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NASW ASI Group Term Life Insurance Plan

Help Provide for Your Family's Future Financial Security

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Group Term Life Insurance Plan

The NASW ASI Group Term Life Insurance Program provides you with access to an affordable plan for your family in case something should ever happen to you.

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It’s important for you to take care of your family’s day-to-day needs – both now and should anything ever happen to you…

Would there be enough money to help pay for your final expenses, your house and utility payments, your day-to-day living costs, college expenses for your children?

41% of Americans say they don’t have sufficient life insurance coverage.1 This means that if the primary wage earner died, many families could face immediate or near immediate trouble paying living expenses.

You can help provide financial security for your family for whenever the unexpected happens. Simply apply now for what you need; acceptance is subject to approval. Please refer to the chart below to see the cost for someone your age and fill out an application today to help protect your family.

Your spouse or domestic partner may also apply for the same amount of coverage as you. If you are currently covered, he or she may apply for coverage on his or her own. Spouse / domestic partner will also be able to keep his or her coverage in the event you pass away.

Plus you pay an affordable group rate thanks to the group purchasing power of NASW.

To view the current ‘Term Life Rate Chart’, see the Rates Tab above.

Note: Domestic partner coverage may not be available in all states. You must execute a domestic partner affidavit for your domestic partner to qualify for coverage. Please call (866) 514-8974 to request an affidavit.

For more information, call toll-free (866) 591-8267.

1 “Facts from LIMRA, Life Insurance Awareness Month, September 2023”, LIMRA

Apply Now

Life Form Series includes GBD-1000, GBD-1100, or state equivalent.
70572

Underwritten by:
Hartford Life and Accident Insurance Company Hartford, CT 06155
(AGL-1949 and AGL-1950)

May not be available in all states.

UP TO $100,000* IN LIFE INSURANCE COVERAGE

As an NASW member under age 70, and a resident of the U.S., its territories and protectorates, you can secure this valuable term life coverage for $100,000. Although you’re eligible to apply for coverage as long as you are under age 70, please note that reduced coverage begins at age 75.

YOUR SPOUSE/DOMESTIC PARTNER QUALIFIES

Your spouse or domestic partner, under the the age of 70 and a resident of the U.S., its territories and protectorates, may also apply for the same amount of protection as you. If you are currently covered, he or she may apply for coverage on his or her own. He or she will also be able to keep his or her coverage in the event you cancel your Term Life policy or you pass away. Coverage cannot be duplicated by applying as a member and a spouse or domestic partner.

PAYS “LIVING BENEFITS” IF YOU’RE TERMINALLY ILL

With the Accelerated “Living” Benefit”**, you can collect up to 50% of your benefits (or $100,000, whichever is less) if you’re under age 60 and diagnosed with a Terminal Illness, meaning you have a life expectancy of 24 months or less. Your beneficiary will collect the remainder of your benefits after your death. You must be covered with at least $20,000 of life insurance and be actively at work to be eligible for the “living benefit”.

ADDITIONAL BENEFITS

If you sustain an Injury that results in loss of life within 90 days of the accident, the policy pays a Principal Sum of $5,000. If the result in loss of life is due to a felonious assault, the policy pays another benefit in the amount of $5,000. These benefits will be paid: 1) after we receive proof of loss, in accordance with the proof of loss provision; and 2) according to the general provisions of the policy.

CHOOSE YOUR BENEFICIARY

Please designate your beneficiary on the application. You may designate anyone you would like. If you do not designate a beneficiary, your benefits will be paid to your spouse/domestic partner, your children, your parents, your siblings, or the executors or administrators of your estate, in that order. If you have selected insurance for your spouse / domestic partner, you will automatically be designated as his or her beneficiary.

APPLY TODAY

Simply apply now by using the Apply Now button. Or, you can download, complete, sign and return the application for processing by using the Downloadable Application button. Application is subject to approval.

30-DAY FREE LOOK

When you receive your Certificate of Insurance, please read it carefully. If you’re not completely satisfied, simply return your Certificate, without claim, within 30 days. If you’ve paid any premium, it will be promptly refunded. No questions asked.

* Once the insured attains the age of 75, all benefits reduce by 20%. At ages 78, 81, and 84 benefits reduce another 20%. Please refer to your Certificate of Insurance for further details.

** ** Accelerated benefits may be taxable. These materials are not intended to provide tax, accounting or legal advice and cannot be relied upon for any such purpose. We recommend that you consult with a qualified tax advisor. For Residents of Texas: Accelerated benefits may affect your or your family’s initial or continued eligibility for public assistance, such as medical assistance (Medicaid), Aid to Families with Dependent Children (AFDC), supplementary social security income (SSI), we recommend that you consult with social service agencies with any questions regarding eligibility for public assistance.

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT:

If you or your dependents sustain an Injury that results in any of the following Losses within 90 days of the date of accident, we will pay the injured person’s Principal Sum, or a portion of such Principal Sum, as shown in the table below, after we receive proof of loss in accordance with the proof of loss provision.

This Benefit will be paid according to the general provisions of the policy.

We will not pay more than the Principal Sum to any one person, for all Losses due to the same accident. Your amount of Principal Sum is $5000.

For Loss of:Benefit:
LifePrincipal Sum
Both Hands or Both Feet or Sight of Both EyesPrincipal Sum
One Hand and One FootPrincipal Sum
Speech and Hearing in Both EarsPrincipal Sum
Either Hand or Foot and Sight of One EyePrincipal Sum
Movement of Both Upper & Lower Limbs (Quadriplegia)Principal Sum
Movement of Both Lower Limbs (Paraplegia)Three-Quarters of Principal Sum
Movement of Three Limbs (Triplegia)Three-Quarters of Principal Sum
Movement of the Upper & Lower Limbs of One Side of the Body (Hemiplegia)One-Half of Principal Sum
Either Hand or FootOne-Half of Principal Sum
Sight of One EyeOne-Half of Principal Sum
Speech or Hearing in Both EarsOne-Half of Principal Sum
Movement of One Limb (Uniplegia)One-Quarter of Principal Sum
Thumb and Index Finger of Either HandOne-Quarter of Principal Sum

Loss means with regard to:

  1. hands and feet, actual severance through or above wrist or ankle joints;
  2. sight, speech and hearing, entire and irrecoverable loss thereof;
  3. thumb and index finger, actual severance through or above the metacarpophalangeal joints; or
  4. movement, complete and irreversible paralysis of such limbs.

 

Loss resulting from sickness or disease or medical or surgical treatment of a sickness or disease, is not considered as resulting from Injury.

Injury means bodily injury resulting directly from an accident and independent of disease or bodily infirmity, which occurs while you and your dependents are covered under the policy.

QUESTIONS?

Call toll-free (866) 591-8267

Apply Now

Life Form Series includes GBD-1000, GBD-1100, or state equivalent.
70572

Underwritten by:
Hartford Life and Accident Insurance Company Hartford, CT 06155
(AGL-1949 and AGL-1950)

May not be available in all states.

QUARTERLY RATES PER $1,000 UNIT

Attained AgeUnit of InsuranceQuarterly Premium
Under 30$1,000$0.28
30$1,000$0.29
31$1,000$0.29
32$1,000$0.30
33$1,000$0.31
34$1,000$0.32
35$1,000$0.34
36$1,000$0.36
37$1,000$0.38
38$1,000$0.41
39$1,000$0.44
40$1,000$0.48
41$1,000$0.52
42$1,000$0.57
43$1,000$0.62
44$1,000$0.67
45$1,000$0.72
46$1,000$0.79
47$1,000$0.86
48$1,000$0.95
49$1,000$1.03
50$1,000$1.13
51$1,000$1.23
52$1,000$1.34
53$1,000$1.47
54$1,000$1.61
55$1,000$1.75
56$1,000$1.91
57$1,000$2.10
58$1,000$2.28
59$1,000$2.47
60$1,000$2.67
61$1,000$2.89
62$1,000$3.15
63$1,000$3.42
64$1,000$3.70
65$1,000$4.02
66$1,000$4.38
67$1,000$4.77
68$1,000$5.20
69$1,000$5.65
70$1,000$9.85
71$1,000$9.85
72$1,000$9.85
73$1,000$9.85
74$1,000$9.85
75-77*$800$11.52
78-80*$600$8.64
81-83*$400$8.68
84-84*$200$4.34
85-89*$200$6.22
90-94*$200$8.84
95-99*$200$16.41

Rates shown above are rounded to the nearest penny. Please note that your Billing Notice will reflect the exact premium. Rates and/or benefits may be changed on a class basis. Rates are based on your attained age and increase as you enter each new age category. For your convenience, you will be billed on a quarterly basis.

Note: Domestic partner coverage may not be available in all states. You must execute a domestic partner affidavit for your domestic partner to qualify for coverage. Please call (866) 591-8267 to request an affidavit.

If you prefer a coverage amount under $100,000 please print a paper application and indicate your preferred amount and mail ($1,000 minimum up to $100,000 maximum in $1,000 increments).

For more information, call toll-free (866) 591-8267.

* Renewal rates only. Once the insured attains the age of 75, all benefits reduce by 20%. At ages 78, 81, and 84 benefits reduce another 20%. Please refer to your Certificate of Insurance for further details.

Apply Now

Life Form Series includes GBD-1000, GBD-1100, or state equivalent.
70572

Underwritten by:
Hartford Life and Accident Insurance Company Hartford, CT 06155
(AGL-1949 and AGL-1950)

May not be available in all states.

WHEN COVERAGE BEGINS

Your (and your spouse/domestic partner’s) coverage will become effective on the first day of the month following the Administrator’s approval of your application and first premium payment.

WHEN COVERAGE ENDS

As long as you remain an eligible member, pay your premiums when due, and the Master Policy remains in force, it’s possible to keep this coverage until you reach age 100, although benefit levels are reduced beginning at age 75. Your spouse/domestic partner’s coverage will remain in effect until he or she reaches age 100, as long as your coverage is active, premiums are paid, and they meet the eligibility requirements and continuation provisions are met.

EXCLUSIONS

Suicide is not covered during the first two years of coverage. Benefits paid for death caused by suicide while sane or insane within the first two years of the effective date of insurance are limited to a refund of your premiums paid. During the two years immediately following an increase in coverage, the benefit is limited to 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 the deceased person is payable if he or she is covered under The Policy and commits suicide after the two-year period.

APPLICABLE TO ALL BENEFITS EXCEPT THE LIFE INSURANCE BENEFIT AND THE ACCELERATED BENEFIT: THE POLICY DOES NOT COVER ANY LOSS BY:

  1. intentionally self-inflicted Injury;
  2. suicide or attempted suicide, whether sane or insane;
  3. war or act of war, whether declared or not;
  4. Injury sustained while on full-time active duty of the armed forces (land, water, air) of any country or international authority, except Reserve National Guard Service; We will refund the pro rata portion of any premium paid for You or Your Dependents while You or Your Dependents are in the armed forces on full-time active duty, for a period of two months or more. Written notice must be given to Us within 12 months of the date You or Your Dependents enter the armed forces;
  5. Injury sustained while On any aircraft except a Civil or Public Aircraft, or Military Transport Aircraft;
  6. Injury sustained while On any aircraft:
    1. as a pilot, crewmember or student pilot;
    2. as a flight instructor or examiner;
    3. if it is owned, operated or leased by or on behalf of the Policyholder, or any Employer or organization whose eligible persons are covered under The Policy;
    4. being used for tests, experimental purposes, stunt flying, racing or endurance tests;
  7. Injury sustained while taking drugs, including but not limited to sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless as prescribed by or administered by a Physician; or the injury results solely from accidental circumstances;
  8. Injury sustained while riding or driving, in a scheduled race or testing any Motor Vehicle on tracks, speedways or proving grounds;
  9. Injury sustained while committing or attempting to commit a felony; or
  10. Injury sustained while Intoxicated.

    Intoxicated means:

    1. the blood alcohol content;
    2. the results of other means of testing blood alcohol level; or
    3. the results of other means of testing other substances; that meet or exceed the legal presumption of intoxication, or under the influence, under the law of the state where the accident occurred.

        Reserve or National Guard Service means:

  1. attending or en route to or from any active duty training of less than sixty (60) days;
  2. attending or en route to or from a service school of any duration;
  3. taking part in any authorized inactive duty training;
  4. taking part as a unit member in a parade or exhibition authorized by official orders.

 

DEFINITIONS:

Spouse means your spouse who is not legally separated or divorced from you and is not in active full-time military service. Spouse will include your domestic partner, provided you have executed a domestic partner affidavit satisfactory to us, establishing that you and your partner are domestic partners for purposes of the policy.

Your Conversion Right: If Life Insurance coverage under the policy ends for any reason, except non payment of premium, you and your dependents may have the right to convert that coverage to an individual conversion policy without providing evidence of insurability. Conversion is not available for Accident Death and Dismemberment Benefit or any amount of life insurance for which you or your dependents were not eligible and covered under the policy.

Felonious Assault means a violent or criminal act directed at You during the course of:

  • a robbery, kidnapping or criminal assault; or
  • an attempt at any of the above; which constitutes a felony under the law.

The Felonious Assault Benefit will not pay for a Loss that results from a Felonious Assault committed by a member of the injured person’s family or household, or the injured person’s fellow employee.

This information explains the general purpose of the insurance described, but in no way changes or affects Master Policy AGL- 1949 and AGL-1950 and as actually issued. In the event of a discrepancy between this information 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, reduction of benefits 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.

Acceptance into this plan is subject to medical evidence of insurability as determined by The Hartford 1. 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/test requested by the company will be conducted at your convenience and at no expense to you.

A.G.I.A., Inc. is the Plan Administrator that administers the insurance plan on behalf of the Hartford Life and Accident Insurance Company for the benefit of the Group Policyholder. NASW Assurance Services, Inc. is compensated for the placement of insurance and for the services it provides to customers on behalf of the insurance company, in addition to other compensation it may receive. This is a participating group policy under which dividends and/or experience credits may be paid to NASW Assurance Services, Inc. Compensation is paid to or retained by the Group Policyholder NASW Assurance Services, Inc. and NASW directly or indirectly for services associated with this insurance program.

Endorsed by:

Underwritten by:

Hartford Life and Accident Insurance Company
Hartford, CT 06155

 

1The Hartford Financial Services Group, Inc. (NYSE: HIG) operates through its subsidiaries under the brand name, The Hartford, and is headquartered in Hartford, Connecticut. For additional details, please read The Hartford’s legal notice at www.thehartford.com.

CW Notice of Insurance Information Practices

MA Notice of Insurance Information Practices

Administered by:
A.G.I.A., Inc.
P.O. Box 26450, Phoenix, AZ 85068

Matt Bishop for the NASW Assurance Services
CA License No. 0F00863

Apply Now

Life Form Series includes GBD-1000, GBD-1100, or state equivalent.
70572

Underwritten by:
Hartford Life and Accident Insurance Company Hartford, CT 06155
(AGL-1949 and AGL-1950)

May not be available in all states.

To apply, please click on your state of residence below for a printable application. If you do not see your state below, we are working on adding more states applications. Please check back at a later time.

Please mail your completed application to:
NASW Assurance Services
Group Insurance Program Administrators
PO Box 26450
Phoenix, AZ 85068-9955

Alabama Arizona Arkansas Colorado Delaware District of Columbia Georgia Hawaii
Iowa Kentucky Louisiana Michigan Mississippi Nevada North Dakota Oklahoma
Pennsylvania Rhode Island South Carolina South Dakota Tennessee West Virginia Wisconsin Wyoming

Life Form Series includes GBD-1000, GBD-1100, or state equivalent.
70572

Underwritten by: Hartford Life and Accident Insurance Company Hartford, CT 06155
(AGL-1949 and AGL-1950)

May not be available in all states.

Terms Of Use

Terms of Service

Terms of Service
Important
Please Read This Entire Agreement Carefully

You must agree to these Terms of Service (“Agreement”) in order to enter into a transaction on this website. Please read this Agreement carefully.

The terms and conditions set forth in our Privacy Policy are hereby incorporated into this Agreement.

The Program Administrator provides this website, (collectively “Website” or “Site”) the materials and services to you as a user conditioned upon and subject to your acceptance of this Agreement. By using and/or accessing this site or its services, you acknowledge that you have read, understand, and agree to be legally bound by this agreement.

Definitions

The following defined terms are used in these Terms of Services:

“Program Administrator” means the entity that is offing and providing services through this website (collectively “Program Administrator” or “Administrator” or “we” or “us”).

“Carrier” means the insurance products described on this site are underwritten by reputable, licensed Underwriting Carrier(s).

“Service Provider” means service products are offered by a variety of reputable, approved vendors and their affiliates.

“Payee” means the merchant or other entity to which you authorize a bill payment to be directed.

“Payee Account” means the billing account with the merchant or other entity to which you authorize a bill payment to be directed. It may be represented by an account number, policy number, access number or code, or other number used by the merchant to identify your account.

“Payment Instruction” means your instruction and authorization to the program administrator to make a bill payment to a payee.

“Payment Account” means the bank account that you authorize the program administrator to debit by electronic funds transfer when you make your bill payment using account information from your personal checking or savings account.

“Payment Card” means the credit card or debit card that you instruct your program administrator to charge to pay your bill payment.

“Business Day” means Monday through Friday, excluding Federal Reserve holidays.

Bill Payment Service

When you initiate a Payment instruction, you authorize your program administrator to charge your payment card or debit your payment account and remit funds to the payee. If we are unable to obtain funds for a bill payment for any reason associated with your payment card or payment account (for example, there is not a sufficient balance available on your payment card or in your payment account to cover the transaction), then we will not be able to complete your bill payment transaction. If there is a problem in processing your payment instruction, the program administrator may attempt to contact you, using the telephone number you have provided.

If the program administrator makes a bill payment to your payee account but is unable to obtain funds for that payment from your payment card or payment account, you agree that your bill payment to your payee account will be reversed.

You agree that from time to time the payment services contemplated under this agreement may be inaccessible or inoperable for any reason, including, without limitation: (i) equipment malfunctions; (ii) periodic maintenance procedures or repairs which may be undertaken from time to time; or (iii) causes beyond the program administrators control or which are not reasonably foreseeable to the program administrator.

Our Liability for Failure to Complete Transactions

The program administrator will use commercially reasonable efforts to process your bill payments in accordance with your Payment Instructions. However, we shall incur no liability if a bill payment is not made in a timely manner or if it is unable to complete any payments initiated by you through the Bill Payment Service because of the existence of any one or more of the following circumstances:

  • Sufficient funds are not available through your payment account or your payment card;
  • Failure of any payee to account correctly for or credit the payment in a timely manner, or otherwise mishandle or delay the payment;
  • The bill Payment service is not working properly and you know or have been advised by us about the malfunction before you execute the transaction;
  • You do not provide us with all required information to complete the bill payment, such as your correct name, telephone number, or your complete and correct payee account information; or
  • Circumstances over which the program administrator has no control including, but not limited to large-scale technical malfunctions, including, but not limited to loss of access to the internet or loss of access to the Federal Reserve System, prolonged outages of phone lines, electricity or similar infrastructure, acts of nature, war, riot, civil disobedience or similar events of insurrection, governmental or court orders, regulatory or legislative changes by any local, state or federal governmental agency, strikes, work stoppages, or other similar occurrences or circumstances.


LIMITATION OF LIABILITY AND YOUR EXCLUSIVE REMEDY

In the absence of any of the exclusions set forth above, it shall be the program administrator’s responsibility to correct any transactions not completed in accordance with your payment instructions. In the event that the program administrator is unable to correct the transaction, we shall refund the amount of funds received from you and this refund shall constitute your sole remedy. In no event shall the program administrator’s liability to you ever exceed the amount of funds that we receive from your payment account or payment card for a bill payment. THE FOREGOING SHALL CONSTITUTE THE PROGRAM ADMINISTRATORS ENTIRE LIABILITY AND YOUR EXCLUSIVE REMEDY. THE USE OF THIS PAYMENT SERVICE IS AT YOUR SOLE RISK. IN NO EVENT SHALL [PROGRAM ADMINISTRATOR] BE LIABLE FOR ANY OTHER LOSS, INJURY, OR DAMAGES, WHETHER DIRECT, INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL, OR EXEMPLARY, INCLUDING LOST PROFITS (EVEN IF ADVISED OF THE POSSIBILITY THEREOF) ARISING IN ANY WAY OUT OF YOUR USE OF THE BILL PAYMENT SERVICE. EXCEPT AS OTHERWISE EXPLICITLY SET FORTH HEREIN, WE SPECIFICALLY DISCLAIM AND YOU UNDERSTAND THAT WE MAKE NO WARRANTIES OR REPRESENTATIONS OF ANY KIND, EXPRESSED OR IMPLIED AND THE SAME ARE HEREBY EXCLUDED FROM THESE TERMS AND CONDITIONS AND ALL TRANSACTIONS CONTEMPLATED HEREBY. SOME STATES PROHIBIT THE EXCLUSION OR LIMITATION OF INCIDENTAL OR CONSEQUENTIAL DAMAGES, THUS THIS LIMITATION OF LIABILITY MAY NOT APPLY TO YOU.

User Authentication and Security

The Bill Payment Service has been designed in compliance with the Payment Card Industry (PCI) Data Security Standards so that no one can access your payment account without proper user authentication. If you use this site, you are responsible for maintaining the confidentiality of your personal information, including your Payment Account Number, and for restricting access to your computer, and you agree to accept responsibility for all activities you initiate or that you authorize to be initiated or that are authorized utilizing your payment account or from your computer. You are solely responsible for all bill payments you authorize using the Bill Payment Service. If you permit other persons to use the Bill Payment Service or your bill payment authentication responses or other means to initiate a payment instruction on your behalf, you are solely responsible for any transactions they authorize.

If you believe that your authentication information or other personal information have been lost or stolen or that someone may attempt to use the Bill Payment Service without your consent, you must notify us at once by calling the program administrator at (800) 424-5181 during normal customer service hours.

Errors and Questions

In case of errors or questions about your transactions, you need to contact us as soon as possible.

1. Telephone us at the program administrator (800) 424-5181 during normal customer service hours.

2. Write us at: Program Administrator
Office of Administration
P.O. Box 26450
Phoenix, AZ 85068

Charges

Transaction charges, if any, for using the Bill Payment Service may vary depending upon the Payee and permissible charges allowed in a particular state. These charges will be disclosed to you prior to your payment instruction. By submitting your payment instruction, you agree to pay these transaction charges. There may be a charge for additional transactions and other optional services. You agree to pay such charges and authorize the program administrator to charge your designated payment card or debit your payment account for these amounts and any additional charges that may be incurred by you. You are responsible for any and all fees and charges that you may incur.

Governing Law

These Terms of Services shall be governed by the laws of the state of California without regard to that state’s conflicts of laws provisions and by applicable Federal laws and regulations.

Waivers

No delay or omission by us in exercising any rights or remedies under these Terms of Services will impair such right or remedy or be construed as a waiver of any such right or remedy. If we exercise any right or remedy, in whole or in part, that exercise will not prevent us from any further or future exercise of such right or remedy or any other right or remedy. No waiver will be valid unless in writing signed by us.

Disclosures & Consent to Electronic Transactions / Electronic Signature

  • a. By entering this website and agreeing to be bound by this agreement, you are providing your affirmative consent to the use of an electronic signature to authenticate the insurance transaction in electronic form. You understand and agree that the insurance company will rely on your electronic signature to process and effect insurance transactions
  • b. You acknowledge that you understand that you are not obligated to enter into transactions electronically and that you have a right to conduct transactions in paper format if you wish. By entering this website and agreeing to be bound by this agreement, you affirmatively consent to conduct transactions in electronic form. If you wish to conduct transactions in paper form, please contact your association/policyholder or its representatives. There is no charge to you for requesting a paper transaction.
  • c. When you have successfully entered your enrollment information and have selected “I Accept” on the website confirmation page, you will be given the opportunity to print a paper copy of your insurance or service elections free of charge. Please print a paper copy of your elections for your records because if you will not be able to access your enrollment information on the site after your enrollment. If you wish to confirm or make changes to your coverage or beneficiary elections after your enrollment, you must contact the Program Administrator Office of Administration. You understand and agree that requests for change submitted to the carrier, service provider, or the Site will not be valid or take legal effect after the end of your enrollment.
  • d. Once you have given consent for an electronic transaction, you may withdraw your consent only if the carrier or service provider has not taken action in reliance on your consent. To update your contact information or to withdraw your consent to an electronic transaction, you may contact your Administrator by calling (800) 424-5181 or by writing to the Office of Administration, PO Box 26450, Phoenix AZ 85068.
    There is no fee charged for such requests. However, your withdrawal of consent shall not diminish the legal effectiveness or enforcement of any transaction agreed to prior to your withdrawal of consent. If you withdraw consent after your enrollment, your insurance or service will remain effective until your request for cancellation is received by the program administrator policyholder or its representative.
  • e. You agree that your electronic signature authorizes The Underwriting Carrier(s), Service Provider(s) or its authorized representatives:
    • 1. to process this transaction at your request and any future transactions that may be needed to administer and help keep in force your coverage under the insurance policy or service agreement. For example, we will rely on your electronic signature to authorize us to process your request for service, insurance coverage(s) and beneficiary designation(s) made during your enrollment.
    • 2. to process, as applicable:
      • i. a billing transaction, including but not limited to: processing a payment by credit card using the credit card number you have provided; processing an electronic bank draft using the checking account number you have provided; or sending you a billing statement at the address you have provided; or
      • ii. a billing transaction with your financial institution to deduct the appropriate amount from your account.
    • 3. to communicate with you by mail, telephone or electronically by sending to you communications including, but not limited to, any and all types of electronic communication by email, fax, mail and telephone.
  • f. After you enroll, you understand and agree that you will not have access to your electronic enrollment record. You may print a confirmation of your enrollment election at the time of enrollment, or you may contact your Administrator for confirmation after your enrollment period ends.


User Representations

You represent and warrant to the program administrator that: (a) you over the age of eighteen (18) and have the power and authority to enter into an perform your obligations under this agreement; (b) all information provided by you to the program administrator is truthful, accurate and complete; (c) you are the authorized signatory of the credit or charge card provided to pay fees contemplated herein; (d) you shall comply with all of the terms and conditions of this agreement; and (e) you have provided and will continue to provide accurate and complete registration information, including, without limitation, your legal name, address and telephone number.

Additional Terms and Conditions

The program administrator provides information and services on this Website, and all layouts, materials, designs, and images on this Website are copyrighted or proprietary to the particular program administrator, its affiliated companies and/or third party service providers. As a condition of your use of this Website and the services, you agree that you will not use the contents of this Website in any other website or in a network computer environment. All uses of this website apart from educational, informational and enrollment purposes are strictly prohibited.

In addition, as a further condition of your use of this website and the services, you agree that you will not use the website or services to infringe the intellectual property rights of the program administrator in any way; use the website or services to modify or manipulate the website or services or any of the program administrators hardware or software to invade the privacy of, or obtain private information concerning any enrollee or applicant of the carrier/service provider or to erase or damage any information contained on the computer or the information of any user connected to this website or the services, or to reveal any portion of this website or the services. Furthermore, you agree that you will not use the website or services to introduce viruses, worms, Trojan horses or other malicious, destructive or harmful codes or programs, and you agree that you will take every precaution not to introduce these harmful codes into the website and services.

You agree that the materials and services on this website are provided “as is” and for informational purposes only. You understand that neither the carrier, the service provider nor the program administrator makes any representations or warranties that the materials are suitable for your needs, are complete, timely, reliable, or are free from errors, inaccuracies or typographical mistakes. The information contained on this website was believed to be accurate at the time it was placed on the website. The carrier, service provider and the program administrator periodically update the information on the website, but disclaim any responsibility to do so. Therefore, you understand and agree that the carrier, service provider and the program administrator take no responsibility for the timeliness, accuracy or applicability of the information at the time it may be accessed and that the carrier, service provider and the program administrator disclaim all warranties, express or implied, including, but not limited to, implied warranties of merchantability of fitness for a particular purpose or of non-infringement of other’s rights.

You understand and agree that neither the carrier, nor the service provider, nor the program administrator is engaged in rendering legal, tax, insurance benefits or any other advice through this website or services. Your insurance needs are highly individual, and the carrier, the service provider and the program administrator do not represent themselves as giving financial advice or advice on your individual insurance needs through this website and services. You understand and agree that you should consult your own attorney and financial advisor(s) for advice in these areas.

You understand and agree that the information on the carrier’s insurance products or the service provider products as described in this website is not complete and does not change or affect the insurance policies or service agreements as actually issued. Although you have been provided with a description of benefits, you understand for insurance products, that only the insurance policy issued to the policyholder (your association) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the information on the website and services, the benefit highlights, and the insurance policy, the terms of the insurance policy apply.

For insurance products, you understand and agree that insurance will not be valid or in force with respect to you or your dependents if any such person is not eligible in accordance with the terms of the program administrator policy issued to your association/policyholder. You acknowledge and agree that if program administrator participation requirements are not met, the insurance policy will not be issued and the elected coverage(s) will not be in force.

You understand that this website and the payment services contemplated hereunder may be performed by third-party vendors.

If any provision of this agreement is determined to be illegal or unenforceable, then such provision will be enforced to the maximum extent permissible and the other provisions will remain fully effective and enforceable.

By enrolling you acknowledge that you have read the Program Administrator Privacy Policy on the program administrator’s website.

Revisions

We reserve the right to change or supplement this Terms of Service Agreement at any time by posting the changes on this web site. By using this web site, you accept the terms and conditions of this Terms of Service Agreement and you agree to review this Terms of Service Agreement from time to time to stay informed of changes that may occur. This Terms of Service Agreement also applies to personal information that we maintain on former customers.

Privacy Policy

AGIA Privacy Policy

AGIA Affinity (“AGIA”), believes protecting privacy of internet users visiting our website, www.agia.com (the “Site”), is of the utmost importance to ensure your trust in the programs we offer. AGIA’s Privacy Policy will inform you of the ways in which the Site collects personal information, the uses to which that information will be put, and the ways in which AGIA will protect any personal information you choose to provide us. For the purposes of this Policy, personal information that can be used to identify you or your activities on the Site of information about you which you provide to AGIA through services offered on the Site.

In many cases, AGIA will collect personal information on behalf of our commercial clients in accordance to a contract. In these circumstances, we act as a “Service Provider” or “Processor” to our clients under applicable privacy laws and are obligated to process personal information in accordance with clients’ instructions. In any case where AGIA is acting as a Service Provider or processor to our client, if you wish to exercise any of the rights outlined in this Policy, you should direct your request to our client, who is the party responsible for receiving, assessing, and responding to your requests. If a request is submitted directly to AGIA in a scenario where we only process your information in the role of Service Provider or Processor, AGIA may deny your request. If unsure, clarification of AGIA’s role regarding your personal information can be requested at anytime by contacting AGIA directly using the contact information described in this notice.

AGIA’s Privacy Policy applies solely to data collected via the Site. There may be additional personal information that we have or collect about you or your company pursuant to other relationships which is subject to other agreements and rules.

We take the privacy of your personal information very seriously and we will use your personally identifiable information only in accordance with the terms of this Privacy Policy. Personally Identifiable Information (“Personal Information”) means any information that could reasonably be used to identify you, including your name, address, birth dates, financial information, telephone number, social media contact information, or any combination of information that could be used to identify you. We will not sell or rent your personally identifiable information or a list of our customers to third parties. However, as described in more detail below, there are limited circumstances in which some of your information will be shared with third parties under strict restrictions, so it is important for you to review this Policy. This Privacy Policy applies to all services that are offered through the Site.

By accepting this Privacy Policy, you expressly consent to our use and disclosure of your personal information in the manner described in this Privacy Policy. By consent, you are acknowledging that you have read and understood this Privacy Policy and agree to be bound by it. If you do not agree with the terms of the Privacy Policy, please do not access our website. This Privacy Policy is incorporated into and subject to the terms of the website Terms of Service. The following discloses our website information gathering and use practices and is limited to the protection and use of personal information collected by us in the online environment. Your access to and use of our website are subject to this Privacy Policy and any other terms of use or policies posted by us.

Please review this privacy statement carefully to understand what information we collect on the website, how it is used, and how you can work with us if you have a concern about your privacy.

Personal Information We Collect

There is an opportunity on our website for you to voluntarily provide us with personal information for inquiring about AGIA’s business. For example, we will need personal information from you when you submit a question online, or request product information. This information includes your name and e-mail address. We use your voluntarily provided personal information to provide you exceptional service and to create a more meaningful visit for you at this website. You may also choose to apply for a job with AGIA and submit a job application via our career site at https://www.agia.com/careers . Any personal information you send AGIA will be used only for the purpose indicated on the careers site or in this statement.

By providing us with personal information so we may assist you on this website, you are “opting-in” to receive future communication from the website concerning information on products, promotions, or other services that we believe would be of interest to you. If, at any time, you receive a communication from the website that is unrelated to a transaction you have initiated, and you would like not be contacted again, please contact us using the procedures outlined below under “Questions About Your Information” to “opt-out” from future communications.

We reserve the right to use your personal information for market research purposes to better serve you but we will not sell your voluntarily provided information and will not share it with unauthorized persons or organizations.

When you visit this website, we collect and store non-identifying information about your visit. The information we collect may include the time and length of your visit, the pages you look at on our site, and the site you visited just before coming to ours. We may also record the name of your Internet Service Provider (ISP) or your Internet Protocol (IP) Address. We use this aggregate information to measure site activity as well as to generate ideas for enhancing our website to serve you. This information is not specific to any individual and is anonymized to prevent personal identification.

How We Use Your Personal Information

Internal Uses

We collect, store and process your personal information on servers located in the United States. We use the information we collect about you in order to provide our services, process your transactions, and provide customer service. We provide access to personal information about our customers only to those employees who require it to provide our services, process customer payments and provide customer service.

  • Cookies: We may utilize website cookies to collect information for the purposes of Site functionality, analytics, advertising, IP addresses only where strictly necessary. A cookie is a small amount of data, which often includes an anonymous unique identifier, which is sent to your browser from a website’s computer and stored on your computer’s hard drive but cannot read data from your hard drive. Cookies can be used to provide you with relevant content and to make it easier for you to use a website upon a future visit. We may include cookies on our website and use them to recognize you when you return to our website. You may set your browser so that it does not accept cookies; however, certain features of our sites may not function properly or be available if your browser is configured to disable cookies.

  • Web Beacons: Some pages on our site, as well as pages where our banner ads appear, and certain emails we send, may contain electronic images known as Web beacons, or single-pixel GIFs. These Web beacons collect certain types of non-personally identifiable information, such as a visitor’s cookie number, time and date of a page view, and a description of the page where the Web beacon is placed. The Web beacons are used to compile and aggregate statistics that help us improve the effectiveness of our advertising and make our site easier to use. The information collected using these Web beacons does not identify individual users to our site.

AGIA Personal Information Processing

Because AGIA offers various insurance and non-insurance products and services, it should be noted that the information below may not be applicable in all circumstances, data elements are dependent on the individual customer relationship.

Personal Information Category

Description

Source Categories

Business Purpose for Collection

Third Parties With Whom we May Share Personal Information

Government-Issued Identifiers

• SSN
• State ID Card
• Passport
• Driver’s License

• Directly from you (or a member who named you as beneficiary)
• Employer, Plan Sponsor, or their Administrator
• Third Parties Insurance Carriers and/or Agents and Brokers

• Quotes for products and services
• Policy Administration and/or Claims processing
• AGIA services to the client
• Marketing/Analytics
• Direct Marketing
• Communication with Individuals

• Insurance Underwriter
• Vendors
• Service Providers
• Employer

Contact Information

• Company or School Name
• Title
• Alias
• Mailing Address
• E-Mail Address
• Telephone Numbers

• Directly from you (or a former member who named you as beneficiary)
• Employer, Plan Sponsor, or their Administrator
• Third Parties Insurance Carriers and/or Agents and Brokers

• Quotes for products and services
• Policy Administration and/or Claims processing
• AGIA services to the client
• Marketing/Analytics
• Direct Marketing
• Communication with Individuals

• Vendors
• Service Providers
• Employer/Client

Individual Identifiers

• Age
• Gender
• Race
• Sexual Orientation
• Marital Status
• Veteran Status
• Beneficiaries/Dependents
•  Physical or Mental Disability

• Directly from you (or a former member who named you as beneficiary)
• Employer, Plan Sponsor, or their Administrator
• Third Parties Insurance Carriers and/or Agents and Brokers

• Quotes for products and services
• Policy Administration and/or Claims processing
• AGIA services to the client
• Marketing/Analytics
• Direct Marketing
• Communication with Individuals

• Vendors
• Service Providers
• Employer/Client

Other Identifiers

• Client/Member
• Account
• Name/Number
• Policy Number
• Employee/member ID Number

• Directly from you
• Employer, Plan Sponsor, or their TPA
• Third Parties
•  Insurance Carriers and/or Agents and Brokers

• Quotes for products and services
• Policy Administration and/or Claims processing
• AGIA services to the client
• Marketing/Analytics
• Direct Marketing
• Communication with Individuals

• Insurance Underwriter
• Vendors
• Service Providers
• Employer/Client

Financial Information

• Financial Account Numbers
• Credit Card Numbers (Payment Card Data)
• Consumer Reporting Data
• Insurance Account Numbers

• Directly from you
• Employer, Plan Sponsor, or their TPA

• Policy Administration

• Vendors
• Service Providers

Health Information

• Inferred Data (Health)
• Status of Disability
• Data collected by a Healthcare Provider or Health Insurance Company Subject to HIPAA or CMIA
• Payment Information for Healthcare Services
• Information About a Consumer’s Diagnosis or Treatment for Health Conditions
• Patient records, clinical trial records

• Directly from you
• Employer, Plan Sponsor, or their TPA
• Third Parties
•  Insurance Carriers, Agents or Brokers

• Policy Administration and/or Claims processing
• AGIA services to the client
• Communication with Individuals

• Vendors
• Service Providers
• Employer

Policy Information

•  Any Policy or Documentation or Subsequent Information Submitted to AGIA in Order to Obtain Quotes for a Product or Service

• Directly from you (or from a current or former plan member who named you as a beneficiary)
• Employer, Plan Sponsor, or their TPA
• Third Parties
•  Insurance Carriers, Agents or Brokers

• Quotes for products and services
• Policy Administration and/or Claims processing
• AGIA services to the client
• Marketing/Analytics
• Direct Marketing
• Communication with Individuals

• Vendors
• Service Providers
• Employer/Client

Employment-Related Information

• Job/Role Titles
• Resume with Work History

• Directly from you
• Employer, Plan Sponsor, or their TPA

• Policy Administration and/or Claims processing

• Vendors
• Service Providers
• Employer

Commercial Information

• Service Records
• Personal Property
• Customer Service Records
• Communication Preferences
• Other Preferences

• Directly from you (or from a current or former plan member who named you as a beneficiary)
• Employer, Plan Sponsor, or their TPA
• Third Parties
• Insurance Carriers, Agents, or Brokers

• Quotes for products and services
• Policy Administration and/or Claims processing
• AGIA services to the client
• Marketing/Analytics
• Direct Marketing
• Communication with Individuals

• Vendors
• Service Providers
• Employer/Client
•  Non-Client Business Partners

Audio, Video, or Other Media

• Customer Service Call Center Recordings
• Voicemails

• Directly From You

• Quotes for products and services
• Policy Administration and/or Claims processing
• AGIA services to the client
• Marketing/Analytics
• Direct Marketing
• Communication with Individuals

• Vendors
• Service Providers

Disclosure to Third Parties

This website does not sell or rent any of your personal information to affiliates or unaffiliated third parties. We will not share any of your personal information with third parties except in the circumstances described below or with your permission.

• We disclose personal information with third parties or affiliates that we in good faith believe are appropriate to enable them to provide services to you and to contact you regarding additional products and/or services that you have expressed an interest.

• Cooperation in investigations of suspected fraud or other illegal activity, situations involving potential threats to the physical safety of any person, or to conduct investigations of violations of the -site’s Terms of Use or the Terms of Service Agreement, or as otherwise required by law. This may also include protecting and defending the rights, property, or safety of AGIA, other users of this Site or responding to claims that any content violates the rights of third parties.

• Certain federal, state and local laws or government regulations may require us to disclose non-public personal information about you. In these circumstances, we will use reasonable efforts to disclose only the information required by law, subpoena or court order to be disclosed.

• We disclose information to your agent or legal representative (such as the holder of a power of attorney that you grant, or a guardian appointed for you).

• As with any other business, it is possible that in the future we could merge with or be acquired by another company. If such an acquisition occurs, the successor company would have access to personal information maintained by us, including customer account information, but would continue to be bound by this Privacy Policy unless and until it is amended.

• As otherwise permitted by federal or state law.

Do Not Track

• Some internet browsers offer the user a “Do Not Track” technology.  The Do Not Track (DNT) header is the HTTP header field DNT that requests that a web application disable either its tracking or cross-site user tracking of an individual user.  At the current time, this Site does not have the capability of recognizing a “Do Not Track” request.

Email

• The website does not automatically recognize your e-mail address. You only receive e-mail from us if you check a box indicating an interest in a particular e-list or if you provide an e-mail address for a customer service inquiry and need an answer via e-mail. We collect the e-mail addresses of those who communicate with us via e-mail and online forms, including those who specifically check a box to subscribe on our online forms (for example, request for information on this website). Any user who signs up for e-mails can unsubscribe or manage his/her subscription by linking to the personal URL e-mailed to all subscribers. Every e-mail sent also includes information about how to stop receiving e-mails from us.

• We do not share the e-mail addresses we collect with similar benefits organizations.

Links to Other Sites

• For the convenience of our visitors and customers, this website may contain links to other sites. While we generally try to link only to sites that share similar high standards and respect for privacy, we are not responsible for the content, products or services offered or the privacy and security practices employed by these other sites.

• AGIA is not responsible for the content or privacy practices of linked websites or their use. Once you leave the Site using an external link, you should refer to those websites’ privacy policies, terms of use, and practices in order to evaluate how they will handle any information they collect from you.

Questions About Your Information

If you have any questions, concerns, or complaints about this Privacy Policy in general or questions related to your personal information, please contact AGIA customer service at (800) 424-5181, via e-mail at [email protected], or, if you would prefer to communicate with us by regular mail, please use the following address:

AGIA Affinity
Office of Administration
P.O. Box 26450
Phoenix, AZ 85068

To protect your privacy, any personal information we obtain from you is protected using the best available technology. Your product information requests are encrypted when sent to our customer service center for fulfillment; we use a secure server to safeguard the information you provide to us when asking a customer service question and when you enroll online; and all online enrollment information fulfilled by our customer service center is protected by Secure Socket Layer (SSL) technology to ensure your data is encrypted and safe from view by unauthorized parties.

In order to ensure secure web pages in your browser using SSL, we’ve acquired a security certificate from one of the Internet’s leaders in secure web technology verification. The Security Certificate SecureSite seal ensures that we are handling all of your transaction information securely and with the utmost care.

California Consumer Privacy Act and California Privacy Rights Act: Privacy Policy for California Residents

•  This section of the Privacy Policy describes the rights of California residents under the California Consumer Privacy Act of 2018 (“CCPA”) and the California Privacy Rights Act of 2020 (“CPRA”). The CCPA and CPRA requires that we provide privacy information to California residents and we use this separate section to ensure compliance with the CCPA and CPRA requirements. This section applies solely to natural persons residing in California (“Consumers”), and does not apply to individuals living elsewhere, businesses or other corporate entities.

Sale of Personal Information

•  Personal Information is information that identifies, relates to or could reasonably be linked with a particular California resident or household. We do not sell your personal information.  The CCPA and CPRA requires disclosure of this fact.

Your Rights Under the California Consumer Privacy Act and California Privacy Rights Act

Right to Confirm or Access Information

•  You may have the right to confirm whether we process certain information or what information we process, and to obtain a copy of that information in a format that allows you to transmit the information to another business without difficulty.

•  Once we receive and confirm your identity and verifiable consumer request, we will disclose to you the following at your direction (with various exceptions):

a)  The categories of personal information we collected about you in the last 12 months;

b)  The categories of sources for the personal information we collected about you in the last 12 months;

c)  Our business or commercial purpose for collecting or selling that personal information;

d)  The categories of third parties with whom we share that personal information;

e)  The specific pieces of personal information we collected about you;

f)  If we sold or disclosed your personal information for a business purpose a list of the personal information types that each category of recipient purchased; and

g)  If we disclosed your personal information to a third party for a business purpose, a list of the personal information types that each category of recipient received.

Right to Delete Personal Information

•  You have the right to request that AGIA delete any of your personal information we collected from you and retained, with certain exceptions. You will need to submit a valid and verifiable request so AGIA can confirm your identity and/or authorization to make such a request. AGIA will determine if retaining the information is permitted or required under the law. If no retention conditions apply, we will delete your personal information from our records and direct any Service Providers to do the same.

Right to Correct Personal Information

•  Taking into consideration the nature of the personal information and the purposes of the processing of your personal information, you may have the right to correct inaccuracies in such information. Upon submission to AGIA of a valid and verifiable request where your identity and authorization can be confirmed, AGIA will use all reasonable efforts to correct the inaccurate information.

Right to Limit Processing of Sensitive Personal Information

•  AGIA processes sensitive personal information only as necessary in performance of our services to ensure the security and integrity of your information or as otherwise specified under regulation. Because AGIA does not process your sensitive personal information for other purposes, there is not a mechanism for you to limit the processing of this information.

Right to Opt-Out of Profiling

•  AGIA does not engage in automated processing of personal information to make decisions that yield legal or other material consequence. Because we do not engage in this processing, AGIA does not provide a mechanism for you to limit our processing of personal information in this manner.

Right to Opt-Out

•  AGIA does not sell your personal information; therefore we do not provide a mechanism for you to limit our processing of personal information in such a manner.

Right to Non-Discrimination

•  AGIA will not discriminate against you for exercising any of your rights under the CCPA or CPRA. Examples of discrimination could be charging you inflated rates by imposing penalties or granting discounts or other benefits, denying you goods or services or providing you a different level of quality of goods or services.

•  Any acts of discrimination are prohibited by the CCPA and CPRA and AGIA will not engage in them.

Personal Information We Collect, Sources and How We Use It

•  In our Privacy Policy, sections titled, “Personal Information We Collect”, “How We Use Your Personal Information”, and “AGIA Personal Information Processing” outline the personal information we collect, its sources and how we use it for all consumers we interact with, including California residents. In effect, it is used to provide and manage products and services we provide and support our everyday operations, including risk management, legal and compliance requirements.

Exercising Your Rights as a California Consumer

•  You, or a person authorized by you to act on your behalf, or an entity registered with the California Secretary of State and authorized by you to act on your behalf, can make a request regarding your personal information under the CCPA and CPRA. You may also make a request on behalf of your minor child.

•  If you would like to exercise your right to request a copy of your personal information or your right to delete your personal information, please contact AGIA customer service by calling (800) 424-5181, by email at [email protected], or utilize regular mail by using the following address:

AGIA Affinity
Office of Administration
P.O. Box 26450
Phoenix, AZ  85068

Revisions and Notification of Changes

• We reserve the right to change or supplement this Privacy Policy at any time by posting the changes on this Site. Any changes AGIA makes to this Privacy Policy become effective immediately when the revised Policy is posted on this Site. By using this Site, you accept the terms and conditions of this Privacy Policy and you agree to review this Privacy Policy from time to time to stay informed of changes that may occur. This Privacy Policy also applies to personal information that we maintain on former customers. If we make any changes regarding disclosure of personal information to third parties, we will attempt to contact you prior to the date the modified policy is scheduled to take effect. We will post notice of the new Privacy Policy from the privacy links on our Site. Your use of the Site following such change constitutes your agreement to follow and be bound by the Privacy Policy as changed.

Children

AGIA does not knowingly collect, use or disclose information of children under the age of thirteen (13) without the consent of their parents or legal guardians. Further, if you are sixteen (16) years of age or older, you have the right to direct us to not sell your personal information at any time. However, AGIA will never knowingly sell or share personal information of children if between 13 to 16 years of age or the parent or guardian of a consumer less than 13 years of age. This Site is not intended for children and any instance where such information was collected would be unintentional.