Please note that the form linked above is a sample and should not be completed.
If you are interested in continuing your life insurance, please complete and mail your Notice of Continuation Form to The Hartford Portability and Conversion Unit, P.O. Box 43786, Cleveland, OH 44143-0786 or fax it to 1-440-646-9339. The completed Notice of Continuation must be received (postmarked) within 31 days of the date your employer signed your Notice of Continuation form.
Once we receive your completed Notice of Continuation Form, you can expect to receive a quote in the mail within 15 business days.
Some of the reasons you would receive this form include an employment status change, a marital status change, you or a dependent experiencing an age reduction or maximum age limit, or you have retired or have reached the end of an employer-sponsored continuation provision.
We are experiencing extremely high call volume, and we are not able to provide your quote through our call center. In order to help all customers through this challenging time, we have a special team providing customized quotes to you upon receiving your mailed-in Notice of Continuation Form.
The rate examples below will assist you in calculating the approximate cost to continue your coverage. These costs are approximate and may vary based on the specifics of your group policy. Please refer to your group policy for specific rules/options (i.e. the maximum amount of coverage that can be continued, any restrictions, etc.) applicable to the coverage you have with your employer.
Conversion Individual Whole Life
Determine your age using the birth date that is closest to your anticipated effective date of insurance.
Annual Premium = (Rate x (Face amount / 1,000)) + $60
(Example is 100K. If you elect another amount, please use the formula above.)
*Employees who reside in New York or West Virginia and qualify for the 12 month term option will be required to pay annually.
Portability Term Life
*Please note that this option may not be available for every employer group. Your information and your employer's information will be validated once the Notice of Continuation Form is received.
RATES ARE SUBJECT TO CHANGE WITHOUT NOTICE
PORTABILITY TRUST LIFE RATES
(Rates are per $1,000 of Coverage)
Annual Premium = Rate x (Face Amount / 1,000) x 12
EXAMPLE:
$50,000 coverage at age 45
$0.34 (monthly rate) x $50,000/1,000 (coverage) x 12 months = $204.00 per year
The Life Conversion option provides the opportunity for you to obtain an individual life insurance policy that accumulates cash value and is offered at individual insurance rates. There are no mandatory age reductions and coverage can continue with premium payment until the Scheduled Maturity Date (standardly age 121) at which time the cash surrender value is paid to the insured.
If coverage is ending because The Hartford Group Life policy is terminating or coverage for a class of employees is terminating, some restrictions may apply. If coverage is ending for any other reason, you can generally convert up to the full amount of your terminating coverage. Conversion is also available to your dependents if they had coverage under your group plan. You may have the option to obtain a one-year term policy prior to the permanent life policy becoming effective. Please refer to The Hartford Group Life policy for information. Premiums for a Life Conversion policy are substantially higher than your Employer Group plan rates.
Under the Portability option you may obtain a group life insurance policy to continue 100%, 75%, or 50% of the amount of life insurance coverage (Basic, Supplemental, or both) you had under your Group plan up to a maximum amount, generally $250,000 depending upon the provisions of your Group plan. The Portability policy provides group term coverage and is available to you provided you have not yet reached your Social Security full retirement age.
The Portability option may also be available to your dependents if you carried dependent coverage under your employer's group plan and if the group plan includes portability as an option for dependents. The amount of coverage you elect to port is reduced by 75% at age 65 and coverage terminates at age 75. Portability is not available if your employer is terminating the group plan. Note: if you choose to elect the Waiver of Premium provision as outlined in your contract you are not eligible for Portability. The same applies if you choose to elect Portability; Waiver of Premium would not be available. Additional restrictions may also apply. Premiums for a Life Portability policy may be higher than your Employer Group plan rates and rates increase every five years (years in which your age on your birthday ends in 5 or 0).
If you would like more information on the differences between portability and conversion, please look over the Side by Side Employee Guide.
The best way to receive an accurate quote, at no obligation or cost to you, is to send in your Notice of Continuation. There are three simple ways to send in your request:
1. Email your signed Notice of Continuation Form to portabilityandconversions@selmanco.com
2. Fax your signed Notice of Continuation Form to 440-646-9339
3. Mail your Notice of Continuation Form to The Hartford Portability and Conversion Unit, P.O. Box 43786, Cleveland, OH 44143-0786
PLEASE NOTE THIS IS A TIME SENSITIVE DOCUMENT AND MUST BE SENT IN WITHIN 31 DAYS OF THE DATE YOUR EMPLOYER SIGNED THE FORM.
If I request a quote, how does The Hartford determine the amount of coverage to quote?
The 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.
If I receive a quote for coverage, does this mean I qualify for the coverage amount quoted?
The amount quoted is not a guarantee that a policy will be issued in that amount. Upon receipt of your application for coverage, The Hartford will perform an eligibility review to determine if 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.
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 payable under portability and/or conversion policies may be affected by the amount of your other coverage.
What if my employer hires me back and/or if my leave/furlough is temporary? Will this impact my portability or conversion policy?
Yes, benefits payable at the time of claim may be impacted. Please notify us if you returned to work and would like to terminate your portability or conversion policy.
What should I do if I have not received a Notice of Continuation Form?
Please contact your employer if you have not received the form within 15 days from your coverage loss.
What is my policy effective date?
The effective date of a Life Conversion policy is the 32nd day following the group coverage termination date. The effective date of a Life Portability Policy is the day following the group coverage termination date.
If my application for coverage is not approved by the effective date, am I still covered?
Yes, if your application is approved, the effective date of your policy will be retroactive to the date indicated above.
I understand that there is no medical underwriting or physical exam required, but can I still be denied for coverage?
Your request for coverage can be denied if you do not meet the timeliness requirement. You must mail or fax the Notice of Continuation Form to request a quote within 31 days from the date your group coverage terminated. Requests received more than 31 days after your group coverage terminates will be denied. 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 your employer’s plan provisions. In addition, any request for coverage that is not available under your employer’s Group plan will also be denied.
Telephone: 1-877-320-0484
Hours of Operation: Monday-Friday from 9AM to 7PM ET
Mailing Address: The Hartford, Portability and Conversion Unit, P.O. Box 43786, Cleveland, OH 44143-0786
Fax: 1-440-646-9339
The quotations provided on this website are an estimate and non-binding. The sample quotes are based on standard eligibility information. To obtain a personalized formal written quotation, you will need to complete the bottom half of the Notice of Continuation Form. This form is provided by your employer. Please note that your employer must complete the top half of this form. Once received we will validate your eligibility for coverage and provide the written quotation and application by mail. Standard turnaround time for written quotes is 10-15 Business Days. You may expect a longer timeframe if there is a delay obtaining your coverage information.
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including underwriting company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the underwriting company listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.