As a member of IEEE under age 70, you are eligible to apply for coverage for yourself, your spouse under age 70 and unmarried dependent children under age 19 (26 if a full-time student). To become insured, an application must be submitted and the required premium contribution must be paid. 

This coverage is available to residents of 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.

You may select principal sum ranging from $50,000 to $500,000 (in units of $50,000) for yourself—at specially negotiated group rates. You have two options—the member-only coverage or family coverage. The member-only coverage pays benefits for covered accidental death or injury for you alone. Family coverage is designed to cover all of your eligible dependents for benefit amounts based on a percentage of your principal sum.

An individual may not be insured under one or more AD&D Group Policies underwritten by New York Life for a total amount of AD&D coverage that exceeds current over-insurance standards.

When you reach age 70, coverage converts to Common Carrier Travel Accident Insurance and any principal sum in excess of $100,000 reduces to $100,000. Common Carrier Coverage protects against accidents that occur while riding on public transportation—airplane, bus, train or taxi.

Your Cost

Review your cost for Group Accidental Death & Dismemberment Insurance.

Schedule of Benefits

Except as stated in the description of the disappearance benefit below, for an injury directly and independently caused by an accident while coverage is in force for you, your spouse or your child, the benefits specified below will be paid if such resulting loss(es) occur within 365 days of that accident.

Benefits are payable for the following losses:

• FULL PRINCIPAL SUM for loss of: life; or two limbs; or movement of both upper and lower limbs (quadriplegia); or sight of both eyes; or both speech and hearing; or one limb and sight of one eye.

• THREE-QUARTERS OF PRINCIPAL SUM for loss of: movement of both lower limbs (paraplegia).

• ONE-HALF OF PRINCIPAL SUM for loss of: one limb; or movement of both upper and lower limbs on one side of the body (hemiplegia); or sight of one eye; or speech; or hearing.

• ONE-QUARTER OF PRINCIPAL SUM for loss of: the thumb and index finger on one hand.

Loss means: with reference to limbs, actual severance through or above the wrist or ankle joints; with reference to thumb and index finger, actual severance through or above metacarpophalangeal joints; with reference to sight, speech or hearing, entire and irrevocable loss thereof; and with reference to movement, complete and irreversible paralysis of such limbs.

Disappearance—If an insured is riding in a conveyance and such conveyance either disappears or sinks as a result of an accident and the insured's body is not found within one year after that accident, the insured will be presumed dead, as a result of accidental injury, and the benefit in effect will be payable.

The total benefit payable for all losses due to a single accident will not be more than the principal sum. Only one of the sums, the largest, will be paid for all injuries to the same limb resulting from one accident.

The Following Benefits Are Payable in Addition to Any Other Benefits Received Provided the Member is Under Age 70

Common Carrier Benefit

If a covered loss occurs as a result of an accident while a passenger on a licensed common carrier (train, bus, etc.), an additional $25,000 benefit will be payable.

Repatriation Benefit

If a covered accidental death occurs outside of the insured person’s state of residence, an additional benefit equaling the actual expenses incurred will be paid for the preparation and transportation of the body to the place of burial or cremation. The benefit will not exceed the lesser of $25,000 or 25% of the principal sum.

Rehabilitation Benefit

Rehabilitation training can help an insured person return to former productivity following an accident. This benefit may be paid for a covered loss other than loss of life. The amount paid will equal the actual expenses incurred for rehabilitation training. This benefit will not exceed the lesser of $10,000 or 10% of the principal sum. The expense must be incurred within two years after the date of the accident.

Seatbelt Benefit

If an insured person is involved in an automobile accident in which he/she was properly wearing a seatbelt and dies within 365 days as a result of that accident, the beneficiary can receive an additional amount that is the lesser of $50,000 or 50% of the Principal Sum payable. Please refer to the Certificate of Insurance for certain limitations and conditions on this benefit.

Education Benefit

If the benefit for loss of life is payable with respect to the insured member, and his/her dependents are covered on the date of the accident, this coverage will pay an education benefit equal to the lesser of 2% of the member's principal sum payable or $2,500 per year or the actual amount of the tuition charge for one year. This benefit will be payable up to four years, for each insured dependent who is enrolled (or enrolls within 365 days of the accident) as a full-time student at an institution of higher learning (college, university or trade school). In addition, if no insured spouse or child qualifies for this benefit following the covered loss of the member's life, a lump sum benefit equal to 2% of the member's principal amount will be payable.

Spouse Critical Period

If either the insured member or insured spouse dies because of a covered accident, the survivor will receive additional monthly payments equal to 1% of the member's Principal Sum. These payments will be made until the earlier of six months or the survivor's death.

Adaptive Home/Auto Benefit

If a covered loss (other than loss of life) results in a physical disability, and, because of that disability, an insured person incurs expenses necessary to modify his/her home and/or car, a benefit amount equal to the lesser of 5% of the principal sum or $5,000 is payable. Please refer to the Certificate of Insurance for certain limitations and conditions on this benefit.

Burn Disfigurement

If a covered loss causes an insured to suffer a disfigurement due to burns, covering at least 5% of the body, an additional benefit equal to the lesser of 10% of the principal sum or $30,000 will be payable.

Day Care Benefit

If the insured member's death results from a covered loss and his or her children, under age 13, are enrolled in a day care program at the time of the loss (proof of enrollment is required; details will be found in your Certificate of Insurance), a benefit equal to the lesser of 5% of the member's principal sum, or $2,500, or the actual day care costs for one year, is payable. The benefit is paid each year for each child who qualifies, except that no more than four day care benefits will be paid for each such child. If the insured member has no child eligible for this benefit at the time of the covered loss, a benefit of $500 will be paid.

Elder Care

If an insured's death is the result of a covered accident and that insured's elderly relative (other than a spouse) was dependent on the insured for support and maintenance, a benefit equal to the lesser of 5% of the principal sum or $5,000 will be payable.

Common Disaster

If both the insured member and spouse die within one year of same or separate accidents that occurred within the same 24-hour period, in addition to the benefit payable for loss of life for each, the insured spouse benefit amount for loss of life will be increased to 100% of the member's principal sum if the member and spouse are survived by one or more eligible children and the combined member and spouse Principal Sums do not exceed $500,000.

Only the Following Benefit Is Payable at Member Age 70 and After Common Carrier Travel Accident Benefit

When the insured member reaches age 70, coverage is converted to Common Carrier Travel Accident Insurance only. A benefit is payable for a covered loss that is the result of an accident while traveling as a passenger in a common carrier (such as a train, bus, aircraft) properly licensed and operated for that purpose. Any principal sum in excess of $100,000 will be reduced to $100,000.

Exclusions and Limitations

No benefit will be payable for any loss that occurs during or is due or related to or resulting from: participation in or incarceration resulting from, in a role other than as victim, commission of a felony, or illegal occupation/activity; voluntary intake of drugs, narcotics or intoxicants, unless prescribed by a physician, illegal use of drugs or intoxicants, or legal intoxication; any declared or undeclared war or act thereof; operating, riding in or descending from any aircraft except when riding as a passenger; physical or mental sickness or medical/surgical treatment thereof; suicide or intentionally self-inflicted injury while sane or insane. 

In addition, when you reach age 70, coverage converts to Common Carrier Travel Accident Insurance, and any principal sums in excess of $100,000 reduce to $100,000.

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.

Effective Date

Insurance for you and your eligible dependents will become effective on the date specified by New York Life Insurance Company provided the initial contribution has been paid and you and your approved dependents are actively performing the normal activities of a person in good health of like age (For NC residents: a person of like age) on that date. Dependent insurance will not take effect unless your insurance is in effect on a premium-paying basis, and any person who is not performing his/her normal activities as required will not become insured until the date 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. (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.)

When Coverage Ends

Insurance will terminate on the occurrence of the earliest of these conditions:

• If premium contributions due are not paid.
• If IEEE membership is not maintained.
• If the group policy is terminated or modified by the policyholder or New York Life Insurance Company to end insurance for the group of insureds to which the insured belongs.
• Member requests to terminate coverage.
• For any insured person, if the principal sum for that insured has been paid.
• For dependent spouse and/or child coverage, if member coverage ends, except that such dependent coverage may be continued if the member’s principal sum has been paid.
• For a dependent spouse, when he/she is no longer a lawful married spouse.
• For a dependent child, upon reaching age 19 (26 if a full-time student).

A member’s surviving spouse and children may continue coverage if it was in force at the time of the member’s death, as described in the Certificate of Insurance.

Renewal Payments and Claims

Once you are accepted, 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

When you become insured you will be sent a Certificate of Insurance summarizing your coverage. This brochure contains only a brief description of some of the policy’s principal provisions and features. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the trustee under trust agreement with the IEEE, Inc.

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—no questions asked!

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-18700-1, on Policy Form GMR-FACE/G-18700-1.

About New York Life Insurance Company

80764

Insurance Application and Brochure

Domestic Partner Form

41-Point Safety Checklist