How do I apply?

1.  Print and fill out the application.  Be sure to sign and date the application/ medical authorization form.

2.  Use the premium table to decide on coverage and to figure the amount of your payment.  Request the amount of coverage you desire on the application.

Current Quarterly Premiums (Per $25,000 Of Coverage)

Age Member or Spouse
Under 30$6.00
30 - 346.23
35 - 39 7.73
40 - 44 10.80
45 - 49 16.95
50 - 54 27.83
55 - 59 46.35
60 - 69* 87.75
70 - 74* 135.68

All dependent children (regardless of how many) may be insured for one payment of $2.00.  Coverage is $500 per child age 15 days to age 6 months; $2,500 per child age 6 months through age 18; through age 22 if a full-time student).

Notes:

      • “Age” means attained age at the time of application.
      • Premiums increase as the insured enters a new age bracket.
      • Maximum coverage is $300,000 including any other coverage you may have through the GEVBP Group Term Life Plan
      • Upon attainment of age 70, benefits will reduce 50%.  Coverage terminates at age 75 if you are no longer working.
      • Premium for a spouse is based on the spouse’s attained age.
      • Spouse coverage may not exceed the member’s coverage and terminates at 75.
      • An administrative fee of $2.00 will be added to each account per quarterly billing cycle (contact Mass Benefits for billing options that do not contain this fee).

3.  Mail the signed form and check for your first semi-annual payment to:

                               Mass Benefits Consultants, Inc.
                               GEVBP Administrator
                               P.O. Box 828
                               Annandale, VA  22003-0828
 
Residents of Puerto Rico – Mail your application to the address indicated on page 2 of the application.
 

4.  Your insurance will become effective on the first day of the month after your application is approved and the required premium is paid.   Payment of premium contributions with your application does not mean that there is any insurance in force before the effective date as determined by New York Life.

 

Download Enrollment Form


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