Effective Date of Coverage
Your CSEA Final Expense Life Plan benefits can begin following approval from New York Life. Your coverage will take effect on the first day of the month after your application has been approved and first payment has been received, via payroll deduction or from CalPERS if you are retired. Once approved you will receive a Certificate of Insurance describing the terms and conditions of your coverage. If you are not working full-time on the date your insurance is scheduled to become effective, your insurance will not become effective until you return to full-time work. However, if you are not actively working due to a non-working day, you will still become insured on the scheduled effective date provided you would have been able to do your regular job on that non-working day.
Effective Date of Coverage
If you decide your Endorsed CSEA Final Expense Life Plan isn't for you, just let us know within the first 30 days. We'll promptly refund your premiums and invalidate your coverage provided there has been no claims … no questions. No obligation.
When Coverage Ends
Your coverage will end upon Policy termination age as long as you continue to pay premiums when due, remain a CSEA member, and the Policy remains enforced.
You can name any beneficiary you wish for member coverage. You may change this beneficiary at any time, by written request. Your beneficiary is the person(s) last designated by you in writing, and recorded by or on behalf of New York Life Insurance Company. You are the automatic beneficiary for dependent insurance, as described in the Certificate of Insurance. If you wish to name another beneficiary for dependent spouse or child insurance, contact the administrator at +1-800-296-2732) for the applicable form.
How New York Life Obtains Information and Underwrites Your Request For Final Expense 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 +1-866-692-6901 (TTY +1-866 346-3642). For Canadian residents, the address is: MIB Information Office, 330 University Avenue, Suite 501, Toronto, Ontario, Canada M5G 1R7, telephone +1-416-597-0590). Information for consumers about MIB may be obtained on its website at www.mib.com.
NEW YORK LIFE INSURANCE COMPANY 6.15 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.
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 domicle is California. J. Christopher Burke California Insurance License #0F70947. J. Christopher Burke AR Insurance License #8876308.
This Final Expense Whole Life Insurance Plan is underwritten by:
New York Life Insurance Company
51 Madison Avenue
New York, NY 10010
Under Group Policy G-30383-0 on policy form GMR-FACE/G-30383-0.
New York Life is licensed/authorized to transact business in all of 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 benefits available and is for informational purposes only. The complete terms and provisions of coverage and 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.