Get Ad&d Conversion Bellcore. Ad&d Conversion Bellcore

This guide provides essential information on how to complete the AD&D Conversion Bellcore form. The form allows users to convert their group accidental death and dismemberment insurance to an individual policy, ensuring continued coverage and peace of mind.

Follow the steps to successfully complete the AD&D Conversion Bellcore

1. Press the ‘Get Form’ button to download and access the AD&D Conversion Bellcore form in your preferred editor.
2. Complete the section marked 'This Part of Application to be Completed by Proposed Insured'. Fill in your full name, social security number, address, and date of birth. Specify your former and present occupations, and describe your current duties.
3. Indicate the amount you wish to convert. Select the desired coverage options, including whether you want individual or family coverage.
4. Choose your premium payment frequency: semiannually, quarterly, or annually. Make sure to enclose your check made out to 'LINA' for the appropriate amount.
5. Designate your beneficiary for the loss of life benefits. Provide the full name of the beneficiary and describe their relationship to you.
6. Review the complete application for accuracy and completeness. Confirm that all statements are truthful to the best of your knowledge.
7. Sign and date the application in the designated space to acknowledge your agreement.
8. Have your employer complete the section titled 'This Part of Application to be Completed by Employer'. This includes confirming your group policy number and the date you became ineligible for group coverage.
9. Ensure your employer signs and dates the application before submission.
10. Mail the completed application, along with your check, to Life Insurance Company of North America, Individual Conversion Unit, P.O. Box 20187, Lehigh Valley, PA 18002-0187.

Act now and fill out your AD&D Conversion Bellcore form online to secure your coverage.