MODEL BULLETIN

© 2015 National Association of Insurance Commissioners 1

POLICYHOLDER DISCLOSURE 

NOTICE OF TERRORISM

INSURANCE COVERAGE

You are hereby notified that under the Terrorism Risk Insurance Act, as amended, you have a right to purchase insurance coverage for losses 

resulting from acts of terrorism. As defined in Section 102(1) of the Act: The term “act of terrorism” means any act or acts that are certified by 

the Secretary of the Treasury—in consultation with the Secretary of Homeland Security, and the Attorney General of the United States—to be 

an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within 

the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to 

have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the 

policy or affect the conduct of the United States Government by coercion. 

YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROM CERTIFIED 

ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A 

FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH

MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED 

STATES GOVERNMENT GENERALLY REIMBURSES 85% THROUGH 2015; 84% BEGINNING ON JANUARY 1, 2016; 83% 

BEGINNING ON JANUARY 1, 2017; 82% BEGINNING ON JANUARY 1, 2018; 81% BEGINNING ON JANUARY 1, 2019 and 80% 

BEGINNING ON JANUARY 1, 2020, OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED 

DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM CHARGED FOR THIS 

COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAY BE 

COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT.

YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 BILLION CAP 

THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS’ LIABILITY FOR LOSSES RESULTING FROM 

CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100 

BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE 

REDUCED.

Acceptance or Rejection of Terrorism Insurance Coverage

I hereby elect to purchase terrorism coverage for a prospective premium of $_____________.

I hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that I will have no 

coverage for losses resulting from certified acts of terrorism.

_________________________ ___________________________

Policyholder/Applicant’s Signature Insurance Company

_________________________ ___________________________

Print Name Policy Number

_________________________

Date
© 2015 National Association of Insurance Commissioners 2

Disclosure No. 2

POLICYHOLDER DISCLOSURE 

NOTICE OF TERRORISM

INSURANCE COVERAGE

Coverage for acts of terrorism is included in your policy. You are hereby notified that under the Terrorism Risk Insurance 

Act, as amended in 2015, the definition of act of terrorism has changed. As defined in Section 102(1) of the Act: The term 

“act of terrorism” means any act or acts that are certified by the Secretary of the Treasury—in consultation with the Secretary 

of Homeland Security, and the Attorney General of the United States—to be an act of terrorism; to be a violent act or an act 

that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the 

United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been 

committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to 

influence the policy or affect the conduct of the United States Government by coercion. Under your coverage, any losses 

resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula 

established by the Terrorism Risk Insurance Act, as amended. However, your policy may contain other exclusions which 

might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States Government 

generally reimburses 85% through 2015; 84% beginning on January 1, 2016; 83% beginning on January 1, 2017; 82% 

beginning on January 1, 2018; 81% beginning on January 1, 2019 and 80% beginning on January 1, 2020, of covered 

terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. The 

Terrorism Risk Insurance Act, as amended, contains a $100 billion cap that limits U.S. Government reimbursement as well as 

insurers’ liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in 

any one calendar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. 

The portion of your annual premium that is attributable to coverage for acts of terrorism is __________, and does not include 

any charges for the portion of losses covered by the United States government under the Act.

I ACKNOWLEDGE THAT I HAVE BEEN NOTIFIED THAT UNDER THE TERRORISM RISK INSURANCE ACT, AS 

AMENDED, ANY LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM UNDER MY POLICY 

COVERAGE MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT AND MAY BE 

SUBJECT TO A $100 BILLION CAP THAT MAY REDUCE MY COVERAGE, AND I HAVE BEEN NOTIFIED OF 

THE PORTION OF MY PREMIUM ATTRIBUTABLE TO SUCH COVERAGE.

_________________________ 

Policyholder/Applicant’s Signature

_________________________

Print Name

_________________________

Date

Name of Insurer: ____________________

Policy Number: _____________________