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Get Notice Of Group Life Conversion

Tor s Instructions for Group Life Conversion 1. Complete sections 1 and 2. Only complete section 3 if a covered dependent wishes to convert. Sign and date this form. 2. Present this form to the employee. Inform employee he or she has 31 days from the date of termination to apply for individual coverage. 3. After the employee has completed page 3 of this form (premium calculation), provide him or her with the Employee s Kit for Group Life Conversion (publication number GR/413). 4. Review the.

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