This policy may contain reductions of benefits, limitations and exclusions. Click for standard Limitations and Exclusions. Product availability, features, rates, limitations and exclusions may vary by state. For costs and complete details of the coverage, please contact your insurance representative or Assurity to review the policy for more information. The state specific policy form is the ultimate authority for any questions about this product.
Policy Form No. I H2004 and if made available, associated Form Nos. R I2005, R I2006, R I2007, R I2008, R I2009, R I2010 underwritten by Assurity Life Insurance Company, Lincoln, Nebraska.
When and if the policy is approved and made available for sale to New York residents, the following language with actual form numbers will need to be added immediately after the above:
Policy Form No. I HXXXX XX and if made available, associated Form Nos. R IXXXX XX, R IXXXX XX, R IXXXX XX, R IXXXX XX R IXXXX XX, R IXXXX XX underwritten by Assurity Life Insurance Company of New York, Albany, New York.
IMPORTANT NOTICE— This policy provides ACCIDENT INSURANCE ONLY. This policy DOES NOT PROVIDE COVERAGE FOR SICKNESS. The face amount of the policy will only be paid to the named beneficiary if the insured’s death results directly from an injury sustained in a covered accident within 180 days of the accident while the policy is in force and independent of all other causes. No benefits are payable if the insured’s death results from a cause other than an accidental bodily injury.
When and if the policy is approved and made available for sale to New York residents, the above IMPORTANT NOTICE must be appended to include the following language inserted immediately after the second full sentence which ends in “FOR SICKNESS” with actual expected benefit ratio provided:
It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. The expected benefit ratio for this policy is XX percent. This ratio is the portion of future premiums that the company expects to return as benefits, when averaged over all people with this policy.
Assurity reserves the right to order, at the company’s expense, evidence of insurability which the company feels is necessary for the prudent evaluation of the risk.
Assurity is a marketing name for the mutual holding company Assurity Group, Inc. and its subsidiaries. Those subsidiaries include but are not limited to: Assurity Life Insurance Company and Assurity Life Insurance Company of New York. Insurance products and services are offered by Assurity Life Insurance Company in all states except New York. In New York, insurance products and services are offered by Assurity Life Insurance Company of New York, Albany, NY.
