Terms

When Coverage Begins:Your coverage will begin on the first of the month following the date your application is approved by New York Life Insurance Company, provided you are Actively-at-Work full-time on the date, meet required evidence of insurability requirements and the premium is paid. Benefits will begin on the first day of a covered total disability after completion of the applicable Waiting Period. Benefits will continue until the earlier of (a) the day the insured ceases to be totally disabled or (b) the end of the maximum benefit period.

When Coverage Ends:Your coverage will end when you are no longer an AOA member, you are no longer at full-time work, you reach age 70, you stop paying your premiums when due, when you receive covered total disability benefits for the maximum benefit period, when you begin active duty in the armed forces, or the date the group policy ends.

Important Definitions

Average Monthly Income means a person’s average monthly wages, salaries, bonuses, commissions, fees and any other amounts received by such person for personal services, including the cost of his or her fringe benefits and share of total surplus. It does not include income from overtime, other extra compensation, interest, dividends, rent, royalties, annuities, other insurance and other unearned income.

Covered Total Disability is an incapacity that completely and continuously prevents the insured member from doing the material and substantial duties of his/her regular occupation during the waiting period and during the next 12 consecutive months and any occupation for which he/she is or may become qualified by reason of education, training or experience, after the waiting period and the initial 12 consecutive month period has elapsed. Note: An insured member will not be considered to have incurred a covered disability if at any time he/she is engaged in any occupation for pay or profit.

A loss of license, in and of itself, does not constitute an incapacity that prevents the insured member from doing the material and substantial duties of his or her regular occupation and will not be deemed a Covered Total Disability.

Such covered disability must begin while the insured member is insured under the Policy and be the result of: (1) and injury, For a Covered Total Disability to be considered to have resulted from an injury, the Covered Total Disability must begin within 365 days after an accident, if the accident occurs while the insured member is insured under the policy. If more than 365 days has elapsed, such Covered Total Disability will be considered to have resulted from an Injury; (2) a sickness; or (3) an organ donation that an insured member makes, provided he/she has been insured under the Policy for at least six consecutive months on the day of such donation.

Successive Periods of Covered Total Disability will be considered one period of Covered Total Disability if such disabilities are due to the same or related causes, and which are separated by less than 14 days of return to continuous full-time work during which you are not totally disabled or different or unrelated causes are not separated by return to full-time work.

Waiting Period is the initial, continuous period of a Covered Total Disability which must be completed before such Covered Total Disability benefits become initially payable.

General Exclusions

The following Exclusions apply to all benefits of the Policy.

Exclusions: The following Exclusions apply to all benefits of the Policy. Exclusions: The Policy does not cover, and will not pay a benefit for any Loss or Disability: is related to; 1) the insured’s engagement in any of the following in a role other than as a victim: war, an act of war, or an armed conflict which involves the armed forces of one or more countries.2) due to an act of intentionally self-inflicted Injury or occurs while intentionally injuring oneself while sane; 3) due to participation in or incarceration resulting from any of the following in a role other than as a victim: (a) the commission of a felony; (b) an illegal occupation or activity; (c) an insurrection; (d) terrorist activity; or (e) a riot 4) due to pregnancy (except that Complications of Pregnancy are covered); 6) due to or related to a service in the military, naval or air force of any country, alliance or international organization or in a civilian unit which severs such forces 7) a disability that occurs during, is due to or relating to the insured member travel in, on or fall from any aircraft which is used to train, test or experiment or is part of the military , naval or air force.

Impairment Restriction is a disability that is due to or related to a condition which has an Impairment Restriction. However, at any time and at his or her own expense, the INSURED MEMBER can give medical evidence of insurability for a condition which has an Impairment Restriction. After review of such evidence, New York Life will determine: (a) if and when such Impairment Restriction should be removed or liberalized; or (b) if it should be continued.

Important Information from New York Life Insurance Company: New York Life Insurance Company reserves the right to request medical information to determine applicant’s medical eligibility for coverage. Based on the age of the person proposed for insurance and the amount of coverage requested, a physical examination, EKG, blood test or other information may be required. Not all applicants will have to supply additional information. However, if it is required, New York Life will arrange for an independent professional paramedic to contact you to perform these simple tests at your convenience. The exam and blood test are free-of-charge.

If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage be effective prior to this date. Payment of a premium contribution with your application does not mean that there is any insurance in force before the effective date as determined by New York Life.

IMPORTANT NOTICE:

How New York Life Obtains Information and Underwrites Your Request For Group Short Term 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, 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, 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. 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.

If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage be effective prior to this date. Payment of a premium contribution with your application does not mean that there is any insurance in force before the effective date as determined by New York Life.

Questions? Call toll-free 1-866-331-0180

When program experience has been good New York Life Insurance Company will periodically return excess premiums in the form of dividends to the AOA as the policyholder. The AOA will retain these dividends in a Dividend on Deposit Account with New York Life. The AOA will in turn periodically make these dividends available through premium credits to existing insureds in the programs which generated the dividends. Sufficient reserves will be retained by the AOA in the Dividend on Deposit Account to cover administrative and marketing costs generated by the New York Life Insurance Programs sponsored by the AOA. These programs are administered together to take advantage of the savings resulting from this integrated approach.

Administrative expenses incurred by the AOA to provide the valuable membership benefits resulting from these sponsored insurance programs are reimbursed from available program dividends. New York Life may also, out of premium, pay a reasonable fee to the AOA for making the AOA assets available to it to promote these programs to the membership. These assets include the AOA Intellectual Property Rights and mailing lists of eligible members.

Endorsed By


Administered by:
AGIA Insurance Services, Inc.
P.O. Box 26860
Phoenix, AZ 85068



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. Matthew Bishop California Agent insurance license number is 0F00863. Matthew Bishop Arkansas Agent insurance license number is 8493373.

The Group Short-Term Disability Income Insurance is underwritten by: New York Life Insurance Company
51 Madison Avenue, New York, NY 10010
under Group Policy G-29336-2 on
Policy Form GMR-FACE/ G-29336-2

New York Life is licensed/authorized to transact business in all the 50 united states, District of Columbia and Puerto Rico. Please note that this coverage is not available in all states.

New York Life Insurance Company’s state of domicile is New York and their NAIC ID # is 66915.

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