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Estimated Cost1
Benefit Amount
1Estimated cost is for illustrative purposes only and may differ from the actual premium. Rates current as of 2020.
Estimated Cost1
Monthly Benefit Amount
Waiting Period
Plan Option
1Estimated cost is for illustrative purposes only and may differ from the actual premium. Rates current as of 2020.
We review your medical history to determine your health status. ExamOne, our paramedical services provider, will schedule a 30-minute call to review your health history. If a medical exam is needed, ExamOne will also arrange for a convenient time and location to collect your blood and urine specimens. In some cases, we may require additional financial or medical records.
You must be an eligible member to apply for coverage. You can contact your plan administrator at (800) 123-4567 if you require further information.
If applying for spouse or child insurance only, the member must have group insurance with New York Life.
To edit your application, you will be taken back to the page where the information was collected (your information entered so far will be saved). Would you like to continue?
A licensed advisor will assist you with the application process and answer any product questions you may have.
Plan Information: (800) 368-3484
Technical Help: [email protected]
If you are applying online, you are applying for insurance coverage using electronic processes that will include the use of electronic records and electronic signatures. New York Life is required by law to provide you with certain disclosures and information about your insurance application ("New York Life Online Privacy Policy"). Upon your consent, New York Life will deliver its online privacy policy to you electronically.
Please print or download "New York Life's Online Privacy Policy" and keep it for your records. Your consent also permits the general use of electronic records and electronic signatures in connection with your application.
If you do not consent to electronic delivery of New York Life's Online Privacy Policy, you must be provided with a paper/hardcopy version. However, New York Life cannot proceed with the acceptance and processing of your electronic application.
This notice contains important information that you are entitled to receive before you consent to electronic delivery. Please read carefully this notice regarding use of your consent to e-signature and records print a copy for your files.
By electronically signing this form you are consenting to the use of electronic transactions and electronic signatures on New York Life's website, as well as receipt of electronic versions of certain records. In addition you are agreeing to be bound by any consent or agreement you make or transmit through the internet on this website, including but not limited to any consent you give to receive records or communications from New York Life solely through electronic transmission.
You agree that, by using this site, your agreement or consent will be legally binding and enforceable and the legal equivalent of your handwritten signature. If you consent to electronic disclosures, that consent will apply to: (a) Any or all information that New York Life is required to give you or may receive from you in connection with your insurance, (b) this application, and (c) any associated notices, disclosures, or other documents.
You may withdraw this consent at any time. By withdrawing your consent New York Life cannot continue to process your electronic application. You may re-apply by downloading a paper hardcopy version of the application. If you wish to withdraw your consent to e-signatures or wish to receive have hardcopy/paper records or have New York Life's Online Privacy Policy sent to you—please contact the plan administrator.
In order to electronically complete your application/request for insurance, the following computer hardware and software requirements must be supported:
We know that keeping your personal information private is important to you. That's why the New York Life Insurance Company wants you to know how we protect the information you share with us and the measures we take to safeguard your information.
Our policies and procedures protect the privacy of current and former customers.
We will follow the privacy law in your state if that law is different than the policy described in this notice.
Click here to learn about our practices regarding the collection, use and disclosure of personal information about California residents who are covered by the California Consumer Privacy Act, and how covered individuals can exercise their rights.
In the normal course of business we may collect:
New York Life maintains physical, electronic, and procedural safeguards that meet state and federal regulations. Access to customer information is limited to people who need the information to perform their job responsibilities.
In order to most effectively protect you, the following security measures have been taken when managing data through this website:
We may share the information we collect about a person as allowed by law, including for normal business administration and related business services. The information may be shared:
We may disclose the information we collect when required or permitted by law, such as to:
We will never share your health information with third parties for marketing purposes.
This notice is in effect as of July 2, 2014. We reserve the right to change our privacy policy. You can always review the current privacy policy from the front page of the site, or you can contact us for a copy by writing to:
New York Life Insurance Company
Group Association Membership Division
44 South Broadway - 15th Floor
White Plains, NY 10601
Our goal is to ensure that your relationship with us is handled with the high degree of integrity and professionalism you expect. Thank you for your continuing trust in New York Life.
When you do choose to provide us with information at the site, we will use it in the following restricted ways:
When You Apply Online
When you apply online through our site you will have to identify yourself to us. As a result, the personal information you provide to us will be captured. This information will be used only for the purpose of processing your request. It will never be sold to any non-affiliated companies.
Technical Information
Like many websites, we collect limited anonymous information about our users and their systems. When users come to our site, we collect their IP addresses, browser types, the domain they came from, and their likely country of origin. This anonymous information is aggregated and is not associated with individual users. It is collected to help us analyze usage patterns, improve the site's overall performance, and provide information useful to our users.
Like other websites, this website uses cookies. A cookie is a text file containing a unique identifier that is placed on your computer when you visit our site. Cookies are used to store information so that our server can properly identify your computer. In order to protect your privacy, no personal information of any kind is stored. Cookies do not damage your system or files in any way.
Most browsers recognize when a cookie is offered and allow users to opt-out of receiving them. If you are not sure whether your browser has this capability, you should check with the software manufacturer or your Internet Service Provider (ISP). Please be aware that if you choose to disable cookies, you will not have access to many beneficial features of our website, including the Customer Service Area.
We employ services, which collect data remotely through the use of web beacons or tags embedded in the website content. These services then return completely anonymous data to New York Life within aggregated website traffic reports. The web beacons used by these services do not collect, gather, monitor or share any personal information about website visitors. They are merely the technology used to compile anonymous observations about our website's usage and visitor behavior. Web beacons are typically very , usually 1 by 1 pixel in size, and have no impact on the site's performance.
Our site provides links to other websites, including our subsidiaries and affiliates, our business partners, and third party sites containing information that we believe you may find useful. When you visit those sites, you will be operating under their individual privacy policies. We encourage you to carefully review the respective privacy policies.
We have implemented generally accepted standards of technology and operational security to protect personally identifiable information collected online from loss, misuse, alteration, or destruction. All information you supply on the site is encrypted during transmission and then stored on a secure server. We will not send any email messages to you that include your personal information, as these email messages cannot be encrypted and thus cannot be considered fully secure. Non-encrypted e-mail can be intercepted and viewed by other Internet users without your knowledge or consent.
New York Life employees follow a company wide security policy. Only authorized personnel are allowed access to personally identifiable information collected online and these employees have been trained to safeguard the confidentiality of this information.
Group life and disability insurance available. Get a quote below and start your application today!
Compare coverage options for group life or disability insurance. See how cost-effective coverage can be.
Think about what your family would need to maintain their current standard of living if you were no longer there to help provide for them. Your income is most likely critical to meeting monthly expenses. Apply for coverage up to $2 million in term life insurance with options to choose a 10- or 20-year term. We have choices that will meet your budget today while still providing peace of mind for your family's future.
10-Year Level Term Life Insurance | 20-Year Level Term Life Insurance
If you're sidelined by an accident, injury, or illness that prevents you from working, don't be tempted to take your paycheck for granted. Over 50% of Americans don't have enough savings to cover three months of living expenses if they're not earning any income. Take advantage of our coverage options for the most affordable plan.
At the heart of New York Life is a commitment to be there for our customers when they need us—whether today or decades into the future. Today, no U.S. life insurer has a higher financial strength rating than New York Life. For our customers, that means promises kept, and peace of mind for the millions of families and businesses who rely on us.
A.M. Best
Fitch Ratings
Moody's Investors Service
Standard & Poor's
Get a quote and submit your application online. It's never been easier.
For certain plans, ExamOne will call you to review your health history and possibly schedule a medical exam. Learn more
Decisions are made after all information is received. Your plan administrator will mail details upon approval.
This will determine your plan options and estimated cost.
We need to collect certain information about you even if you are applying for dependent-only coverage.
If you already have insurance inforce, select only the additional amount needed.
This is where high-level coverage category information will go. Information found here applies to all plans within this coverage category.
This is where marketing information about the plan will go. This should have a high-level gist about the plan and plan features.
This is where plan information about the applicant will go.
Add Insurance
Benefit Amount
Optional Benefit(s):
CIR Benefit Amount
Chronic Illness Rider (CIR): Accelerate up to 50% of the portion of your life insurance subject to the Chronic Illness Rider should you be permanently unable to perform 2 out of 6 activities of daily living or require substantial care due to permanent cognitive impairment.
Waiver of Premium (WP): Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.
This is where plan information about the applicant will go.
Add Insurance
Benefit Amount
Optional Benefit(s):
CIR Benefit Amount
Chronic Illness Rider (CIR): Accelerate up to 50% of the portion of your life insurance subject to the Chronic Illness Rider should you be permanently unable to perform 2 out of 6 activities of daily living or require substantial care due to permanent cognitive impairment.
Waiver of Premium (WP): Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.
Add Insurance
Benefit Amount
This is where high-level coverage category information will go. Information found here applies to all plans within this coverage category.
This is where marketing information about the plan will go. This should have a high-level gist about the plan and plan features.
This is where plan information about the applicant will go.
Add Insurance
Monthly Benefit Amount
Option A (5-Year Plan): Benefits are payable up to five years for total disabilities starting before age 60. For total disabilities starting at ages 60 through 62, benefits may continue up to age 65. For total disabilities starting at ages 63 through 74, benefits may continue for up to two years.
Option B (Career Plan): If you are totally disabled before age 63, benefits are payable up to age 65. There is a two-year maximum benefit for total disabilities starting at ages 63 through 74.
Waiting Period: The number of consecutive days you must be totally disabled by illness or injury before benefits commence. Coverage with a longer waiting period is less expensive.
This is where plan information about the applicant will go.
Add Insurance
Monthly Benefit Amount
Option A (5-Year Plan): Benefits are payable up to five years for total disabilities starting before age 60. For total disabilities starting at ages 60 through 62, benefits may continue up to age 65. For total disabilities starting at ages 63 through 74, benefits may continue for up to two years.
Option B (Career Plan): If you are totally disabled before age 63, benefits are payable up to age 65. There is a two-year maximum benefit for total disabilities starting at ages 63 through 74.
Waiting Period: The number of consecutive days you must be totally disabled by illness or injury before benefits commence. Coverage with a longer waiting period is less expensive.
1Estimated cost is for illustrative purposes only and may differ from the actual premium. Rates current as of 2020.
Please provide the following information to complete your application. You'll be able to review everything before submitting.
A representative of New York Life or ExamOne will call you to collect your health information and schedule any appointments. Your prompt responses will help speed up the review of your application. Learn more
We make sure your information is secure. You may find more details about your privacy and safety with us in our privacy policy.
Information provided here will help expedite the underwriting process.
Information provided here will help expedite the underwriting process.
IMPORTANT REPLACEMENT INFORMATION
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 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 insurance 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.
You have indicated that existing life insurance is being replaced. New York State requires that the Important Notice Regarding Replacement or Change Of Life Insurance Policies or Annuity Contracts (SM-NY60-IN-ND) form be completed and returned to the Plan Administrator within 10 days of this application for new insurance. If not received, the New York State Insurance Department requires that your application be automatically declined.
Please download/print this form, read and provide the requested information on the current insurance policy you intend to replace, sign and date the SM-NY60-IN-ND form, and mail back one copy of the form to - Plan Administrator at the address indicated below. Remember to keep a copy for your records!
Please indicate company name, monthly benefit amount, benefit period, and waiting period below:
Please indicate company name, monthly benefit amount, benefit period, and waiting period below:
A beneficiary can be a person or a trust. If naming more than one person as beneficiary, the percentage of death proceeds to be distributed to each must total 100%. If naming a trust as beneficiary 100% of proceeds will be paid to the trust.
You may add up to four primary and four contingent beneficiaries online. If no beneficiary is named proceeds will be paid in accord with policy provisions. If you wish to add beneficiary information at a later time, or need to add more, please contact the plan administrator at (800) 368-3484.
The beneficiary for dependent child(ren) coverage is the member.
I make the following beneficiary designation with respect to new insurance issued on the basis of this application. If you currently have insurance and wish to change your beneficiary, contact the plan administrator for the proper form.
I make the following beneficiary designation with respect to new insurance issued on the basis of this application. If you currently have insurance and wish to change your beneficiary, contact the plan administrator for the proper form.
Adding payment information now can speed up the application process. You won’t be billed until and unless you are approved for coverage. Payment applies to all individuals within each product.
Payment Frequency*
Estimated Cost1
Self: $0 Spouse: $0 Child(ren): $0
Payment Frequency*
Estimated Cost1
Self: $0 Spouse: $0 Child(ren): $0
Based on the billing frequency which I selected above, I request and authorize American Bar Endowment to make withdrawals against the account specified above or any other account subsequently named by me, and such bank to process these withdrawals as if I had signed them, for the purpose of collecting premium contributions due under each insurance plan indicated as AutoPay(EFT) in this Application Form.
1Estimated cost is for illustrative purposes only and may differ from the actual premium. Rates current as of 2020.
Check the information below and correct any mistakes. If you need to make changes, click the Edit button.
Please review the statements below and acknowledge you understand and consent to each. Once you submit your application, you will then be re-directed to DocuSign.
Confirmation #100001234567
Based on the plan(s) applied for, you will receive a call from ExamOne, our medical services provider, to review health history and possibly schedule a medical exam.
A confirmation notice has been sent to your email. Please download a copy of your application, as it can't be sent by email for security reasons.
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