Get the free Aetna LTD Conversion Form INSTR-5 112004.DOC - hawaiiresidency

INSTRUCTIONS FOR CONVERTING YOUR GROUP LONG TERM DISABILITY INSURANCE You may elect to purchase Long Term Disability coverage under the Aetna Life Insurance Company Group Long Term Disability Conversion

How to fill out aetna ltd conversion form

How to fill out Aetna LTD conversion form:

1. Obtain the form: The Aetna LTD conversion form can typically be obtained from your employer or the human resources department.
2. Read the instructions: Before filling out the form, carefully read and understand the instructions provided. This will help ensure accurate completion of the form.
3. Personal information: Begin by providing your personal information, such as your full name, address, contact number, and social security number. It is essential to provide accurate and up-to-date information.
4. Employer information: Next, fill in the details regarding your current employer, including their name, address, and contact information.
5. Existing LTD policy information: If you have an existing Aetna LTD policy, you will need to provide information about it. This may include the policy number, coverage details, and any other relevant information.
6. Desired coverage: Specify the type and amount of coverage you would like to convert to. This could include details about the monthly benefit amount, elimination period, and any additional riders or options you wish to include.
7. Medical information: You might be required to provide certain medical information, such as details about previous medical conditions or any ongoing treatments. Ensure that you accurately disclose all relevant information.
8. Beneficiary information: List the name(s) and contact details of the individual(s) you wish to designate as beneficiaries for your LTD conversion coverage in case of your death.
9. Sign and submit: Once you have completed all the necessary sections of the form, review it for accuracy and ensure all required fields are filled out. Sign the form and submit it to the appropriate department or person as instructed in the form's guidelines.

Who needs Aetna LTD conversion form?

The Aetna LTD conversion form is typically required by individuals who are transitioning from a group LTD plan provided by their employer to an individual coverage plan. This form is primarily used when an employee is leaving the company or is no longer eligible for the group coverage. It allows individuals to convert their existing LTD policy into an individual policy to maintain coverage and protect against the loss of income due to disability. It is essential to consult with your employer or benefits administrator to determine if you are eligible to convert your Aetna LTD policy and whether you need to fill out the conversion form.

For pdfFiller’s FAQs

What is aetna ltd conversion form?

Aetna ltd conversion form is a document that allows policyholders to convert their long-term disability insurance coverage.

Who is required to file aetna ltd conversion form?

Policyholders who wish to convert their long-term disability insurance coverage are required to file the Aetna ltd conversion form.

How to fill out aetna ltd conversion form?

To fill out the Aetna ltd conversion form, policyholders must provide their personal information, policy details, and any additional required information.

What is the purpose of aetna ltd conversion form?

The purpose of the Aetna ltd conversion form is to facilitate the conversion of long-term disability insurance coverage for policyholders.

What information must be reported on aetna ltd conversion form?

Policyholders must report their personal information, policy details, and any other relevant information required for the conversion.

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