days after the date you are billed (send no money now) and any person to be insured is performing the normal activities of a person in good health of like age on the date of approval.

Any person who is not performing his/her normal daily activities as required will not become insured until the day he/she is performing such activities, provided such date is within three months of the date insurance would have been effective and the person is still eligible.

When Coverage Ends

Insurance coverage can remain in force until the insured person reaches age 75 (23 for children, or 25 for children who are full-time students) provided:

• You remain a member of IEEE.
• You continue to pay premium contributions when due.
• The group policy is not terminated or modified by the policyholder to end insurance for the group of insured people to which you belong.
• The insured person does not request to terminate insurance.

Dependent coverage will end when the member’s coverage ends (for reasons other than attainment of age 75.) In addition, dependent coverage will terminate when the dependent spouse or child ceases to be an eligible dependent. Upon your death, coverage for your insured dependents may continue as described in the certificate of insurance.

Renewal Payments and Claims

Once you are approved for coverage, 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 Insurance Company to Trustee of the Institute of Electrical and Electronics Engineers Life Insurance Policy.

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

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 be sent a full refund with no questions asked! 

How New York Life Obtains Information and Underwrites Your Request for Group 20-Year Level 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, 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 or 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 application 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 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 INFORMATION ²we 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 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 family member, employer or associate of a victim of domestic abuse or a person with whom the 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-29215-0, on Policy Form G-29215-0/GMR-FACE.

About New York Life Insurance Company

ID# 80766

Insurance Application & Brochure

Change of Beneficiary

EFT Authorization Form

Demystifying the Application Process

Demystifying the Life Insurance Medical Exam