2007-2008 IEEE Multiplan Brochure

The IEEE Group 20-Year Level Term Life Insurance Plan Application & Information Now you can plan your family’s financial security for the long haul with the new IEEE Group 20-Year Level Term Life Insurance Plan. This Plan was specifically designed to allow members to lock in important protection, without any worries of rate increases or benefit decreases for 20 years. Features of the Plan include: • Affordable group rates guaranteed to never increase for a full 20 years • Benefit level guaranteed to never decrease for 20 years • Flexible coverage amounts available up to $2 million • Lower rates available for members choosing higher levels of coverage and who qualify as nonsmokers Learn more about the Plan features, costs, eligibility, renewability, limitations and exclusions in the enclosed information. Member Planning Kit 42714/42715/1001/44375-S Complete this form and return to: Administrator, IEEE Group Insurance Program P.O. Box 10374 Des Moines, IA 50306-9598 For residents of Puerto Rico, the address is: Global Insurance Agency, Inc., P.O. Box 9023918, San Juan, PR 00902-3918 APPLY NOW to make the new IEEE Group 20-Year Level Term Life Insurance Plan part of your long-term plans. TO APPLY: GROUP 20-YEAR LEVEL TERM LIFE INSURANCE APPLICATION FOR IEEE MEMBERS AND THEIR FAMILIES Call: 1-800-493-IEEE (4333) Email: IEEE@Marshpm.com QUESTIONS? SEND NO MONEY NOW! PLEASE PRINT IN INK OR TYPE ALL ANSWERS. DO NOT USE CORRECTION FLUID OR GEL PENS. INITIAL AND DATE ANY CHANGES YOU MAKE. 1. Member Information: FULL NAME: LAST FIRST (Please make any corrections to your full name and street address if shown below.) MI Request for Group Insurance from NEW YORK LIFE INSURANCE COMPANY 51 Madison Avenue New York, NY 10010 STREET ADDRESS CITY SOCIAL SECURITY #: PHONE NUMBERS: STATE (OR PROVINCE) I Group Term Life I Group 10-Year Level Term Life I Group 20-Year Level Term Life I Level Term Life to Age 65 I Universal Life I Permanent Whole Life Details: Member: I Yes, Country(ies) For how long? I No Spouse: I Yes, Country(ies) For how long? I No DATE OF BIRTH: MO. DAY YR. Are you presently insured under any IEEE Life Plans? I Yes I No If “Yes,” indicate which Plan(s) and provide details (person insured and amount of insurance): MARITAL STATUS: I Married I Divorced I Single I Widowed ZIP CODE Home Work Fax ( ) ( ) ( ) I I I -I I -I I I I Does any person proposed for insurance intend to reside outside the U.S. or Canada in the next 12 months? MEMBER: SPOUSE*: / / CHILD(REN)*: / / (name if proposed for insurance) First/MI/Last (name if proposed for insurance) First/MI/Last (name if proposed for insurance) First/MI/Last / / ft. in. lbs. HEIGHT: WEIGHT: ft. in. lbs. ft. in. lbs. IM IM IM IM SEX: IF IF IF IF / / G-29215-0 * See Plan Information/Plan Details for definition of eligible dependents. If more than two children are proposed for insurance, attach a separate sheet. Please sign and date the additional sheet. ft. in. lbs. GMA-PRS1 PLEASE COMPLETE ALL PAGES AND SIGN THE LAST PAGE ± PAGE 1

Table of Contents Feed for the Digital Edition of 2007-2008 IEEE Multiplan Brochure

Group Term Life Insurance Plan Group 10-Year Level Term Life Insurance Plan Group 20-Year Term Life Insurance Plan Group Disability Income Insurance Plan Professional Liability Insurance Plan Long-Term Care Plan Additional Plans & Information

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