Termination Checklist Template - Voluntary Termination printable pdf download

Termination Check List – Voluntary Termination

Employee Exit Review* – Employee completes the Employee Exit Review form and returns to

Supervisor or HR representative prior to or on last day of employment.

Voluntary Resignation Form* – Employee completes the form and returns to Supervisor or HR

representative prior to or on last day of employment.

Supervisor’s Exit Reference Evaluation* – Supervisor completes and presents the Exit Reference

Evaluation to the departing employee on or before the last day of employment. Employee must sign one

of the two releases provided on the form.

Explain the Conclusion of Health, Life, Voluntary Life Benefits

 Health and Voluntary Term Life - Notify the participant of their right of conversion to an

individual bill-at-home insurance policy.

 Unum Life Insurance – Election of Portable coverage Form.

 Unum Life Insurance – Rate Form.

 Termination of Coverage Form.

 Exit Date Check List: Follow the flow charts below according to the employee’s decision

regarding conversion insurance.

List A

for those individuals that are not interested in conversion insurance

List B

for those individuals that are interested in conversion insurance options.

List A

– Employee does not want conversion insurance options.

 Go to BAS web page at and put employee termination date into

system. Notify payroll payroll of termination.

 Fill in the termination date in the appropriate boxes.

 Collect all health, vision and dental identification cards and destroy

List B

– Employee wants to consider conversion insurance options

 Health Insurance Continuation – Advise the employee to contact JLBG @ 1-

866-860-4382 within 30 days from the date of termination to apply for an

individual medical policy. Benefits for these policies are generally more

restrictive and premiums may be higher or lower than the diocese health insurance

premiums.

 Voluntary Term Life - Employee may contact JW Terrill 800-279-7728 for an

option to convert basic term life and Voluntary Term Life to an individual policy

issued by Unum within 30 days of the date of termination.

 Collect all health, vision and dental identification cards and destroy.

*Forms are available at

Administration/Office for Human Resources/HR Documents.

Termination Checklist Template - Voluntary Termination