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Simplified Life Insurance

ATTENTION: If applying for Life or Disability as a California or New York resident please contact Hagan Benefits at 877-285-4445 or see the bottom of this page for a specified application.

You are Prepard to Practice ...
But Are you Prepared for the Future?

Exclusive Simplified Issue Life Insurance

Life insurance can be one of the most important coverages you can purchase, especially when it comes to your family's security. As your family changes over time, the amount of insurance you need may also change. Now is a good time to review your Life insurance protection and take advantage of the additional coverage available to members of ACEP.

Simplified Issue Life Insurance Features:

Up to $150,000 of Life Insurance
Only 3 Medical questions to answer
Under Age 60 may apply
Policy age limit is 70
Smoker and Non-Smoker rates available

Don't Wait. Plan Ahead.

Who is Eligible?

All Active Members of ACEP who are:

Under the age 60 and are citizens or legal residents of the United States, its territories and protectorates and Actively-At-Work on a full-time basis (at least 30 hours per week) for four consecutive weeks.

What date will it become effective?

Your coverage becomes effective the first of the month following our receipt of your activation form and first premium payment. This subject to the Deferred Effective Date provision.

Deferred Effective Date:

If on the date that You are to become covered under The Policy or covered for increased benefits under The Policy, You are:

not Actively-At-Work; or
unable to carry on all the normal and customary activities of a person of like age and gender, in good health and if not employed;

You will not be so covered until the earlier of:

the first day of the month on or next following the date You have been Actively-At-Work for 90 consecutive days; or
the first day of the month on or next following the date You have been able, for 90 consecutive days, to carry on all the normal and customary activities of a person of like age and gender, in good health.

Can I Request a Change in Coverage?

If You give Us an application for a change in coverage for which You are eligible and pay the required premium, the change will become effective on the first day of the month on or next following the later of:

the date We receive the application; or
if Evidence of Insurability is required, the date We determine that You are insurable.

Helping to Secure Your Way of Life

What are the Exclusions?

Suicide

If You commit suicide while sane or insane:

during the first two years following Your effective date of coverage under The Policy, We will only pay Your Life Insurance Benefit in an amount equal to the premium paid for coverage to the date of death; and
during the two years immediately following an increase in coverage under The Policy, We will only pay Your Life Insurance Benefit in an amount equal to the Amount of Life Insurance in force prior to the increase, plus an amount equal to the premium paid for the increase to the date of death.

The full Life Insurance Benefit Amount for You is payable if You are covered under The Policy and commit suicide after the two year period.

The chart below outlines the annual premiums that apply to each newly insured person under the new Simplified Issue Policy. All premiums are based on each person's smoker status and age at the time of issuance and change when the person attains a new age bracket. Rates are subject to change at any time with 30 days prior notice from The Hartford.

Individual Annual Life Premiums
	per $1,000 Benefit Amount
	Non-Smoker	Smoker
Under 30	$1.13	$2.04
30-34	$1.20	$2.32
35-39	$1.44	$2.95
40-44	$2.13	$4.51
45-49	$3.29	$7.04
50-54	$5.06	$10.86
55-59	$8.85	$18.47
*60-64	$12.41	$24.55
*65-69	$20.20	$37.35

*Renewal Premiums Only

Rates and/or benefits may be changed on a class basis. Rates are based on the attained age of the insured Person and increase as you enter each new age category. You are considered a non-smoker if you have not smoked cigarettes, cigars or a pipe, or used chewing tobacco, nicotine chewing gum or snuff during the 12 months before submitting an application for insurance.

When will my policy Terminate?

Coverage will end on the earliest to occur of the date The Policy terminates; or the Premium Due Date on or next following the date You cease to be an active member of ACEP or attain Policy Age Limit; the date You are no longer in a class eligible for coverage, or the class is cancelled; or the Premium Due Date that You fail to pay any required premium, subject to the 31-day Individual Grace Period.

Individual Grace Period:

You will be allowed an Individual Grace Period of 31 days from the Premium Due Date for payment of each premium due after the initial premium. Your insurance will be continued during the Individual Grace Period. The Individual Grace Period will not continue coverage beyond a date shown in the Termination provision.

Notice Of Policy Cancellation:

The master policy will be issued on an optionally renewable basis, and may be cancelled at any time by The Hartford or the group policyholder, subject to 60 days advance notice from either party.

NOTICE OF INSURANCE INFORMATION PRACTICES

In order to properly underwrite and administer your application for insurance coverage, we must collect certain information concerning your insurability. You are our most important source of information, but we may also contact other sources such as medical professionals and institutions, employers and other insurance companies. While all information regarding your insurability will be treated as confidential, in some situations, and in compliance with applicable law, we may disclose necessary items of information to third parties without your specific authorization.

INVESTIGATIVE CONSUMER REPORTS

As part of our procedure for processing your application, an investigative consumer report may be prepared by an outside insurance reporting organization. Personal information may be collected from others regarding your general reputation and lifestyle. If an interview is conducted with someone other than you, we will inform you of your right to be interviewed in connection with the preparation of the investigative consumer report. You have the right to send a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

PERSONAL HISTORY INTERVIEW

To provide you, our client, with the best possible service, we may also conduct what we call a personal history interview. This is a phone call placed from our underwriting office. Its purpose is to make sure that the application information is complete. Our interviewers are trained to conduct their calls in a friendly, professional manner. The nature of the information discussed is always treated as personal and confidential and will only be used to assess your eligibility for insurance.

MEDICAL INFORMATION BUREAU (MIB) PRE-NOTICE

Information regarding your insurability will be treated as confidential. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may, however, make a brief report thereon to the MIB, Inc., formerly known as Medical Information Bureau, a not-for-profit membership organization of insurance companies, which operates an information exchange on behalf of its members.

If you apply to another MIB member company for life or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request, will supply such company, with the information about you in its file. Upon receipt of a request from you, MIB will arrange disclosure of any information in your file. Please contact MIB at (866) 692-6901 (TTY (866) 346-3642). If you question the accuracy of the information in MIB's file, you may contact MIB and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of MIB's information office is 50 Braintree Hill Park, Suite 400, Braintree, Massachusetts 02184-8734. Hartford Life Insurance Company, Hartford Life and Accident Insurance Company , or their reinsurers, may also release information from their files to other insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Information for consumers about MIB may be obtained on its website at www.mib.com.

ACCESS, CORRECTION AND DISCLOSURE

You can obtain access to personal information about you contained in our policy files by sending us a written request. You may also request any necessary corrections, amendments or deletion of any information in our files which you believe to be inaccurate or irrelevant. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may release information in their files to other life insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Also, please be advised that personal and confidential information collected by us may, in certain circumstances, be disclosed to third parties without authorization. A notice providing further description of the circumstances under which information about you may be disclosed and the types of persons and organizations to whom it may be disclosed will be sent to you upon your written request. If you desire further information or access to your personal information, please send your written request to: Hartford Life Insurance Company or Hartford Life and Accident Insurance Company, 200 Hopmeadow St., Simsbury, CT 06089.

Acceptance into this plan is subject to medical evidence of insurability as determined by The Hartford. Depending on your age, the amount of coverage you request, and your answers on the application, a medical examination, medical test(s), or other evidence of good health may be required. Any exams/tests requested by the company will be conducted at your convenience and at no expense to you.

This website explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this website and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

Need more coverage?

Call us today! 1-877-285-4445

Apply now for Simplified Issue Term Life Insurance or print a PDF and complete application and fax to 605-334-0556.

Attention CA and NY residents: You cannot apply online, instead please utilize the following PDF applications:
California Residents: Click Here
New York Residents: Click Here

Underwritten by:
Hartford Life and Accident Insurance Company,
Simsbury, CT 06089
FORM GBD-1000A (AGL-1905) (TX)

The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.