Helping to Protect your Future.


MIB Notice

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.


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.


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.


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


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


Term Life Insurance FAQ

Policy AGL-1752

What kind of life policy is this?
It is a term life policy.

Are the premiums level?
The premiums are level for five years and will change at the 0 or 5 birthdays (example: age 30, 35, 40, 45).

Can I purchase this on my family?
Yes, you can purchase coverage on your spouse for up to $250,000 and $5,000 on your children.

Do I need to name my spouse as beneficiary?
No, you may select anyone as a beneficiary.

Do I need to be an ACEP member to apply?
Yes, you must be and remain an ACEP member to continue coverage; however, you can convert coverage.

Is there a Waiver of Premium option?
Yes, after you have been on Total Disability for six months you are eligible.

When applying for coverage will I need to get a physical?
Blood and urine tests may be requested along with medical records and an attending physician statement (APS).

What premium modes can I select from?
We offer Direct monthly ACH, Monthly, Quarterly, Semi-Annual and Annual.

How will my beneficiary make a claim on this policy?
Claims can be made by calling HBI. At that point, we will mail all of the appropriate forms immediately.

What forms must a beneficiary complete to receive the insurance benefit?
The forms include a general claim form for the beneficiary, an attending physician statement and a request for a certified death certificate.


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

Term Life Insurance Plan

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


This insurance program is not available to residents in all states.

Make Sure Your Life Insurance Helps Fit Your Growing Needs


Nothing can replace the loss of a loved one, but carefully chosen life insurance coverage can help to ease the financial stress that death brings to a family. As your financial responsibilities increase, you should ensure that your life insurance will help to meet the added expenses.


All active members of ACEP who are under age 60, reside in the United States and can provide acceptable evidence of insurability are eligible to apply for coverage.  Your legal spouse, can also apply as long as they meet the same eligibility requirements. Your unmarried, dependent children, from age 15 days up to age 25 are eligible for coverage as well. All full-time employees of members (working at least 30 hours per week) under age 60 are also eligible to apply.


When both spouses are eligible members, each may apply for coverage as "members"; however, coverage may not be duplicated by applying as dependents of each other. Coverage for eligible children may only be requested by one member.


Planning ahead often spells the difference between success and failure. When it comes to your family's security, that means adequate life insurance protection. Now is a good time to review your life protection and make sure it has kept pace with inflation and your changing needs.


Benefits include:

Up to $500,000* of protection for members
$250,000 of protection for spouses and employees
$5,000 of protection for children (to age 25)
Non-tobacco user rates
Accelerated Death Benefit
Level premiums at 5-year increments
*The maximum benefit amount will be reduced to $300,000 on the premium due date on or next following the date you attain age 65, with an appropriate reduction in premium.


Monthly Individual Premiums $25,000 Benefit Amount
Benefits Amounts under $100,000 - (per $25,000 in coverage)


Member Age Smoker Non-Smoker
Under Age 30 $1.60 $2.00
30-34 $1.68 $2.18
35-39 $2.32 $3.22
40-44 $3.52 $5.27
45-49 $5.84 $9.32
50-54 $8.97 $14.59
55-59 $13.80 $22.12
60-64* $21.97 $33.75
65-69* $3524 $51.00

Monthly Individual Premiums $25,000 Benefit Amount
Benefits Amounts $100,000 and Higher - (per $25,000 in coverage)



Member Age Smoker Non-Smoker
Under Age 30 $1.44 $1.83
30-34 $1.49 $1.97
35-39 $1.98 $2.80
40-44 $2.88 $4.43
45-49 $4.73 $7.78
50-54 $7.27 $12.27
55-59 $11.25 $18.79
60-64* $19.26 $30.35
65-69* $33.09 $48.50

*Premium rates for persons age 60 or older are renewal only.

Rates are based on the attained age of the insured person and increase as you enter each new age category.


Rates and/or benefits may be changed on a class basis

Coverage for children is $16.50 annually.


Smoker means you or your Eligible Dependent who has smoked cigarettes, cigars or used a pipe or chewing tobacco, nicotine chewing gum or snuff during the 12 months prior to the date application for coverage was made.

Accelerated Death Benefit (Living Benefits Option)
Facing a Terminal Illness is a critical time for anyone, both emotionally and financially. Most people have friends or family for emotional support, but where do they turn for financial assistance?


The Hartford's Living Benefits Option may relieve some of the financial burdens associated with a Terminal Illness. This benefit allows you (and your spouse if covered) a one time option to receive up to 50% of the Term Life insurance proceeds, from $12,500 to a maximum of $100,000, upon being diagnosed by a physician as having twelve months or less to live as long as you are under age 70. Life proceeds can be distributed after a request and due proof have been received.

For example, if you're covered for $100,000 under the Term Life Plan and you become Terminally Ill, you may request an amount between $10,000 and $50,000. However, if you select $20,000 now, you may not request the remaining $30,000 in the future.


The funds are received in a lump sum payment without restriction on how you can use them. The face amount of your term life policy is then reduced by the Accelerated Death Benefit amount paid out.

Individuals should consult their personal tax advisor since the proceeds under this benefit may be taxable.


This information is written in connection with the promotion or marketing of the matter(s) addressed in this material. The information cannot be used or relied upon for the purpose of avoiding IRS penalties. These materials are not intended to provide tax, accounting or legal advice. As with all matters of a tax or legal nature, you should consult your own tax or legal counsel for advice.

Coverage Effective Date

Your and your dependent's insurance will become effective on the first day of the month following the your application is approved and you pay your premium.


If on the date that you are to become covered, you, your covered spouse or your employee are not Actively-at-Work at least 30 hours per week, or if not employed, unable to carry on the normal activities of a person of like age and sex in good health, coverage will not become effective until the first day of the month on or next following the date you complete such activities for 90 consecutive days.


Your coverage will remain in force as long as you pay your premiums when due, remain an active member of the American College of Emergency Physicians, you are under age 70, and the program remains in force. Dependents' coverage terminates if your coverage terminates, premiums are not paid when due or such person ceases to be an eligible dependent.


Waiver of Premium for Disability

If you become Totally Disabled before age 60 while you're covered under this program and the disability continues for six consecutive months, your life insurance will be continued in force without further premium payment while you remain disabled. Please note this provision does not apply to dependents' benefits. A Total Disability is one which prevents you from engaging in any occupation for wage or profit and must result from an injury or sickness.

Conversion Privilege

If your coverage ends for any reason (except for policy cancellation, coverage for a class of persons ends, or because of non-payment), you have the right to request an individual policy without having to provide evidence of insurability. To convert to an individual policy you must complete a notice of conversion privilege form for the conversion policy and send in the required premium within 31 days from the time your term life plan ends. Complete details may be found in your term life certificate of insurance.


30-Day Satisfaction Guarantee

You have 30 days from your effective date of coverage to look over the program and discuss it with your family and advisors. If you are not satisfied, you may return your certificate within 30 days for a full premium refund.

Beneficiary Designation

You may name anyone as the beneficiary of this insurance. You can change your beneficiary at any time by giving written notice to the Plan Administrator.


Exclusions and Limitations

The life benefit will not be  paid for death occurring as a result of suicide while sane or insane (in Missouri while sane) during the first two years (we will refund the entire premium paid to date if suicide is committed  during the first two years). Life benefits are paid to the beneficiary you designate.

Privacy Policy
MIB Notice


Print a PDF and complete application and fax to 605-444-7017

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


Acceptance into this plan is subject to medical evidence of insurability as determined by The Hartford1. 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, 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.


Underwritten by:
Hartford Life and Accident Insurance Company
Hartford, CT 06155


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

1The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.