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Client Name Group Number Portability Coverage Election (To be completed by the employee) This form lets you continue your coverage after your employment terminates. Check the box(BS) for the product(s)
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How to fill out portability coverage election

How to Fill Out Portability Coverage Election:
01
Obtain the portability coverage election form from your insurance provider or employer. This form is typically available during open enrollment periods or during a qualifying life event.
02
Carefully read through the instructions provided on the form. Make sure you understand the purpose and benefits of portability coverage.
03
Fill out your personal information accurately, including your name, address, contact details, and social security number.
04
Indicate the type of coverage you currently have and the coverage you wish to port. This may include medical insurance, dental insurance, vision insurance, or a combination of these.
05
Identify your dependents, if applicable, and include their personal information as required.
06
Review the available coverage options and select the plan that best suits your needs. Consider factors such as cost, coverage limits, network providers, and any additional benefits.
07
If you have any pre-existing conditions, disclose this information as required. Pre-existing conditions may impact your eligibility or coverage options.
08
Sign and date the form. Ensure that you have filled out all the necessary sections and provided any supporting documentation requested.
09
Submit the completed form to your insurance provider or employer within the designated submission period. Keep a copy of the form for your records.
10
Follow up with your insurance provider or employer to confirm that your portability coverage election has been processed and implemented.
Who Needs Portability Coverage Election:
01
Individuals who are transitioning from one job to another and want to continue their health insurance coverage.
02
Individuals who are leaving a job but want to retain their current health insurance benefits.
03
Individuals who are retiring but want to maintain their health insurance from their previous employer.
04
Individuals who have lost their job and need to secure new health insurance coverage.
05
Individuals who have recently gotten divorced or separated and need to find new health insurance options.
06
Individuals who were covered under a spouse's insurance but need to obtain their own coverage.
07
Individuals who are eligible for a special enrollment period due to a qualifying life event, such as marriage, birth/adoption, or loss of other health coverage.
Remember, it is always recommended to consult with your insurance provider or employer for specific instructions and information regarding portability coverage election.
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What is portability coverage election?
Portability coverage election allows a surviving spouse to retain the deceased spouse's unused estate tax exemption.
Who is required to file portability coverage election?
The executor of the deceased spouse's estate is required to file the portability coverage election.
How to fill out portability coverage election?
The portability coverage election is filled out by using IRS Form 706.
What is the purpose of portability coverage election?
The purpose of portability coverage election is to preserve the deceased spouse's unused estate tax exemption for the surviving spouse.
What information must be reported on portability coverage election?
Information such as the deceased spouse's basic exclusion amount, the surviving spouse's basic exclusion amount, and details of the estate assets must be reported on the portability coverage election form.
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