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COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
DIVISION OF INSURANCE
1000 Washington Street, Suite 810 • Boston, MA 02118-6200
(617) 521-7794 Toll-free (877) 563-4467
http://www.mass.gov/doi
CHARLES D. BAKER JAY ASH
GOVERNOR SECRETARY OF HOUSING AND
ECONOMIC DEVELOPMENT
KARYN E. POLITO JOHN C. CHAPMAN
LIEUTENANT GOVERNOR UNDERSECRETARY OF CONSUMER AFFAIRS
AND BUSINESS REGULATION
GARY D. ANDERSON
ACTING COMMISSIONER OF INSURANCE
INDIVIDUAL ACCIDENT ONLY INSURANCE POLICIES
THAT MEET THE REQUIREMENTS OF
MASSACHUSETTS’ REGULATION 211 CMR 42.00
Company Name Approval Date
1. AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS
1932 Wynnton Road
Columbus, GA 31999
(800) 992-3522
Policy #s:
A-33000-MA 1 accidental death and dismemberment policy 04/25/00
A-34100-MA accidental death and dismemberment policy 09/26/03
A-34200-MA accidental death and dismemberment policy 09/26/03
A-34300-MA accidental death and dismemberment policy 09/26/03
A-34400-MA accidental death and dismemberment policy 09/26/03
A35B24MA accident only policy 12/20/10
A35100MA accident only policy 12/20/10
A35200MA accident only policy 12/20/10
A35BOFMA accident only policy 12/20/10
A35300MA accident only policy 12/20/10
A35400MA accident only policy 12/20/10
A36000MA accident-only policy 01/26/16
A36500MA accident-only policy 01/26/16
2. AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK
One Marcus Boulevard
Albany, New York, 12205
(800) 366-3436
Policy #s:
NY-32000MA 2 accidental death and dismemberment policy 11/03/95
NY-33000MA 2 accidental death and dismemberment policy 03/02/99
NY-33100MA 3 accidental death and dismemberment policy 03/02/99
1
Effective April 12, 2004 American Family Life Assurance Company of Columbus ceased offering its approved individual
accident only policy in Massachusetts.
2
American Family Life Assurance Company of New York notified the Division that it has not marketed its approved individual
accident only policy in Massachusetts.
Page 1 As of October 3, 2017
INDIVIDUAL ACCIDENT ONLY INSURANCE POLICIES
Company Name Approval Date
3. AMERICAN FIDELITY ASSURANCE COMPANY
2000 N. Classen Blvd
Oklahoma, City, Oklahoma
(800) 437-1011
Policy #s:
AO-03 (MA) accident only policy 09/25/08
4. AMERICAN HERITAGE LIFE INSURANCE COMPANY
1776 American Heritage Drive
Jacksonville, FL 32224
(800) 521-3535
Policy #s:
AP3MAN accidental injury policy 06/24/99
AP2MAN accidental injury policy 01/25/05
5. AMERICAN NETWORK INSURANCE COMPANY 4
AON Select Company
110 Gibraltar Road
Suite #116
Horsham, PA 19044
(800) 343-3133
Policy #s:
AO-87-MA accidental injury policy 08/01/89
6. ASSURITY LIFE INSURANCE COMPANY
1526 K Street
Lincoln, NE 68501-2533
(800) 627-7212
Policy #s:
AAW-A117 MA 5 accidental only policy 04/22/03
W A 200 (MA) accidental only policy 04/22/09
W A 205 (MA) accidental only policy 04/22/09
W H1101 (MA) accidental only policy 10/22/14
W H1102 (MA) accidental only policy 10/22/14
3
Effective January 14, 2002 American Family Life Assurance Company of New York ceased offering its approved individual
accident only policy in Massachusetts.
4
Effective January 6, 2009 American Network Insurance Company was placed in rehabilitation per order of the Pennsylvania
Insurance Commissioner and the company is not longer marketing the approved individual accident only policies in
Massachusetts.
5
Effective May 1, 2009 Assurity Life Insurance Company ceased offering its approved individual accident only policy in
Massachusetts.
Page 2 As of October 3, 2017
INDIVIDUAL ACCIDENT ONLY INSURANCE POLICIES
Company Name Approval Date
7. BANKERS LIFE AND CASUALTY COMPANY
222 Merchandise Mart Plaza
Chicago, IL 60654-2001
(312) 396-6000
Policy #s:
GR-771-PL accidental injury/death policy 10/22/85
8. BOSTON MUTUAL LIFE INSURANCE COMPANY
120 Royall Street
Canton, MA 02021-9968
(800) 669-2668
Policy #s:
WIND-ACC 11/05 MA accidental only policy 11/13/06
9. THE CHESAPEAKE LIFE INSURANCE COMPANY
9151 Boulevard 26
North Richland Hills, TX 76180
(817) 255-3100
Policy #s:
CH-26114-IP (01/10) MA accidental disability income policy 05/13/11
CH-26110-IP (06/09) MA accidental injury policy 05/13/11
10. COLONIAL LIFE & ACCIDENT INSURANCE COMPANY
1200 Colonial Life Boulevard
P.O. Box 1365
Columbia, SC 29202
(800) 325-4368
Policy #s:
ACCH-MA 6 accidental injury policy 09/08/97
ACCPOL-MA accidental injury policy 04/25/03
Accident 10.-HS-MA accidental only policy 11/16/10
Accident 1.0-NS-MA accidental only policy 11/16/10
6
Effective June 30, 2010 Colonial Life Insurance Company ceased offering its approved individual accident only policy in
Massachusetts.
Page 3 As of October 3, 2017
INDIVIDUAL ACCIDENT ONLY INSURANCE POLICIES
Company Name Approval Date
11. COMBINED INSURANCE COMPANY OF AMERICA
5050 Broadway
Chicago, IL 60640
(800) 225-4500
Policy #s:
11885 7 accidental hospital indemnity policy 03/16/83
11761-MA 8 accidental disability income policy 10/18/94
11789-MA 8 accidental injury policy 05/20/96
11617-MA 8 accidental injury policy 03/28/97
11780R-MA 9 accidental death policy 03/28/97
11698-MA 10 accidental injury policy 10/06/97
11697-MA 11 accidental injury policy 10/09/97
11
11806-MA accidental injury policy 11/13/97
14000-MA accidental injury policy 04/21/98
11795-MA 12 accidental death and dismemberment policy 06/12/98
10192-MA 13 accident only policy 06/27/03
10212-MA accidental death policy 11/24/03
14030-MA accident only policy 02/27/06
14144-MA accidental disability income policy 01/28/15
14150R-MA accident only policy 08/21/15
14138-MA accidental disability income policy 03/01/16
12. FAMILY LIFE INSURANCE COMPANY
10700 Northwest Freeway
Houston, TX 77092
(800) 877-7705
Policy #s:
FLEAP-11-MA accidental injury policy 02/16/12
7
Effective April 18, 2000 Combined Insurance Company of America ceased offering its accident only policy in Massachusetts.
8
Combined Insurance Company of America notified the Division that it has not marketed its approved individual accident only
policy in Massachusetts.
9
Effective January 14, 2000 Combined Insurance Company of America ceased offering its approved individual accident only
policy in Massachusetts.
10 Effective April 2, 2002 Combined Insurance Company of America ceased offering its approved individual accident only policy
in Massachusetts.
11 Effective February 27, 2004 Combined Insurance Company of America ceased offering its approved individual accident only
policy in Massachusetts.
12 Effective May 1, 2005 Combined Insurance Company of America ceased offering its approved individual accident only policy in
Massachusetts.
13 Effective May 6, 2009 Combined Insurance Company of America ceased offering its approved individual accident only policy in
Massachusetts.
Page 4 As of October 3, 2017
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