Group Life Portability Insurance Application Instructions
This document provides instructions for applying for portable Group Life Insurance after employment termination. It covers eligibility requirements, how to apply, and premium rates. It also includes details for additional coverages like AD&D and Dependents Insurance.
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How do I fill this out?
To fill out this form, you need to provide personal, employment, and insurance details. Ensure all required fields are completed accurately. Refer to the provided instructions for specific guidance.
How to fill out the Group Life Portability Insurance Application Instructions?
1
Review eligibility requirements carefully.
2
Complete personal information section.
3
Fill out employment and insurance details.
4
Calculate and enter premium amounts.
5
Submit the form to the provided address or contact number.
Who needs the Group Life Portability Insurance Application Instructions?
1
Employees whose employment has terminated and want to continue their life insurance.
2
Individuals under age 65 seeking portable life insurance coverage.
3
Those eligible for additional coverages like AD&D and Dependents Insurance.
4
Employers assisting terminated employees with continuing benefits.
5
Insurance agents helping clients with post-employment insurance options.
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Save the changes to the PDF.
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Download the edited PDF for submission.
What are the instructions for submitting this form?
Submit the completed form by fax to 800.331.3397 or by mail to Standard Insurance Company, 900 SW Fifth Avenue, Portland OR 97204. Ensure all required fields are filled accurately and attach any necessary documents. Be sure to meet the 31-day submission deadline to ensure eligibility. My advice is to double-check all information and calculations before submission to avoid any delays.
What are the important dates for this form in 2024 and 2025?
Ensure you submit the form within 31 days after your employment terminates to be eligible for coverage.
What is the purpose of this form?
The purpose of this form is to allow employees who have terminated their employment to continue their group life insurance coverage. It provides a way to maintain insurance benefits, including accidental death and dismemberment (AD&D) and dependents insurance, under a portable provision. This ensures continued financial protection even after employment has ended.
Tell me about this form and its components and fields line-by-line.
- 1. Member Information: Includes personal details such as name, address, social security number, birthdate, and contact information.
- 2. Dependents Information: Requires information about dependents, if applicable, including names and birthdates.
- 3. Employer Information: Includes employer details such as name of the group, city, state, zip code, and HR contact information.
- 4. Eligibility: Contains questions regarding insurance coverage duration, medical reasons for termination, and tobacco usage.
- 5. Amount of Insurance Coverage Requested: Sections to fill in the requested amounts of life insurance and AD&D coverage for the member, spouse, and children.
What happens if I fail to submit this form?
If you fail to submit this form, you may lose the opportunity to continue your life insurance coverage after employment termination.
- Loss of Coverage: Without submission, your group life insurance benefits will terminate.
- Financial Risk: Failure to maintain insurance coverage can result in financial vulnerability in the event of death or dismemberment.
How do I know when to use this form?
- 1. Employment Termination: Apply when your job is ending and you are under age 65.
- 2. Portable Insurance: Use to continue group life insurance and additional coverages like AD&D.
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You can enter text, modify existing information, add signatures, and calculate premium amounts.
How do I calculate premium amounts on the form?
Refer to the provided premium rate tables, enter your age, insurance amount, and perform the necessary calculations as instructed.
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Yes, you can save your progress and return to complete the form at any time on PrintFriendly.
How do I know if I'm eligible for the insurance?
Review the eligibility criteria listed in the instructions to determine if you qualify for the portable insurance.
Where do I send the completed form?
Submit the completed form to the provided contact address, fax number, or email as mentioned in the instructions.
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