Application to Convert Group Life Insurance
This file provides the essential steps to convert your group life insurance to an individual whole life policy. It includes instructions on filling out the application form and important information for both employers and employees. Ideal for anyone who has recently become ineligible for group insurance.
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How do I fill this out?
Filling out this application is an important step in ensuring your life insurance coverage continues. Both the employer and the insured need to complete their respective sections of the form carefully. Make sure to follow the prompts and provide accurate information to avoid any issues with the conversion process.
How to fill out the Application to Convert Group Life Insurance?
1
Review your current group life insurance policy and eligibility for conversion.
2
Complete Part 1 of the application with your employer's assistance.
3
The insured should fill out Part 2 with accurate personal information.
4
Attach any necessary documents like a voided check if choosing EFT.
5
Mail the completed application along with the premium to Dearborn Life Insurance Company.
Who needs the Application to Convert Group Life Insurance?
1
Individuals who have left their job and want to maintain their life insurance coverage.
2
Employers who need to provide documentation for employees leaving the company.
3
HR professionals managing employee benefits and insurance options.
4
Insurance agents assisting clients with life insurance conversions.
5
Financial advisors advising clients on maintaining life insurance after employment.
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What are the instructions for submitting this form?
Submit the completed application form to Dearborn Life Insurance Company at 701 E. 22nd Street, Lombard, IL 60148. You should include a check or money order for the first premium payment. For any inquiries, contact Dearborn Life Insurance Company at (877) 442-4207.
What are the important dates for this form in 2024 and 2025?
Important dates regarding this form include current deadlines for conversion, effective dates for new policies, and any upcoming changes to insurance regulations that may impact submissions.
What is the purpose of this form?
The purpose of this form is to provide a seamless process for individuals transitioning from group life insurance to individual coverage. It ensures individuals maintain life insurance even after they become ineligible for group plans, particularly after employment termination. Completing this application allows individuals to convert their existing coverage into a new policy without penalty.
Tell me about this form and its components and fields line-by-line.
- 1. Group Number: The identifier for the specific group insurance plan.
- 2. Reason for Termination: The justification for the change in coverage, e.g., employment end.
- 3. Date Coverage Terminated: The official date when the group insurance coverage ceased.
- 4. Amount of Group Insurance: The total amount of insurance coverage available for conversion.
- 5. Insured's Full Information: Personal details of the insured, including name, address, and SSN.
- 6. Beneficiary Designation: The individual(s) named to receive benefits from the life insurance policy.
What happens if I fail to submit this form?
Failing to submit this form on time can result in loss of insurance coverage. Without conversion, you may need to seek other insurance options which can be more costly or less favorable. It's important to submit the application before the conversion deadline to ensure continued coverage.
- Loss of Coverage: You may lose the opportunity to convert your group coverage.
- Higher Premiums: Failing to convert timely may result in higher premiums if obtaining new coverage.
- Insurance Reinstatement: You may have challenges in reinstating coverage after a lapse.
How do I know when to use this form?
- 1. Prior to Employment Termination: Fill out this application as soon as you know your employment will end.
- 2. During the Transition Period: Use the form while you are still within the group policy's eligibility window.
- 3. If Changing Insurance Providers: When transitioning to an individual policy from a group plan.
Frequently Asked Questions
How do I start the conversion process?
Begin by completing the application and ensuring both parts are filled out correctly.
Can I convert my insurance if I'm unhealthy?
Yes, the conversion can be done regardless of your current health status.
What information is required from my employer?
Your employer needs to fill out Part 1 of the application, which includes the reason for termination and group insurance details.
How do I submit the completed application?
Mail the completed application along with your premium to Dearborn Life Insurance Company.
What if I make a mistake on the application?
You can strike through any errors and initial them to correct your application.
Is electronic funds transfer (EFT) available?
Yes, you can opt for EFT and must sign the authorization provided on the application.
What is the minimum amount I can convert?
The minimum issue amount for conversion is $2,000.
What happens after I submit my application?
The company will process your application and notify you regarding your eligibility.
How are premiums calculated?
Premiums are based on your age and the amount of insurance you wish to convert.
Can I use this application for family members?
This application is specifically for your life insurance; consult your provider for family member options.
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