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 or 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 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 (866) 692-6901
. For Canadian residents, the address is: MIB Information Office, 330 University Avenue, Suite 501, Toronto, Ontario, Canada M5G 1R7, telephone (416) 597-0590
. Information for consumers about MIB may be obtained on its website at www.mib.com
For NM Residents: PROTECTED PERSONS 1 have a right of access to certain CONFIDENTIAL ABUSE INFORMATION 2 we maintain in our fies 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 person or prospective insured person.
2 CONFIDENTIAL ABUSE INFORMATION means information about: acts of domestic abuse or abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant 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 relationship.
Pamela Oyler, an employee of USBA, is a licensed Arkansas Agent whose Insurance License Number is 347836.
Pamela Oyler, an employee of USBA, is a licensed California Agent whose Insurance License Number is 0G58528.
Male rates apply to all Montana residents regardless of sex.
Puerto Rico Residents
Application forms and premium payments are to be sent to:
Global Insurance Agency, Inc.
P.O. Box 9023918
San Juan, PR 00902-3918
Licensing and Area Limitations
New York Life and USBA are licensed to conduct business in the 50 United States, the District of Columbia and Canada. New York Life is domiciled in New York State and its NAIC Identification Number is 66915. USBA is domiciled in the state of Kansas.
Area Limitations for Certain Group Life Plans
USBA’s Group Life Plans are generally available in all 50 States, the District of Columbia, Puerto Rico and Canada (except Quebec). The following plans are not currently available in the states indicated.
- USBA Smart Value 10 Year Group Level Term - Not available in New York.
- USBA Long Term 20 Year Group Level Term - Not available in New York and Washington State.
- USBA Fifty Plus Group Whole Life - Not available in Washington State to members age 65 and over.
Important Replacement Information for New York Residents
It may not be in your best interest to replace existing life insurance policies or annuity contracts in connection with the purchase of a new life insurance policy, whether issued by the same or a different insurance company. A replacement will occur if, as part of your purchase of a new life insurance policy, existing coverage has been, or is likely to be, lapsed, surrendered, forfeited, assigned, terminated, changed or modified into paid-up or other forms of benefits, loaned against or withdrawn from, reduced in value by use of cash values or other policy values, changed in the length of time or in the amount of insurance that would continue, or continued with a stoppage or reduction in the amount of premium paid. Prior to completing a replacement transaction, you may want to contact the insurance company or agent who sold you the life insurance or annuity contract that will be replaced, to help you decide whether the replacement is in your best interest.
There are no membership fees and no annual dues with USBA. And only members can qualify to apply for coverage under our Group Life Insurance Plans.
To qualify for USBA membership you must be … Active Duty or a Retired member of the U.S. Military, in the Reserves (including I.R.R. and National Guard), an Honorably Discharged Veteran, or a Federal Civilian Employee … or the spouse of any of the above qualifying categories.
To apply for USBA-sponsored Group Life coverage, you must be age 18 to 64. *(Note: age 64 is the oldest you can be to apply for coverage, although all of our plans stay in effect well past that age.)
Your children may also be covered up to age 23, or until they marry. In some cases they can then qualify for Associate Membership on their own, without meeting any of the above qualifying categories for regular USBA membership.
If you have questions about your qualifications, just call one of our trained Member Service representatives at (877) 297-9235.
*NOTE: USBA Fifty Plus Group Whole Life is available to members through age 80. Please refer to Plan descriptions for applicable state limitations/restrictions.