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This document is an application form to convert a group life insurance policy to an individual policy. It provides instructions on completing the application, beneficiary designations, and tax certifications.
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How to fill out APPLICATION FOR CONVERSION OF GROUP LIFE INSURANCE

01
Obtain the APPLICATION FOR CONVERSION OF GROUP LIFE INSURANCE form from your employer or insurance provider.
02
Fill in your personal details, including your name, address, date of birth, and contact information.
03
Provide your group policy number and details about the group life insurance plan you are converting from.
04
Indicate the type of insurance policy you wish to convert to (e.g., term life, whole life).
05
Complete any health information sections honestly and accurately, as this may affect your coverage.
06
Sign and date the application form to certify that all information provided is true.
07
Submit the completed application to your insurance company or designated representative.
08
Keep a copy of the application for your records.

Who needs APPLICATION FOR CONVERSION OF GROUP LIFE INSURANCE?

01
Individuals who have lost their employer-sponsored group life insurance due to job termination, retirement, or other qualifying events.
02
Employees who want to maintain life insurance coverage after leaving their group policy.
03
Individuals who may want to convert their group life insurance to an individual policy for continued protection.
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People Also Ask about

Your employer must notify you within 15 days after your group health plan ends that you qualify for a conversion plan. Your health plan must receive your application and first premium payment within 63 days after your group health insurance ends. You will have to pay the premiums yourself.
Key Takeaways Convertible insurance is a term life insurance policy that can be converted into a whole or universal policy without a health test.
The conversion privilege provision allows an employee that participates in a group plan to convert their group life insurance policy into an individual life insurance policy with little hassle, without having to go through another approval process or a medical exam.
Conversion rights – When your group life insurance terminates or the amount of coverage you have is reduced, you can convert your coverage to an individual Whole Life Policy or you may purchase a Single Premium Convertible One-Year Term Life Policy.
A conversion option, sometimes also called guaranteed cover again or guaranteed insurability, means that you can either change your life insurance cover, extend your life insurance cover, or convert your term life insurance into whole of life insurance without having to provide new medical evidence to your insurer.
A term-to-permanent life insurance conversion, or “term-to-perm” conversion, allows you to extend your life insurance coverage. You may have a 10-,15-, 20- or 30-year term life insurance contract now. Instead of letting it expire, you may be able to exchange it for a permanent policy without needing a new medical exam.
Conversion Coverage When your group health insurance (from a job) ends, your health plan may have to offer you an individual plan. This is called a conversion plan because you convert from the group to an individual plan which you buy yourself.

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APPLICATION FOR CONVERSION OF GROUP LIFE INSURANCE is a formal request to convert a group life insurance policy into an individual policy when a person no longer qualifies for group coverage.
Individuals who were covered under a group life insurance plan and are losing their coverage, such as due to employment termination or retirement, are required to file the application.
To fill out the application, individuals typically need to provide personal information, details of the group policy, and the type of individual coverage desired, along with any necessary signatures.
The purpose is to allow individuals to maintain life insurance coverage without undergoing a medical examination, ensuring continuous protection after leaving the group policy.
The application must include the individual's personal details, the group policy number, the coverage amount requested, and any pertinent health information or statements required by the insurer.
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