One Year of Insurance Coverage

Underwritten by New York Life and Paid by the AAP Group Insurance Trust

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Name:
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Birth Year:
Certificate Number:(located on your Individual Schedule of Benefits)
AAP Member ID#:

If your membership has lapsed, rejoin instantly here.

Yes, I accept this offer of one year of $100,000 Group Term Life Insurance coverage and $1,000/mo. Group Long Term Disability Insurance coverage (with a 90-Day Waiting Period), paid for by the AAP Group Insurance Trust. By checking this box, I certify that I meet the eligibility requirements¹.

RESIDENTS OF PA, VA, & WI: THE LAWS OF YOUR STATE REQUIRE THAT YOU ACTIVELY AFFIRM THIS COVERAGE BY 1/15/2019 OR COVERAGE IS INVALIDATED.

1: To be eligible to enroll in this offer, you must be a current member of the American Academy of Pediatrics who graduated from residency between 1/1/2019 and 12/31/2019, under the age of 40, a resident of the U.S. (except NV)., not currently insured under this plan and who have not been previously declined for coverage under any AAP Group Insurance Trust insurance plan. Additionally, to be eligible for disability coverage under this offer, you must not be engaged in military service, and you must be at FULL-TIME WORK, defined as actively performing the regular duties of your occupation, for pay or profit, on a basis of at least 20 hours per week at a place where such duties are normally performed or other location to which travel is required.

Michigan Residents: I understand that I may use a producer/agent to assist me with the completion of this application at no cost to me.