Life Conversion Checklist Template printable pdf download

LIFE CONVERSION CHECKLIST

Use the checklist below to guide you through the Life Conversion Quote and Application process:

REQUEST FOR QUOTE - SECTION A. EMPLOYER / GROUP ADMINISTRATOR:

• Please note, the Employee must apply for Life Conversion within 31 days from the date of their loss of coverage. You

must notify the Employee of their Conversion rights immediately following their loss of coverage. If their application

is received after 31 days, Life Conversion coverage may be denied.

• Complete Section A, sign and date the Request for Quote form to confirm member eligibility information.

• Forward the completed form and this checklist to the Employee immediately following their loss of coverage.

• Once you’ve confirmed all information in Section A, The Lincoln National Life Insurance Company will work directly

with the Employee / Proposed Insured regarding their Life Conversion application process.

REQUEST FOR QUOTE - SECTION B. EMPLOYEE:

• Please note, you have 31 days from the date of your loss of coverage to apply for an Individual Life Conversion Policy.

If your application is received in our office after 31 days, Life Conversion may be denied. No policy will be issued and

no benefit will be payable until all information, including premium is received.

• Call 1-800-423-2765 or email your Request for Quote form to to receive an Individual Life

Insurance Conversion Quote - you are converting from a Group Policy to an Individual Policy and premiums are subject

to change.

• If you choose to accept the Life Conversion quote for Individual Life Insurance, you will be sent a copy of the quoted

illustration for your review and an application to sign and return with your initial payment of the insurance premium.

• Once you have received these items, please continue on to the following instructions to complete the application process.

APPLICATION FOR CONVERSION OF GROUP LIFE INSURANCE – SECTION A. EMPLOYEE / MEMBER:

• To complete the application process, the following items must be returned to The Lincoln National Life Insurance

Company. These items must be returned within 31 days from the date of your loss of coverage. No policy will be issued

and no benefit will be payable until all information, including premium is received.

Request for Quote Form

Application for Conversion of Group Life Insurance for each Proposed Insured (Employee, Spouse and

Children)

Life Insurance Illustration – you will need to sign the Signature Page of the Illustration for each Proposed

Insured (Employee, Spouse and Children)

Electronic Funds Transfer (EFT) Authorization (if electing to pay Monthly)

Payment for the Initial Premium – based upon the quoted premium in the Life Insurance Illustration.

Mail to:

The Lincoln National Life Insurance Company

P O Box 0821

Carol Stream, IL 60132-0821

• Please allow approximately 60 days to finalize issuance of your Individual Life Conversion Policy. If you should need

any assistance in the meantime, please contact our Client Services Department at 1-800-423-2765.

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.

Page 1 of 2

LF10020

3/11

Life Conversion Checklist Template