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These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.
Accidents. Television and newspapers report them every day. But what if one happened to you? Would your family have the financial resources to survive the crisis? If you travel a great deal in your work … or if you are subject to possible injury on the job … you may need the MOAA Group Accidental Death & Dismemberment Insurance Plan. It helps protect you and your insured family members by providing accident protection that covers you year round … anywhere in the world.
Acceptance is guaranteed for eligible members and dependents.
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These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.
As a member of the Military Officers Association of America (MOAA) under age 70, you are eligible to apply for this Group Accidental Death & Dismemberment (AD&D) 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).
Your Group AD&D benefit options can deliver the extra cash benefits your loved ones would need if you fell victim to a sudden accident.
You may select a Principal Sum ranging from $50,000 to $500,000 (in units of $50,000) for yourself–at economical group rates. You have a choice of two Plans–the Member Only Plan or the Family Plan. The Member Only Plan pays benefits for covered accidental death or injury for you alone. The Family Plan is designed to cover all of your eligible dependents for benefit amounts based on a percentage of your Principal Sum.
If you choose the Family Plan, benefits for your spouse will equal 50% of your base Principal Sum and each child will be covered for 10% of your base Principal Sum. If you have no eligible children, your spouse’s benefit increases to 60%. If you do not have an eligible spouse, each child would be covered for 15% of your base Principal Sum. The MOAA AD&D Plan stands as an important safety net to help MOAA families rebuild their lives after a covered accident. But it delivers more than basic protection. MOAA also negotiated a broad package of additional benefits— automatically included in your coverage.
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.
Acceptance is guaranteed to all eligible MOAA members and their eligible family members. No medical exam is required. No health questions asked.
YOUR COST
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 Plan** (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 |
| 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 the Family Plan. 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 the Family Plan, 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 the Family Plan, the spouse coverage increases to 60% of the Member Principal Sum (instead of 50%).
PLAN FEATURES
This MOAA-endorsed AD&D plan 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 Plan.
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.
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 their accident:
Loss of: |
% of Principal Sum |
|---|---|
| Life; or two limbs; or sight in both eyes; or both speech & hearing; movement in upper & lower limbs; or one limb and sight of one eye | 100% |
| Movement of both lower limbs | 75% |
| One limb; or sight of one eye; or speech; or hearing; or movement of both upper and lower limbs on one side of body | 50% |
| Thumb/index finger of one hand | 25% |
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.
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 premium contributions shown reflect the current rate and benefit structure. Premium contributions may be changed by New York Life Insurance Company on any premium due date an any date on which benefits are changed. However, your rates may change only if they are changed for all others in the same class of insureds. For example, a class of insureds in a group of people all with the same issue age.
EFFECTIVE DATE: Coverage for you and your eligible dependents will become effective on the first of the month following approval of your enrollment form as specified by New York Life Insurance Company provided the initial contribution is 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.)
TERMINATION: You may maintain your coverage for life provided: the Group Policy 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 and pay your premium on time. Coverage for your dependents terminates when your coverage ends, if you stop paying premiums, or when they no longer meet the eligibility requirements. (For a 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 becomes married, or is no longer financially dependent on the member). Insurance for a covered person will end when the Principal Sum has been paid.
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. The beneficiary for dependent coverage is you, the member.
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 as prescribed by a physician; illegal use of drugs or intoxicants, or legal intoxication; any declared or undeclared war or act thereof; Except for the reduced Civil Aircraft Benefit (see PLAN FEATURES), operating, riding in or descending from any aircraft except when riding as a passenger, Except, for any covered person recalled to service or serving in the reserves, this exclusion does not apply to losses that occur while traveling as a passenger on any transport type aircraft operated and/or contracted by the Air Mobility Command; physical or mental sickness or medical/surgical treatment thereof; suicide or intentionally self-inflicted injury while sane or insane.
Principal sums reduce after age 69, as described above within "Current 2019 Monthly Premiums".
CIVIL AIRCRAFT BENEFIT: This benefit is not payable for losses resulting from or in connection with: acrobatics, stunt flying, racing or endurance testing; or crop dusting, seeding, spraying, firefighting, exploration, pipe/power line inspection, hunting or herding, photography, banner towing, experimental testing or flight requiring an FAA permit or waiver, even if granted.
ADDITIONAL INFORMATION: This information is only a brief description of the principal provisions and features of the MOAA Group Accidental Death and Dismemberment Insurance Plan. The complete terms and conditions are set forth in the Group Policy issued by New York Life Insurance Company to the Military Officers Association of America. When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the plan.
MOAA is compensated in connection with this sponsored group plan to provide and maintain this valuable membership benefit.
Endorsed by: MOAA
Underwritten by: New York Life Insurance Company 51 Madison Avenue, New York, NY 10010
Under Group Policy G-29325-0 on Policy Form GMR-FACE/G-29325-0
About New York Life Insurance Company
The information on this site describes benefits available through this insurance program and is intended to provide a brief overview of the coverage. In the event of any conflict or inconsistency between the information on this site and the information contained in the underlying plan documents, the plan documents will in all respects control and govern. If any provision is not explained or only partially explained, your rights will always be determined under the provisions of the underlying plan documents. Insurance coverage and availability may differ by state. For complete plan details, please contact the Program Administrator, Military Officers Association of America (MOAA) Insurance Plans at 1-800-247-2192, Monday-Friday, 7:30 a.m. - 5:00 p.m. and Saturday, 8:00 a.m. - 1:00 p.m. Central Time.
We're here to help! Please contact us in whatever manner is most convenient for you.
| Address Mercer Consumer 12421 Meredith Drive Urbandale, IA 50398 |
|---|
| Phone 1-800-247-2192 |
| Hours M-F 7:30a-5p, Sat 8a-1p CT |
| Email moaa.service@mercer.com |
| Insurance Company Address New York Life Insurance Company 51 Madison Avenue New York, NY 10010 |
| Website http://www.mercer-web.com/products/nyl/nyl.html |
Who is eligible for this insurance?
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).
When does the coverage end?
When is the coverage effective?
What if I have second thoughts after I apply?
What company underwrites this plan?
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.
Are there any exclusions?
Will I need to meet with a salesman?
Your Association is compensated in connection with this sponsored group plan to provide and maintain this valuable membership benefit.
Underwritten by New York Life Insurance Company, under Group Policy No. G-29325-0, on Policy Form GMR-FACE/G-29325-0.
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