Form Gr-10671-16 - Notice Of Continuation Of Coverage

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Notice of Continuation of Coverage

As a terminated employee – or as an active employee or retiree – losing coverage or a portion of coverage for you or your

dependents under your employer’s Group plan(s), you and/or your dependents may be eligible to continue all or a portion of that

coverage without submitting evidence of good health. Potential options are explained below. The specific options available to

you are based on the provisions as defined in the Group plan. Included with this notice is a form you can submit to obtain

additional information. Based on your selection, you will receive a personalized quote, details on the specific coverage options

available to you, and the necessary forms to enroll.

Life Conversion

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 (age 120) 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 an 11-month 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.

Portability

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. 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).

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.

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company, Hartford Life and Accident

Insurance Company and Hartford Life and Annuity Insurance Company. Policies sold in New York are underwritten by Hartford Life Insurance Company. Home Office of

both companies is Simsbury, CT. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the issuing companies listed above detail

exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.

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