Form Gr-10671-18 - Notice Of Continuation Of Coverage Page 2
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Attached is a form that contains additional information about continuing coverage. You can use this to request a quote and the
necessary forms to enroll.
Please note that there is a designated timeframe during which you can exercise your coverage continuation options. To
continue coverage, 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, however, will
continuation of coverage be available beyond 91 days from your group coverage termination date. Any issues
regarding late notification by your employer must be addressed with the employer.
If you have questions about this information, your eligibility, or the status of any request you have submitted, please call a
representative at 1-877-320-0484.
The Hartford, Portability and Conversion Unit
P.O. Box 248108
Cleveland, OH 44124-8108
Fax 1-440-646-9339
GROUP LIFE INSURANCE PORTABILITY AND CONVERSION – Side By Side Employee Guide
To decide whether Portability or Conversion is the right choice for your personal situation, you need to understand the
differences. We help you see them clearly with our side-by-side comparison. Please visit
to view the complete side-by-side comparison table. If you do not have access to the internet you may obtain a copy of this
comparison by calling 1-877-320-0484.
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?
nd
A: The effective date of a Life Conversion policy is the 32
day following the group coverage termination date. The effective
date of Portability, or a SAAD&D Conversion 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-10671-18
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