Compliance Sheet
for the State of
NEW YORK
 
This page was last updated on 9-4-2018
ACCIDENT

Product Name / Policy Form

Application

Brochure

Outline of Coverage for all Applicants

**MedSupp Notice for Applicants on Medicare

Replacement Form

Instructions (See bottom of page)

Rates

GNYINADP

GNYIN-TAP

GNY9435

DS-GNYINADP

GNYMSNOT-8

Replacements Not Allowed

 

See Brochure

MEDICARE SUPPLEMENTS
A Guide to Health Insurance for People with Medicare must be given to all applicants

Product Name / Policy Form

Application

Brochure

Outline of Coverage for all Applicants

**MedSupp Notice for Applicants on Medicare

Replacement Form (If a Replacement Occurs)

Instructions (See bottom of page)

Rates

ProCare Plans: Exclusively offered by the General Agency Division of Globe Life Insurance Company of New York.

A (GNYMSA10)
B (GNYMSB10)
C (GNYMSC10)
D (GNYMSD10)
F (GNYMSF10)
F+(GNYMSHDF10)
G (GNYMSG10)
K (GNYMSK06)
L (GNYMSL06)
N (GNYMSN10)

GNYMA15

F4931GNY

DS-GNYMS2010

Not Required

GNYREPMSM;
GNYU-1366

H, 1

Current

New

WHOLE LIFE

Product Name / Policy Form

Application

Brochure

Outline of Coverage for all Applicants

**MedSupp Notice for Applicants on Medicare

Replacement Form

Instructions (See bottom of page)

Rates

Final Expense Whole Life

GNYL14 (Located in the Life App-pack. See instruction T below.)

GNY3127

Not Required

Not Required

GNY-REP

T, 2, 3

Rate Cards

Rate Calculators

Cash Value Calculators

Whole Life (GNYSWL)

Whole Life Graded (GNYWLGD)

Juvenile Whole Life

GNYJUV14 (Located in the Life App-pack. See instruction T below.)

GNY3962

Not Required

Not Required

GNY-REP

T, 2, 3

Rate Cards

Rate Calculators

Cash Value Calculators

Whole Life (GNYSWL)

INSTRUCTIONS

H

If replacing existing coverage, give form GNYREPMSM and GNYU-1366 to applicant and send signed copy of forms with application.

T

Carefully review and complete Life App Pack GNY3176(31) with the Applicant. For Juvenile Whole Life, use Life App Pack GNY3178(31). (2) Have Applicant complete and sign the Applicant Acknowledgement page of packet. (3) Attach signed Applicant Acknowledgement page with application. (4) Leave remainder of packet with Applicant.

1

Conditional Receipt Form GNYMSCR must be completed and left with applicant.

2

(1) Carefully review Definition of Replacement Form GNY-DEF (located in the Life App-pack) with the applicant.
(2) Have applicant complete and sign both the Home Office copy and the applicant copy. Agent must complete and sign the bottom of both copies.
(3) If applicant answers Yes to any question on Definition of Replacement, have applicant read and sign both the Home Office copy and the Applicant copy of IMPORTANT Notice Regarding Replacement or Change of Life Insurance Policies or Annuity Contracts form GNY-REP. Note form GNY-REP is not part of the Life App-pack. The Company declines all life applications where replacement is involved; however, form GNY-REP is required by NY Ins Law to be available for use.
(4) Leave Applicant copy of form(s) with the applicant.
(5) Return the signed Home Office copy of form(s) with application.

3

Preliminary Information Form GNY-Prelim (Whole Life / Juvenile Whole Life) or GNY-PrelimGD (Whole Life Graded) must be completed at time of application and left with applicant.Cash Value Calculators have been updated to accommodate additional information.

**

If applicant is on Medicare (regardless of age), applicant must be given the appropriate Notice Form at time of application.