CURRENT 2021 MONTHLY PREMIUM CONTRIBUTIONS:

Monthly rates are shown for comparison purposes only.
When the coverage is put in force, you will be billed on an annual basis.

Member Only* (Under Age 70)	Family Coverage** (Under Age 70) Member/Spouse/Child
$50,000………$2.83	$50,000 / $25,000 / $5,000……....$3.75
$100,000…….$5.67	$100,000 / $50,000 / $10,000……..$7.50
$150,000…….$8.50	$150,000 / $75.000 / $15,000……$11.25
$200,000…...$11.33	$200,000 / $100,000 / $20,000…..$15.00
$250,000…...$14.17	$250,000 / $125,000 / $25,000…..$18.75
$300,000…...$17.00	$300,000 / $150,000 / $30,000…..$22.50
$350,000…...$19.83	$350,000 / $175,000 / $35,000…..$26.25
$400,000…...$22.67	$400,000 / $200,000 / $40,000…..$30.00
$450,000…...$25.50	$450,000 / $225,000 / $45,000…..$33.75
$500,000…...$28.33	$500,000 / $250,000 / $50,000…..$37.50

 

Coverage Amounts Available After Age 69* (For Renewal Only)

Insured Person	Member under age 70 (Original Principal Sum)	Member age 70 -74 (Principal Sum Available)	Member age 75-79 (Principal Sum Available)	Member age 80 or older (Principal Sum Available)
Member	$50,000	$25,000	$12,500	$6,250
Spouse	$25,000	$12,500	$6,250	$3,125
Child	$5,000	$2,500	$1,250	$625
Member	$100,000	$50,000	$25,000	$12,500
Spouse	$50,000	$25,000	$12,500	$6,250
Child	$10,000	$5,000	$2,500	$1,250
Member	$150,000	$75,000	$37,500	$18,750
Spouse	$75,000	$37,500	$18,750	$9,375
Child	$15,000	$7,500	$3,750	$1,875
Member	$200,000	$100,000	$50,000	$25,000
Spouse	$100,000	$50,000	$25,000	$12,500
Child	$20,000	$10,000	$5,000	$2,500
Member	$250,000	$125,000	$62,500	$25,000
Spouse	$125,000	$62,500	$31,250	$12,500
Child	$25,000	$12, 500	$6,250	$2,500
Member	$300,000	$150,000	$75,000	$25,000
Spouse	$150,000	$75,000	$37,500	$12,500
Child	$30,000	$15,000	$7,500	$2,500
Member	$350,000	$175,000	$87,500	$25,000
Spouse	$175,000	$87,500	$43,750	$12,500
Child	$35,000	$17,500	$8,750	$2,500
Member	$400,000	$200,000	$100,000	$25,000
Spouse	$200,000	$100,000	$50,000	$12,500
Child	$40,000	$20,000	$10,000	$2,500
Member	$450,000	$225,000	$112,500	$25,000
Spouse	$225,000	$112,500	$56,250	$12,500
Child	$45,000	$22,500	$11,250	$2,500
Member	$500,000	$250,000	$125,000	$25,000
Spouse	$250,000	$125,000	$62,500	$12,500
Child	$50,000	$25,000	$12,500	$2,500

* Amounts of Insurance After Age 69: On the premium due date on or immediately after the date the member reaches ages 70, 75 and 80, the Principal Sum in force reduces 50%, with similar reductions to Spouse and Child Principal Sums under Family Coverage. The Member Principal Sum available at age 80 may not exceed $25,000. Premiums do not reduce. Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life and MOAA.

**Under Family Coverage, if on the date of the accident no dependent spouse is covered, dependent child coverage increases to 15% (instead of 10%) of the Member Principal Sum; if on the date of accident, spouse only is covered under Family Coverage, the spouse coverage increases to 60% of the Member Principal Sum (instead of 50%).

This MOAA-endorsed AD&D policy includes an innovative Civil Aircraft Benefit. If you hold a current valid certificate of competency authorizing performance of a pilot's duties and have logged at least 1,000 flight hours as a pilot in command, and you suffer a covered loss while acting as a pilot or crew member of a civil aircraft, 25% of your Principal Sum is payable. Please refer to the Exclusions and Limitations section for more details.

 

The Following Benefits are Payable IN ADDITION to Any Other Benefit Payable Under the Coverage.

 

DOUBLE BENEFITS (up to an additional $500,000) if the insured person is killed or suffers any covered loss in an accident on an airplane, taxi, train, subway, bus, cruise ship, or other common carrier licensed and registered for the transportation of passengers.

 

UP TO AN ADDITIONAL $150,000 MILITARY AIR TRAVEL BENEFIT if the insured suffers a covered loss while riding as a passenger in a military transport aircraft operated by Air Mobility Command while serving in the Reserves or if recalled to active duty service. The benefit payable is the lesser of the Principal Sum or $150,000.

 

UP TO $30,000 SPOUSE SUPPORT BENEFIT if you and your covered spouse are in a covered accident and the death of either is a covered loss, the surviving spouse will receive an additional monthly benefit of 1% of the deceased person’s Principal Sum for up to six consecutive months, up to $5,000 per month. The benefit is payable until the earlier of six months, or the survivor's spouse's death.

 

UP TO $50,000 SEAT BELT BENEFIT if the insured is involved in an automobile accident in which he/she was properly wearing a seat belt and dies within 365 days as a result of that accident. The lesser of $50,000 or 50% of the Principal Sum is payable. The Certificate outlines certain limitations to this benefit.

 

UP TO $25,000 AIR BAG BENEFIT pays the lesser of $25,000 or 10% of the Principal Sum if the Seat Belt Benefit is payable and the vehicle involved was equipped with a properly functioning air bag.

 

UP TO $30,000 BURN BENEFIT if the insured suffers disfiguring burns covering at least 5% of his/her body in a covered accident (pays 10% of the Principal Sum up to $30,000).

 

UP TO $10,000 REHABILITATION BENEFIT if you’re injured in a covered accident and require rehabilitation. Benefits will be equal to actual rehabilitation expenses up to the lesser of $10,000 or 10% of the Principal Sum. Rehabilitation expenses must be incurred within 2 years after the accident.

 

UP TO $10,000 EDUCATION BENEFIT for your eligible children is payable if the benefit for the member’s loss of life is payable and there are surviving insured dependents who are enrolled, or enroll within 365 days of the member’s death, in an institution of higher learning. The benefit payable will equal the actual cost of tuition up to the lesser of: 2% of the Member’s Principal Sum, or; $2,500 for children, $4,000 for spouse. The benefit is payable annually for up to four years, while the dependent is a student, as defined. If no insured dependent qualifies, 2% of the Member's Principal Sum is payable.

 

UP TO $5,000 HOME OR AUTO ADJUSTMENT BENEFIT to modify your home or car to accommodate for a physical disability resulting from a covered accident. The benefit will be the lesser of 5% of the insured’s Principal Sum or $5,000. Please refer to the Certificate of Insurance for certain limitations and conditions.

 

UP TO $2,500 DAY CARE BENEFIT to help your spouse cover the expense of daycare for your dependent children under age 13 and enrolled in a Day Care Program on the date of loss, in the year following your fatal accident. Pays the lesser of: 5% of your Principal Sum; $2,500; or the actual amount of day care costs for a year. The benefit is payable each year per child who qualifies, and no more than four such benefits are payable per child. If you do not have any children in day care, an additional $500 will be paid.

 

UP TO $5,000 ELDER CARE BENEFIT is payable if a covered accident results in the insured’s death 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.

 

UP TO $25,000 TO BRING YOU HOME IN CASE OF A FATAL ACCIDENT paid to cover actual expenses up to the lesser of 25% of the Principal Sum or $25,000 to return the deceased home for burial or cremation if the death results from a covered accident outside the insured’s state of residence.

 

Exclusions

 

Air Travel - Except as provided in the Civil Aircraft Benefit, a loss that occurs during or is a direct result of the covered person's travel in, travel on, fall from or descent from any aircraft while such aircraft is in flight, unless the covered person is traveling solely as a passenger, except that: if a covered is recalled to service or serving in the reserves, an additional benefit equal to the Principal Sum, up to $150,000 is payable, for a loss that occurs while the covered person is a passenger on any transport type aircraft operated by the Air Mobility Command.

 

Crime/Illegal Occupation/Illegal Activity - A loss that: (a) occurs during; (b) is due to; or (c) is related to; the covered person's 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.

 

Disease/Infirmity - A loss that is due to or related to: (a) disease or bodily infirmity of mind or body; (b) medical or surgical treatment of such disease or bodily infirmity; or (c) bacterial infections, except infections which occur as the result of an: (1) accidental cut or wound; or (2) accidental ingestion of contaminated material.

 

Drugs - A loss that: (a) occurs during; (b) is due to; or (c) is related to; the covered person's (a) use of drugs, intoxicants, narcotics, barbiturates or hallucinogenic agents, unless such use is as prescribed by a doctor or if the loss results from purely accidental and unforeseen circumstances; (b) illegal use of drugs, intoxicants, narcotics, barbiturates or hallucinogenic agents; or (c) legal intoxication.

 

Self-Inflicted Injury/Suicide - A loss that: (a) is due to or is related to: (1) suicide; (2) an attempt at suicide; or (3) an intentionally self-inflicted injury; (b) occurs during an attempt at suicide; or (c) occurs while intentionally injuring oneself; while the covered person is sane or insane.

 

Treatment - A loss that: (a) occurs during; (b) is due to; or (c) is related to; any medical, dental or surgical treatment unrelated to the accident which would otherwise entitle the covered person to benefits.

 

War Conditions - A loss that: (a) occurs during; (b) is due to; or (c) is related to; the covered person's engagement in any of the following in a role other than as a victim: (a) in war, (b) an act of war, or (c) an armed conflict which involves the armed forces of one or more countries.

 

As a member of MOAA under age 70, you are eligible to apply for coverage for yourself, your lawful 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 the United States (except VT, WA and territories).

Insurance will terminate on the occurrence of the earliest of these conditions: if premium contributions due are not paid when due; 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; 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) or when such child becomes married, or is no longer financially dependent on the member. 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.

Coverage for you and your eligible dependents will become effective on the first of the month or after the day following approval of your enrollment form as specified by New York Life Insurance Company provided the initial contribution has been paid within 31 days of the date you are billed. (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 you become insured, you will be sent a Certificate of Insurance summarizing your benefits. 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!

This plan is underwritten by New York Life Insurance Company, under Group Policy No. G-29325-0, on Policy Form GMR-FACE/G-29325-0.

About New York Life Insurance Company

Yes. Please refer to Tell Me More page under the heading Exclusions and Limitations for a listing.

Issuance of this certificate is handled by mail. You can review the materials in the privacy of your home and purchase your insurance directly through the mail without meeting with a salesman. You can, of course, talk to a licensed representative if you'd like. Please call toll-free 1-800-247-2192.