The "I Accept" button at the bottom of this page is very important.
When you click it, you're agreeing to all the information shown below, legal details and requirements of electronic transactions, communications, and signatures. You're also agreeing to other important terms and conditions, preauthorized payments and more. Please take a few minutes to review this information and read it thoroughly. If you have any questions or need any assistance, please call us at 1-888-787-8243
By selecting the "I Accept" button at the bottom of this page, you acknowledge that you have reviewed this information and wish to proceed with enrollment. Accidental Death & Dismemberment Insurance is underwritten by CMFG Life Insurance Company (CUNA Mutual Insurance Society in California and New Mexico), ("the Company").
Consent and Agreement to Electronic Transactions / Electronic Signature
By clicking "I Accept" below, you consent to conduct transactions in electronic form. This can include the use of electronic communications, electronic records, electronic signatures for the communications, and electronic notices and disclosures described below.
You also acknowledge that:
•You can access and read this Consent and Agreement to use Electronic Signature and Electronic Delivery of Information.
•You can print this Consent and Agreement.
•Your electronic signature is the legal equivalent of your written signature, just as if you had signed a paper document.
You are not obligated to enter into transactions electronically and may conduct insurance transactions in paper format instead.
It is your responsibility to provide us with an accurate email address as well as other contact information. It is also your responsibility to inform us of any changes in this information.
If you choose to conduct insurance transactions in paper form, withdraw your consent to electronic transactions, or to would like to update your contact information, please contact CMFG Life Insurance Company. You can call us toll-free at 1-888-787-8243 or write to CMFG Life Insurance Company, P.O. Box 61, Waverly, IA 50677-0061. There is no fee charged for such requests.
You agree that your electronic signature authorizes the Company to do the following:
•Electronically process this insurance transaction and any future transactions that may be needed to administer and help keep your coverage in force under the insurance policy.
•Communicate with you by mail, telephone or email.
You consent to use electronic communications, electronic records and electronic signatures rather than paper documents for:
•agreements and contracts, including this Consent and Agreement.
•notices and/or disclosures that various federal and/or state laws or regulations require that we provide to you.
•notices, documents, statements, data, records or communications regarding your coverage, including changes in terms of coverage.
•privacy policies and notices.
•periodic billing or account statements.
You understand and agree that this election provides consent to the Company to deliver all notices electronically, including notice of nonrenewal and notice of cancellation. To ensure uninterrupted communication, please be sure to update the email address you provided to the Company in the event this email address should change.
You understand and agree that in order to access the documents we send to you electronically, a minimum standard of technology is required, The fully functional hardware, software and services necessary include a computer with a Microsoft Windows or Macintosh operating system, Internet access, a working email address and email software, compatible web-browsing software such as Internet Explorer and Internet access services. You understand that you will be deemed to have received the foregoing documents even if you fail to provide the necessary technology.
A confirmation email will be sent to you upon completion of your enrollment. Please note that after you enroll, you will not have access to your electronic enrollment record. We encourage you to print your enrollment record, including this Important Information, at the time of enrollment.
Additional Terms and Conditions
•Your credit union enables this insurance program to be offered and is entitled to compensation from the Company for doing so.
•You acknowledge and agree that the information you have provided is true and accurate and that you are a member of the credit union you designated.
•You cannot be the insured under more than one no-cost certificate/policy per credit union. Upon discovery of duplicate enrollment, the duplicate will be voided and coverage will not take effect.
Preauthorized Payment Authorization
By clicking "I Accept" below, you authorize the Company to retain your account information and deduct premiums from your checking or savings account or charge your credit card for the additional coverage as indicated above in the Enrollment Summary.
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly presents false information in an application for insurance may be guilty of a crime and subject to fines and confinement in prison, and denial of insurance benefits, depending on state law. Residents of CO: 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. 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 Colorado division of insurance within the department of regulatory agencies. Residents of DC–WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant. Residents of FL and NY: See enrollment form. Residents of AL and MD: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Residents of NJ: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Residents of OH: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Residents of KY and PA: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or a statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
The certificate provides limited benefits. Review your certificate carefully.
CMFG Life Insurance Company
P.O. Box 61, Waverly, IA 50677-0061