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This document is a request form for converting group health or life coverage to individual coverage by the administrator of the insurance policy for terminating employees.
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How to fill out group conversion request

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How to fill out GROUP CONVERSION REQUEST

01
Gather all necessary information about the group that needs to be converted.
02
Fill out the request form with accurate details regarding the current group status.
03
Specify the reasons for conversion and any additional requirements.
04
Review the form for accuracy and completeness before submission.
05
Submit the GROUP CONVERSION REQUEST to the appropriate department or authority.

Who needs GROUP CONVERSION REQUEST?

01
Organizations or individuals overseeing a group that requires a formal conversion process.
02
Group leaders or administrators responsible for managing group structure changes.
03
Members of a group seeking to change their status or structure within an organization.
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People Also Ask about

If your group life insurance ends because the group policy has been terminated or amended, you may have a right to convert a portion of the life insurance to an individual whole life insurance policy.
"Conversion is the derivational process whereby an item changes its word-class without the addition of an affix" (Quirk, Randolph and Greenbaum, 1987: 441). Thus, when the noun 'sign' (1) shifts to the verb 'sign(ed)' (2) without any change in the word form we can say this is a case of conversion1.
Porting is available with Basic, Optional, and Voluntary Life and AD&D plans. Other eligibility and state restrictions may apply. Conversion means you change — or “convert” — your group coverage to an individual policy without having to answer any medical questions.
The conversion privilege under a group life insurance plan allows a covered individual to convert their group coverage into an individual policy if their group coverage ends for certain qualifying reasons. Common triggers include: Termination of employment. Retirement. Loss of eligibility due to reduced work hours.
With most plans, you must apply to convert your coverage within 31 days after the group coverage ends.
Conversion means you change — or “convert” — your group coverage to an individual policy without having to answer any medical questions. Conversion may be a good solution for employees who are leaving a job, reducing hours, retiring, or have reached an age when group coverage may be reduced or eliminated.
If you have convertible term life insurance, you can typically convert it to a whole life policy without going through the underwriting process again. This generally means you won't have to answer health questions or complete a medical exam.

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A Group Conversion Request is a formal application to convert a group insurance policy into individual insurance policies for members of the group.
Typically, the entity or organization responsible for the group policy, such as an employer or plan administrator, is required to file the Group Conversion Request.
To fill out a Group Conversion Request, complete the designated forms provided by the insurance issuer, ensuring all required information about the group members and the existing policy is accurately entered.
The purpose of a Group Conversion Request is to allow individuals from a group insurance plan to obtain individual coverage without having to provide evidence of insurability, typically following the end of their group coverage.
The information that must be reported typically includes details about the group policy, personal information of the group members seeking conversion, their coverage preferences, and any necessary declarations or signatures.
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