Ployee s Mailing Address: (Street, City, State Zip) Has coverage been assigned? Yes If yes, please specify coverage assigned No and attach a copy of assignment form. If coverage has been assigned this form must be mailed to the owner. Employee s Basic Annual Earnings: Reason for Insured s Portability Eligibility: $ Recordkeeper s Name: Print name of person at Recordkeeper completing Part A: Telephone Number: Part B TO BE COMPLETED BY THE EMPLOYEE Employee s Email Address: Soc.
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How to fill out the Metlife Election Of Portable Coverage Form online
Filling out the Metlife Election Of Portable Coverage Form is an essential step for users looking to maintain their life insurance coverage after employment ends. This guide provides clear and detailed instructions for completing the form online, ensuring a smooth and efficient enrollment process.
Follow the steps to complete the Metlife Election Of Portable Coverage Form online.
- Use the ‘Get Form’ button to obtain the Metlife Election Of Portable Coverage Form and open it for editing.
- Begin with Part A of the form, which requires the recordkeeper to enter specific details such as the date of notice, employer’s name, and group customer number. This information helps to establish the context for the coverage you are opting to port.
- Next, complete Part B. This section is vital and needs to be filled out by the employee. You will provide personal details including your email address, social security number, date of birth, and contact information.
- In Part B, indicate your coverage choices for yourself and any dependents by selecting whether to continue, discontinue, or modify the amount of insurance for each type of coverage. Make use of the shaded columns to ensure the recordkeeper properly documents your selections.
- If applicable, list the eligible dependents for whom coverage is requested in the provided section. Be sure to include their names, social security numbers, dates of birth, and sex.
- Proceed to Part C to designate your beneficiaries. This section allows you to specify primary and contingent beneficiaries for your portable term coverages, which is an important step to ensure the benefits are distributed as you intend.
- Once all sections are completed, provide your signature and date to validate the form. Remember, the signed document must be returned to MetLife as the original for processing.
- After signing, you can save your changes, download, print, or share the completed form as needed to complete your enrollment process.
Take action now and complete the Metlife Election Of Portable Coverage Form online to secure your continued coverage.
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