Form Gr-10671-16 - Notice Of Continuation Of Coverage Page 2
Download a blank fillable Form Gr-10671-16 - Notice Of Continuation Of Coverage in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Gr-10671-16 - Notice Of Continuation Of Coverage with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Frequently Asked Questions
Q: If I request a quote, how does Hartford determine the amount of coverage to quote?
A: Hartford will contact your employer to obtain the amount of coverage you had in effect under the group plan. The quote is
based on this amount as well as applicable plan provisions.
Q: If I receive a quote for coverage, does this mean I qualify for the coverage amount quoted?
A: The amount quoted is not a guarantee that a policy will be issued in that amount. Upon receipt of your application for
coverage, Hartford will perform an eligibility review to determine that the amount of coverage you have requested can be granted
based on the coverage you had in effect under the group plan as well as plan provisions.
Q: What is my policy effective date?
nd
A: The effective date of a Life Conversion policy is the 32
day following the group coverage termination date. The effective
date of a Life Portability Policy is the day following group coverage termination date.
Q: If my application for coverage is not approved by the effective date, am I still covered?
A: Yes, if your application is approved the effective date of your policy will be retroactive to the date indicated above.
Q: I understand that there is no medical underwriting or physical exam required but can I still be denied for coverage?
A: Your request for coverage can be denied if you do not meet the timeliness requirement. You must mail or fax this form to
request information within 15 days from the date of this notice or 31 days from your group coverage termination date, whichever
is later. Under no circumstances will continuation of coverage be available beyond 91 days from your group coverage
termination date. Coverage can also be denied if it exceeds the amount you had in effect under your employer’s Group plan or if
it does not align with you employer’s plan provisions. In addition, any request for coverage that is not available under your
employer’s Group plan will also be denied.
Q: If I start to work for a new employer and obtain coverage under that employer’s Group plan, will that Group
coverage impact any conversion or portability policy that I may have purchased?
A: If you obtain coverage under a new employer’s Group plan, your portability or conversion policy will remain in effect provided
you continue to pay the required premiums. However, benefits under conversion policies may be affected by the amount of your
other coverage.
GR-10671-16
2
11-12
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Gr-10671-22 - Notice Of Continuation Of Coverage - The Hartford - Portability And Conversion Unit
Legal
Form Ucs-6b - Employee Notice For Unemployment Compensation Coverage (employer's Reciprocal Coverage Election - Florida Department Of Revenue
Financial
Related Categories
Parent category: Business