Who is an eligible member?
You are eligible as a member if you are an employee or retiree of the United States Department of Agriculture (USDA), under age of 70 and reside in the United States or Puerto Rico. Your lawful Spouse under age 70 and dependent children from 14 days to age 19 (or to age 23 if full-time student).
How much insurance is available?
Employees and Retirees of the USDA may apply for coverage from $10,000 through $300,000 in increments of $10,000. You can apply for coverage for your lawful spouse from $10,000 through $300,000 in increments of $10,000 however; spouse coverage cannot exceed the member’s coverage amount. You can also apply for $3,000 in coverage for each of your dependent children, with one premium covering all dependent children. A dependent that is also an employee or retired employee must apply for member coverage. If both parents are insured as members, only one may request child coverage.
Your insurance will become effective on the first day of the month on or following acceptance of your application by New York Life Insurance Company, New York, NY 10010, “The Company”, provided the premium is paid within 31 days of being billed. The quarterly billing dates for this plan are October 1, January 1, April 1 and July 1. If your effective date is not one of the quarterly billing dates, your renewal premium will be pro-rated.
Just complete the application form. Occasionally, due to age, amount of insurance requested, or a previous medical history, a medical examination or other medical tests may be required at no cost to you. Remember, because you are a member of USDA/ESRA, you are eligible to apply for this life insurance. However, this does not mean that you will be accepted automatically. You must qualify under the company’s standards for acceptance.
You may name any beneficiary you choose (you are the automatic beneficiary for dependent coverage). Beneficiaries may be changed at any time by writing to Mass Benefits.
Once your insurance has been in force for two years, the company cannot contest coverage except for eligibility or failure to pay your premium. If you leave USDA for other employment, your policy will continue in force so long as premiums are paid.
Accelerated Death Benefit
The USDA/ESRA Group Term Life Insurance plan has an Accelerated Death Benefit feature designed to provide terminally ill insureds the option to have a portion of their life insurance paid while they are still alive. The insured is then free to use that money any way he or she desires.
To qualify, a terminally ill insured must provide New York Life with proof of terminal illness and anticipated life expectancy (12 months* or less), as well as any other medically necessary information requested. Additional details and limitations will be detailed in your Certificate of Insurance.
Please note that receipt of accelerated death benefits may affect eligibility for public assistance programs and may be taxable. Prior to applying for accelerated death benefits, insureds should consult with the appropriate social services agency, and assistance should be sought from a qualified tax provider.
NOTE: The Accelerated Death Benefit is not available to resident of Massachusetts.
*24 Months for residents of Illinois.
Waiver of premium.
If you become totally and permanently disabled before you reach age 60, and are unable to earn your salary for nine consecutive months, premium payments can be waived for you and your dependents for as long as the disability lasts.
If coverage for you, your spouse or your children is reduced or ends for any reason (except non-payment of premium or your written request), conversion can be made for the benefit amount that ended without evidence of insurability. However, application for conversion must be made to Mass Benefits or the company within thirty-one days after the last day for the period for which premiums have been paid. Contact Mass Benefits for details.
If death is caused by suicide during the first two years your policy is in force, premiums will be refunded. However, no benefit payments will be made. After two years, benefits are paid no matter what the cause of death.
Missouri residents: Benefits will not be paid for suicide within the first two years of coverage if New York Life can show that suicide was intended at the time of application.
Termination of coverage.
You may provide written request to cancel your insurance at any time. However, coverage can continue until you reach age 75 unless you fail to pay premiums.
Spouse coverage ends when your coverage ends or when he/she reaches age 75, or ceases to be you lawful married spouse.
Coverage for children will terminate when they are no longer eligible, or if coverage for you and your spouse is terminated for any reason.
Under any circumstances of termination, coverage for a member, spouse and dependent children will continue until the end of the period for which premiums have been paid.
Right to change benefits, rates or terminate the plan.
Changes to the group policy are subject to agreement between New York Life Insurance Company and the Policyholder. New York Life Insurance Company reserves the right to change the rates on any premium due date and on any date on which benefits are changed. However, your rates may change only if they are changed for all others in the same class of insureds under this group policy. For example, a class of insureds is a group of people with all the same issue age and gender.
ESRA incurs certain costs in providing oversight and administrative support for this sponsored plan. To provide and maintain this valuable membership benefit, it is reimbursed for these costs. ESRA also receives a fee in connection with this plan.
Simply complete the application form and return in the postage paid envelope. If you are approved, a Certificate of Insurance will be issued and you will be given a 30 day “free look” to determine if it meets your needs. If it does not, simply return the certificate to the plan administrator marked “cancel” and you will be issued a full refund of any premium paid.
Current Quarterly Premiums.
Quarterly premiums for members and spouses are determined by their respective ages on the effective date and each premium due date thereafter. Premium rates are current as of January 2016.
|AGE||Member or Spouse |
(per $10,000 up to $300,000)
|All Children $3,000*|
|35 - 39||4.40||$3.00|
|40 - 44||6.60||$3.00|
|45 - 49||11.20||$3.00|
|50 - 54||17.40||$3.00|
|55 - 59||27.80||$3.00|
|60 - 64||41.90||$3.00|
|65 - 69||82.30||$3.00|
|70 - 75**||194.60||$3.00|
• All eligible children, regardless of the number of children you have, are covered for $3,000 each by one quarterly payment of $3.00.
• A $2.00 administrative billing charge will be added to each quarterly premium notice.
**At age 70 benefits are reduced 50%. Quarterly premiums are billed at a rate of $80.89 per $5,000 and are for renewal only.
How to figure your quarterly premium:
Member Only: Age 33 $20,000 coverage
Quarterly Cost : 2 x $ 3.30 = $ 6.60
Family: Member age 37 $30,000 coverage 3 x $4.40 = $ 13.20
Spouse age 33 $20,000 coverage 2 x $3.30 = $ 6.60
$3,000 all children = $ 3.00
Quarterly Cost = $22.80
This brochure briefly describes the provisions of master group policy G-29165-0/FACE (policy form GMR) issued to the Government Employees Voluntary Benefit Trust (GEVBT). Complete details will be provided in your certificate of coverage that is provided to you upon approval.
How New York Life Underwrites Your Request for Insurance. Information regarding insurability will be treated as confidential. In considering your request for insurance, we will rely on the medical information you provide, and on the information you authorize us to obtain from your doctor, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB, Inc. (Medical Information Bureau). New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. We may make a brief report to MIB; however, we will not disclose our underwriting decision. 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 coverage can be approved. MIB is a nonprofit, membership organization of life insurance companies, which operates an information exchange on behalf of its members. When you apply for insurance or submit a claim for benefits to a MIB member company, medical or non-medical information may be given to the Bureau, which may then be furnished to member companies. If we cannot provide the coverage you requested, we will tell you why. If you fee 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 Fair Credit Reporting Act Procedures. If you question the accuracy of the information provided by MIB, you may contact MIB at 866-692-6901 (TTY 866-346-3642) and seek a correction. MIB’s information office is P.O. Box 105, Essex Station, Boston, MA 02112. For Canadian residents, the address is 330 University Avenue, Suite 403, Toronto, Canada M5G 1R.
PROTECTED PERSONS (1) have a right of access to certain CONFIDENTIAL ABUSE INFORMATION (2) we maintain our files and they may choose to receive such information directly. You have the right to register as a PROTECTED PERSON by sending a signed request to the Administrator at the address listed on the application. Please include your full name, date of birth and address. (1) PROTECTED PERSON means a victim of domestic abuse: who has notified us that he/she is or has been a victim of domestic abuse; and who is an insured or prospective insured. (2) CONFIDENTIAL ABUSE INFORMATION means information about: acts of domestic abuse of abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an application or insured as family member, employer or associate of a victim of domestic abuse or a person with whom an applicant or insured is known to have a direct, close personal, family or abuse-related counseling relationship.
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 we 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.
NEW YORK LIFE INSURANCE COMPANY 4/03 ed.