How to Apply

1. Print and fill out the Application Form. 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 Semi-Annual Rates for Members and Spouses

(Per $25,000 Unit Coverage to a Maximum of $300,000)

(as of January 2017)

AGEPREFERRED (1)STANDARD (2)
Under 30$9.00$14.00
30 - 3412.0019.00
35 - 39 15.00 25.00
40 - 44 21.00 36.00
45 - 49 31.00 56.25
50 - 54 48.00 87.00
55 - 59 74.00 135.00
60 - 64* 134.00 215.00
65 - 74* 175.00 273.00
Children$1.25$2,500 Coverage
$2.50$5,000 Coverage

* 60+ rates are for renewal only.  Upon attainment of age 70, benefits will reduce 50% (premiums do not reduce). Coverage terminates at age 75.

(1) Preferred rates are for non-tobacco/nicotine users.

(2) Standard rates are for tobacco/nicotine users.

Notes:

      • “Age” means attained age at the time your coverage is approved.
      • Premiums increase as the insured enters a new age bracket.
      • Maximum coverage is $300,000 including any other coverage you may have through the UPMA Group Term Life Plan
      • Premium for a spouse is based on the spouse’s attained age. Spouse coverage may not exceed the member’s coverage.
      • An administrative fee of $2.00 will be added to each account per semi-annual billing cycle (contact Mass Benefits for billing options that do not include this fee).

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

Mass Benefits Consultants, Inc.
NAPUS Administrator
P.O. Box 828
Annandale, VA 22003-0828 
 

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 Application


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