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Form Gr-10671-22 - Notice Of Continuation Of Coverage - The Hartford - Portability And Conversion Unit Page 2

Frequently 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?

A: The effective date of an SAAD&D policy is the day following the 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-10671-22

8-09

Form Gr-10671-22 - Notice Of Continuation Of Coverage - The Hartford - Portability And Conversion Unit Page 2