Coverage Effective Date. All coverage is subject to underwriting approval. Approved coverage will take effect on the date approved by New York Life Insurance Company, provided your premium contribution has been paid and you and your eligible dependents (if also to be insured) are performing the normal activities* of a person in good health of like age on this date. If a person is not performing normal activities* on the date their coverage is effective, their effective date will be deferred until they are performing the required activities,* provided they resume normal activities within three months of their original effective date and they remain eligible.
* Residents of NC: Any reference to “performing the normal activities of a person in good health of like age” is replaced with “by the requirement that the health status of the proposed insured remains the same as stated in your application.”
Full Benefits for Maternity. Hospital confinements due to pregnancy will be payable the same as for any illness.
Exclusions & Limitations. Benefits are provided only for confinements that begin while you are insured, and which are recommended by a doctor as necessary to treat an illness or accident. Benefits are not provided for confinement resulting from: war; self-inflicted injury (while sane or insane); “well baby care” of a newborn child; cosmetic surgery or dental care (except as provided in the Certificate of Insurance); mental, nervous, or emotional disorders; alcoholism; drug addiction; or pre-existing conditions (except as defined below).
Pre-existing Conditions. A pre-existing condition is an illness or any condition related to such illness for which you received medical care during the 12-month period immediately prior to the effective date of your coverage.
Benefits will not be payable for any confinement due to a pre-existing condition until after the earlier of: (a) 12 consecutive months after the effective date of coverage during which no treatment or medical advice was received or; (b) 24 consecutive months of coverage under this program.
Coverage Renewal. Your coverage can remain in effect until you reach age 70, as long as you remain an employee of a TXCPA member, you pay your premiums when due, you do not enter Active Duty in the Armed Forces, and the group policy is not terminated or modified so you are no longer eligible. Insured dependents can retain their coverage as long as they meet dependent status requirements and you remain insured. Upon the insured’s death, coverage for insured dependents may continue as described in the group policy. This group policy may be terminated by the TXCPA Insurance Trust or New York Life Insurance Company.
