Choice of Beneficiary
If one spouse dies under the “Family Life Plan,” the surviving spouse will receive the amount of insurance protection you chose. (You are automatically one another’s beneficiary unless you specify differently in writing to the plan administrator.) If both you and your spouse die in the same accident, your children or your estate will receive full benefits on each of you up to $200,000.00.
Coverage ends 15 days after the death of one of the insureds; however, the surviving spouse may choose to maintain the coverage as a percentage of the original benefit amount, based on the number of years they were insured.
Exclusion for Term Life Benefit
There are no military exclusions in this special MCA program. Suicide is the only exclusion 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 the premiums paid for the insured’s insurance.
Notice of Insurance Information Practices
Your application is our major source of information. However, the Hartford may also collect or verify information by contacting individuals or organizations that have information or records about you or others to be insured.
Information regarding your insurability will be treated as confidential. Such information will not be disclosed to others without your authorization, except to the extent necessary for the conduct of our business. The Hartford or its <br />reinsurer(s) may, however, make a brief report thereon to the Medical Information Bureau, a non-profit membership organization of life insurance companies, which operates an information exchange on behalf of its members. If you apply to another Bureau member company for life or health insurance coverage, or a claim for benefits is submitted to such company, the Bureau, upon request, will supply such company with the information in its file.
Upon receipt from you, the Bureau will arrange disclosure of any information it may have in your file within 15 days. Medical information will be disclosed only to your attending physician. If you question the accuracy of information in the Bureau’s file, you may contact the Bureau and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of the Bureau’s information office is MOV, Inc., P.O. Box 105, Essex Station, Boston, MA 02110; telephone number 1-866-692-6901 (TTY 866-346-3642 for hearing impaired).
The Hartford or its reinsurer(s) may also release information in your file to other insurance companies to which you may apply for life or health insurance, or to which a claim for benefits may be submitted. Upon written request, The Hartford will provide you with information in your file. Medical information will be disclosed only through a physician you designate. Details regarding your right to correct or amend information in your file will be furnished upon written request. If you would like further details, contact The Hartford, P.O. Box 2999, Hartford, CT 06104-2999, Attn: Group Benefits Department.
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.
STATE NOTICE
Any person who includes any false or misleading information on an application or filing a claim for an insurance policy is subject to criminal and civil penalties. It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. In certain states, penalties may include imprisonment, fines, denial of insurance, and civil damages.
Any insurance company or agent of an insurance company who knowingly provides false, incomplete or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the State Insurance Regulatory Agency and/or Division of Insurance. If while in the state of Florida, a person knowingly and with intent to injure, defraud, or deceive any insurer, files a statement of claim or an application containing any false, incomplete or misleading information, the person is guilty of a felony in the third degree. Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing a materially false, misleading or deceptive information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall be subject to substantial civil and/or criminal penalty where and to the extent allowed by state law.
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.
NOTE: This information explains the general purpose of the insurance described, but in no way changes or affects the Master Policy AGL-1741 as actually issued. In the event of a discrepancy between this brochure 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 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.
This is private insurance. This is not associated with SGLI.
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Endorsed by:
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Underwritten by:
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Hartford Life and Accident Insurance Company
Simsbury, CT 06089
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The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.
John B. Wigle, License No. 0482924
MCA Insurance Program Administered by:
A.G.I.A., Inc.
P.O. Box 21357, Santa Barbara, CA 93121-9911
Questions? Call toll-free 1-866-340-4360
Policy Form # SRP-1333 A (HLA) (1741)