Get Notice Of Group Life Conversion

Filling out the Notice Of Group Life Conversion is an important process for individuals transitioning from group life insurance to individual coverage. This guide provides a clear, step-by-step approach to assist users in completing the form online, ensuring all necessary information is accurately provided.

Follow the steps to successfully complete the Notice Of Group Life Conversion.

1. Click the ‘Get Form’ button to access the Notice Of Group Life Conversion and open it in your editor.
2. In section 1, enter the policy information as required, including the name of the group policyholder, policy number, and billing group number. Ensure all details are filled out clearly.
3. Proceed to section 2 and complete the employee/applicant information. Include the employee's name, hours worked weekly, date of hire, date insurance became effective, basic annual salary, social security number, date of birth, date last worked, date of disability, date of reduction or termination, and the amount of coverage lost.
4. If applicable, in section 3, provide the dependent information only if one or more dependents are converting their coverage. Include the dependent's name and amount of coverage lost for both basic and optional insurance.
5. After filling out the appropriate sections, review the entire document to ensure all required fields are completed. Sign and date the form where indicated.
6. Calculate your estimated premium in section 4 based on the coverage amount desired and the rate applicable to your age. Make sure to follow the calculation instructions provided.
7. Choose a payment option in section 5, either annual, semi-annual, or automatic monthly payments, and fill in the calculations as required.
8. Once all sections are complete and reviewed, save your changes. You can then download, print, or share the completed form as needed.

Complete your Notice Of Group Life Conversion online today to secure your coverage.