IMPORTANT INFORMATION ABOUT YOUR GROUP TRAVEL ACCIDENT PLAN
(Please read and print for your records)
ACCEPTANCE IS GUARANTEED
There is no physical examination to take or health questions to answer. As a CSEA member residing in the U.S., you cannot be turned down for this plan - regardless of your health, occupation, or the number of miles you travel annually.
You cannot be singled out for cancellation or a rate increase, regardless of the number of claims you make, your age, or changes in your health.
ENROLL IMMEDIATELY FOR EARLIEST EFFECTIVE DATE
Accidents are unpredictable, so request your CSEA protection today. Your coverage starts on the first day of the month following approval of both your Request and receipt of first Payroll/PERS deduction*.
$200,000.00 SAFETY NET FOR $5.50 A MONTH*
CSEA Recommends "All Of Us" Benefit Option
Please strongly consider signing up both you and your family when you enroll in your Travel Accident Benefits (See Terms Tab for Dependent Coverage amounts).
You're all guaranteed acceptance in the program. You all travel – whether it's across town for groceries, to school, to another state for family vacations, or across the country for work.
Because there's no telling when (or who) an accident will strike next, CSEA recommends you consider full family protection with the "ALL OF US" benefit option.
COVERAGE FOR YOUR DEPENDENTS
CSEA benefits can be extended to your family. The "ALL OF US" option gives coverage to your spouse, and also covers all of your unmarried dependent children, too - no matter how many kids you have - up to age 19, or up to age 25 if a full-time student. Spouse benefits equal 50% of Member's benefits if you have no children. If you have children, spouse benefit equals 40% of member benefit and children's benefit equals 10% of member's benefit. If you have no spouse, children's benefit equals 10% of member's benefit. For all covered persons, benefits reduce 50% at age 70, and another 50% at age 75. Total maximum benefit payable will be reduced to $10,000.00 (includes combination of principal sum and In-Hospital confinement expenses) upon reaching age 80 for a member and a spouse. Premiums remain the same.
TERMINATION OF COVERAGE
Your coverage will remain in force as long as the Master Policy remains in place and is not amended to end insurance for the group of individuals to whom you belong, you pay the premium when due, and you remain a Member of the CSEA. Coverage for your dependents ends when your coverage ends or when the eligibility requirements cease being met.
COVERAGE AT LATER AGES
Total maximum benefit will be reduced to $10,000.00 (includes combination of principal sum and In-Hospital confinement expenses) upon reaching age 80 for a member and spouse. Premiums remain the same.
This CSEA plan is for Travel Accident Coverage and was not designed to provide for the following:
The policy does not cover any loss resulting from: intentionally self-inflicted injury, suicide or attempted suicide, whether sane or insane; war or act of war, whether declared or undeclared; injury sustained while full-time in the armed forces of any country or international authority; injury sustained while traveling in, on, or falling or descending from any aircraft unless traveling solely as a passenger; injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a prescription, including sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless the drug is taken as prescribed or administered by a licensed physician; injury sustained while committing or attempting to commit a felony; injury sustained as a result of being legally intoxicated from the use of alcohol.
NOTE: This information explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by New York Life Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the Policyholder. This program may vary and may not be available to residents of all states. This is Limited Accident only coverage.
COMMON CARRIER means a conveyance operated by a concern, if: (a) such concern is organized and licensed for the transportation of passengers for hire, including a commercial passenger plane, taxi, bus, cruise ship, subway or train; and (b) such conveyance is operated by an employee of such concern.
PRIVATE PASSENGER VEHICLE means a validly registered four-wheeled privately owned or Employer-owned car, jeep, truck, RV, pickup or van, including a sport utility vehicle (SUV), that is not licensed commercially or being used for racing, or acrobatic or stunt driving.
IN-HOSPITAL BENEFIT - A benefit of $200 a day is payable if the covered member is confined to a Hospital because of a covered common carrier accident. Benefits for private passenger vehicle accidents are $100 a day for the covered member. The maximum benefit period is two years from the date of the accident. For Dependents, the following percentage of the member's In-Hospital Confinement Benefits are payable: Spouse only-50%; If you have children and spouse: Spouse benefit equals 40% and children's benefit equals 10%; if no spouse, children's benefit equals 10%.
"Hospital" means a licensed institution primarily engaged in providing medical services for inpatients, if such institution has (a) permanent facilities for diagnosis and surgery; (b) 24-hour-a-day nursing service by registered professional nurses on duty or call; and (c) continuous supervision by a staff of one or more Doctors. "Hospital" does not include an institution licensed or used principally for treatment or care of drug addicts or alcoholics, a convalescent home, nursing home, a rest home, a place for the aged or an extended care facility.
"Doctor" means: (a) a licensed physician, dentist, osteopath, optometrist, podiatrist, psychologist, registered clinical psychologist, psychiatrist, chiropractor, licensed or certified physiotherapist; (b) a Christian Science Practitioner, currently listed and certified by the First Church Of Christ, Scientist, of Boston, Massachusetts, while such practitioner provides in-person treatment; or (c) a licensed medical practitioner whose services are required to be covered by law and who renders such services within the scope of his or her license. "Doctor" does not include the covered person or his or her: parent; guardian; spouse; brother; sister; natural, step, adopted or foster child; grandparent; in-law; or a person residing in the covered person's household.
SEAT BELT BENEFIT - New York Life will pay an additional benefit of 10% of the Amount Of Insurance if a covered person's death is a Covered Loss that occurred while: (a) traveling in a private passenger vehicle; (b) the seatbelt was in proper use by the covered person at the time of the accident as certified in the accident report or by the investigating officer; and (c) the driver of the private passenger vehicle was a licensed driver and was not intoxicated, impaired or under the influence of alcohol or drugs. The benefit amount is stated on the Schedule page(s).
A copy of the accident report made out by the police must be submitted to New York Life.
AIR BAG BENEFIT - If the Seat Belt Benefit is payable as stated above, New York Life will pay an additional benefit of 10% of the Amount Of Insurance if the covered person was positioned in a seat protected by a properly functioning, original, factory-installed airbag system that inflates on impact when the accident occurred. The benefit amount is stated on the Schedule page(s).
Coverage is only available to residents of the U.S.
This sponsored CSEA Group Travel Accident Insurance Plan is underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010 under Group Policy GMR, Policy Number G-29148-0 TA. For more information on this coverage see the Certificate of Insurance.
Endorsed by: California State Employees Association
CSEA incurs certain administrative expenses in connection with this sponsored program. To provide and maintain this valuable membership benefit it is reimbursed for such expenses.
California State Employees Association
Administered by A.G.I.A., Inc.
PO Box 9997 Phoenix, AZ 85068-0997
A.G.I.A, Inc. is licensed and authorized to transact business in all 50 United States and the District of Columbia. Their state of domicile is California.
J. Christopher Burke CA Insurance License #0F709407. J. Christopher Burke AR Insurance License #8876308.
New York Life is licensed/authorized to transact business in all the 50 United States, District of Columbia, Puerto Rico and Canada. However not all group plans it underwrites are available in all jurisdictions. Please check the plan details for current availability.
New York Life Insurance Company's state of domicile is New York and their NAIC ID # is 55915.
This is not a policy or Certificate of Insurance. It merely summarizes the principal features and is for informational purposes only. The complete terms and provisions of coverage and the conditions under which it may be kept in force are contained in the group Master Policy issued by New York Life Insurance to the California State Employees Association.
* Payroll deduction is only available for SEIU, CSUEU, ACSS, and Retirees. All other groups leverage auto-renewal through automatic bank deduction or credit card.