American Association of Orthodontists Endorsed Group Term Life Insurance Plan



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The AAO-Endorsed Insurance Program meets my specific needs as an orthodontist, and is both cost-effective and convenient. Dr. Zachary Williams, Raytown, MO American Association of Orthodontists Endorsed Insurance Plan 1200 East Glen Avenue, Peoria Heights, IL 61616-5348 New York Life Insurance Company 51 Madison Avenue, New York, NY 10010

AAO-Endorsed Insurance Plan TERM LIFE PLAN DETAILS As your income increases and the cost of living continues to rise, you may need substantially more life insurance protection for those who depend on you. The most economical way of reaching that goal may be through Term Life Insurance, which provides the greatest amount of protection at the lowest cost. AAO members can enjoy the high benefits offered in the Term Life Insurance Plan through group coverage from New York Life Insurance Company. Choose An Amount From $100,000 To $2,000,000 You have the flexibility to choose any amount you need, in increments of $10,000 from $100,000 to $2,000,000. Coverage can be renewed until age 70. Your Plan Includes An Accelerated Death Benefit* This feature allows you to withdraw as much as 25% of your death benefit, in advance, should you be diagnosed with a terminal illness before age 74 and given less than 12** months to live. You may use this money however you like to help pay for medical care, make final arrangements, take a vacation, etc. There are no restrictions. Inflation Guard Inflation Guard allows you to increase your insurance amount by 10% for ten years, gradually doubling it. If accepted, the increase is automatically included each year if you are under age 70, not disabled, and insured for one full year. For the offer to be effective you do not need to reapply or re-qualify each year simply choose to accept or decline the additional 10%. However, once declined it cannot be resumed. Your total premium will increase annually to reflect your increased benefit amount at your then current age. Coverage Is Available For Your Spouse And Children The loss of a spouse can cause a serious financial burden to any family. Under the Term Life Plan, you may apply for your lawful spouse, under age 65 for the Term Life Plan, for a coverage amount from $100,000 up to $1,000,000 in $10,000 increments, not to exceed your benefit election. Additionally, your unmarried, dependent children who are between the ages of 15 days and 25 years may be covered for $5,000 or $10,000 of coverage each. No matter how many eligible children you may have, one annual premium of $17.50 for $5,000 or $35 for $10,000 covers them all. All dependent coverage is subject to approval by New York Life. ANSWERS TO IMPORTANT QUESTIONS Who Is Eligible? If you are an orthodontist under age 65, residing in the U.S., and an AAO member or a full-time student member, then you are eligible for coverage. How Will You Know You re Approved For Coverage? Once you are approved for coverage, you will receive a certificate describing your coverage, issued by New York Life on Policy Form GMR. When Will Coverage Become Effective? In order to become insured, you must provide satisfactory evidence of insurability and pay the required premium. Insurance will take effect on the first day of the month on or following the date your coverage and any dependent coverage is approved by New York Life, provided the initial premium deposit is paid within 31 days of that date and any person who is to be insured is performing the normal activities of a person in good health of like age and sex on such date. (Dependent children must be at least 15 days old and not hospitalized before Life Insurance can become effective.) How And When Could Your Coverage End? New York Life cannot change benefits, terminate coverage, or change premiums on an individual basis; it may do so on a classwide basis. The benefits provided under the group policy may be changed upon agreement with New York Life and AAO. While the group policy continues in force, you may renew your coverage until age 70. You must also continue to be an AAO member and pay your premium on time to renew your coverage.

In the event of your death, your insured dependents may continue coverage provided the appropriate premium is paid and they remain eligible. Also, a dependent s coverage ends when your spouse divorces or legally separates from you, when your coverage ends due to AAO membership ending, when a child marries, becomes self-supporting, or reaches age 25 or your spouse reaches age 70. All insurance terminates when you: (1) fail to make premium payments; (2) cease your AAO membership; or (3) the group policy is terminated. What Is The Accelerated Death Benefit?* This benefit is designed to provide terminally ill life insureds the option to have a portion of their Life Insurance benefit paid while they are still alive. The insured is then free to use that money any way he/she desires. To qualify for the Accelerated Death Benefit you must be insured under the AAO-endorsed Term Life Insurance Plan, and diagnosed as having a life expectancy of 12** months or less. Proof of terminal illness will consist of a statement from your physician and any additional medical information that New York Life believes necessary to confirm the insured s status. If the insured qualifies, he or she will be paid, in a lump sum, 25% of the benefit in force on the date of the approval of the request. The balance of the face of the policy will be paid to the insured s named beneficiaries upon the death of the insured. Only one Accelerated Death Benefit will be made during the insured s lifetime and any benefit payable for loss of life will be reduced by the amount paid by the Accelerated Death Benefit. Prior to applying for the Accelerated Death Benefit, insureds should consult with the appropriate social services agency and tax advisor. Receipt of the Accelerated Death Benefit may affect eligibility for public assistance programs and may be taxable. What Is My Right Of Conversion? You may convert your coverage to an individual plan offered by New York Life, regardless of physical condition or history, under the conditions stated in your certificate. This right of conversion is also available to your covered family dependents. Conversion must be requested within 31 days of the date you become eligible for this conversion. You ll be notified by the Plan Administrative Office and/ or New York Life if you become eligible for conversion. Can I Choose My Own Beneficiary? Yes. You may name anyone you choose as the beneficiary for coverage on your life. The member is automatically the beneficiary for spouse and children coverage. You may also change your beneficiary at any time by written request. If an insured member dies, Life Insurance then in force on his dependents may be continued as long as they otherwise remain eligible and make timely premium payments. It s easy to get personalized quotes for the Insurance Plan. Take just a few moments now to call the Plan Administrative Office. A trained representative will be happy to discuss your needs, answer your questions, and show you how affordable a term life plan could be. There is absolutely no obligation to apply for this plan just an opportunity to get the facts you need to make a decision. What s important is that your decision will be based upon very timely and relevant information.

Plan Rates ANNUAL PREMIUM RATES PER $1,000 OF INSURANCE FOR INSURED MEMBERS AND INSURED SPOUSES The Non-Smoker premium rate is only applicable to INSURED MEMBERS and/or INSURED SPOUSES for whom the required statement of their qualification for the Non-Smoker premium rate has been submitted to and determined to be acceptable by New York Life. * Renewal Only Current 2014 Premium Rates Insured Member s or Insured Spouse s Age Non-Smoker Smoker $100,000 & Over $100,000 & Over Less than 30 $.40 $.56 30.47.67 31.49.70 32.51.73 33.53.76 34.56.80 35.60.87 36.65.95 37.72 1.05 38.80 1.16 39.88 1.28 40.99 1.44 41 1.11 1.61 42 1.25 1.82 43 1.39 2.02 44 1.54 2.24 45 1.71 2.55 46 1.90 2.83 47 2.10 3.13 48 2.33 3.47 49 2.58 3.84 50 2.85 4.06 51 3.15 4.49 52 3.49 4.98 53 3.88 5.53 54 4.32 6.16 55 4.77 7.05 56 5.23 7.73 57 5.70 8.42 58 6.18 9.13 59 6.66 9.84 60 7.25 10.10 61 7.96 11.09 62 8.83 12.30 63 9.89 13.78 64 11.14 15.52 65* 12.42 16.58 66* 13.77 18.38 67* 15.19 20.28 68* 16.66 22.24 69* 18.22 24.32

Contact the Plan Administrative Office for more information. 800.622.0344 1200 East Glen Avenue, Peoria Heights, IL 61616-5348 AR Lic.#1322, CA Lic.#0F76076 RIGHTS TO CHANGE BENEFITS, RATES, OR TERMINATE THIS PLAN: Changes to the Group Policy are subject to agreement between New York Life and the Group Policyholder. Rates may be changed by New York Life on any premium due date on which benefits are changed but can only be done on a class-wide basis. A class is a group of people with the same age or gender. The Group Policyholder or New York Life may terminate the plan on any premium due date by giving 90 days advance notice. EXCLUSIONS AND LIMITATIONS Benefits will not be paid for death resulting from suicide within the first 12 months of coverage if New York Life can show that suicide was intended at the time of the application. For NY and MT Residents Only: Please call the Plan Administrative Office for additional information. * The Accelerated Death Benefit is not available to residents of Massachusetts. ** 24 months for residents of Illinois. The AAO incurs certain administrative expenses in connection with this endorsed plan. To provide and maintain this valuable AAO membership benefit, the AAO is reimbursed for these expenses. The AAO will receive a premium royalty as a result of participating in the program. The AAO Member Insurance Program is administered by Pearl Insurance. Coverage may vary by state. A complete description of coverage is contained in the Certificate of Insurance, including features, costs, eligibility, renewability, limitations, and exclusions. The AAO Group Insurance Program is underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010, under Policy Form GMR/FACE/G-14242-0. New York Life Insurance Company 51 Madison Avenue, New York, NY 10010 140591_AAO_TL_WEB_BRO