ABC Port Conversion Sample Site

Benefit Continuation - (Company Name)

As a terminating participant in the Group Term Life, Voluntary Term Life, Accidental Death and Dismemberment, Long-Term Disability, Critical Illness, and Accident programs provided by (Company Name) and underwritten by Principal Life Insurance Company®, you may have options for continuing coverage.

  • Portability of Life Insurance and AD&D - Extend or "port" your current coverage, without any medical questions.
  • Conversion of Life Insurance - Change or "convert" your coverage to individual universal life insurance, without any medical questions.
  • Conversion of Long-Term Disability Insurance - Change or "convert" your coverage to an individual disability insurance policy.
  • Portability of Critical Illness Insurance - Extend or "port" your current coverage, without any medical questions.
  • Portability of Accident Insurance - Extend or "port" your current coverage, without any medical questions.
  • Dental Discount Plan - Get immediate access to dental savings for anyone, at any age.

Life Coverage During Disability (premium waiver)
In the event your coverage is terminated (as a result of a disabling condition) and you are subsequently approved for Life Coverage During Disability (premium waiver), your converted and/or ported coverages will be terminated and any premiums paid will be refunded to you.

Portability of Life Insurance and AD&D

If you participate in Group Term Life and/or Voluntary Term Life insurance, you have the option of porting the coverage in lieu of conversion. You select the amount of coverage you wish to maintain. Proof of good health is not required unless you elect to increase your coverage amount. The minimum amount of coverage you may continue is $10,000.

You may also elect to continue coverage for any covered dependents if you continue your coverage. Proof of good health is not required unless you elect to increase a dependent's coverage amount.

To continue this insurance coverage, complete the Portability Application. It's not necessary for you or your former employer to complete the "Employer to Complete" section, as that information has already been provided to the insurance carrier.

The portability rates are included on the Rates document.

Please refer to your certificate of coverage regarding any limitations and termination provisions for this coverage. If you no longer have a copy of this, one will be provided upon your request. You must apply for this coverage within 60 days of losing coverage.

After completing the application, send it and your check for the first month's premium to the address listed on your application. 

You'll then receive a letter from Principal Life explaining your coverage amounts and benefits as well as when and how to make future direct premium payments.   

Conversion of Life Insurance

Individual Purchase Rights (conversion) allow qualifying individuals previously covered under Group Term Life and/or Voluntary Term Life policies, to buy individual life insurance coverage without proof of good health. Coverage is provided through an individual Life Insurance policy issued by Principal Life Insurance Company and Principal National Life Insurance (except in NY). Dependents may also convert their Voluntary Term Life coverage independent of the employee's conversion. The minimum amount of coverage you may convert is $1,000 to the maximum amount of insurance you had under your former employer's policy.

Follow these steps to enroll:

1.    Review the application instructions/rate sheet for your state (see table below) and the group life conversion FAQ sheet (PDF).
2.    Complete the application for individual life insurance—group conversion for your state (see table below).
3.    Mail the completed application and your first premium to the address listed on the application.

You have 31 days after the date your group coverage ends to convert coverage without proof of good health. Conversion rates will be based on your current age and smoking status. Refer to the documents above for additional details regarding rates.

State
(Use your resident state.)
Application Application instructions/
rate sheet
Alabama, Alaska, Arizona, Arkansas,
Colorado, Connecticut, Georgia, Hawaii,
Idaho, Illinois, Indiana, Iowa, Kansas,
Kentucky, Maine, Maryland, Massachusetts,
Michigan, Minnesota, Mississippi, Missouri,
Nebraska, Nevada, New Hampshire, New Jersey,
New Mexico, North Carolina, Ohio, Oklahoma,
Oregon, Pennsylvania, Rhode Island, South Carolina,
Tennessee, Texas, Utah, Vermont, Virginia,
Washington, Wisconsin, Wyoming
AA1220 AA933C
California AA1220CA AA933C
Delaware, North Dakota, South Dakota AA1220ST AA933C
District of Columbia AA1220DC AA933C
Florida AA1220FL AA933C
Louisiana, Montana, West Virginia AA1220AAATERMUL AA3401B
New York AA1226 AA3401B
Conversion of Long-Term Disability Insurance

Important note: If you are currently receiving long-term disability benefits, you are not eligible for LTD conversion.

You may be eligible to convert your long-term disability coverage to an individual disability insurance policy.

You have 31 days after the date your group coverage ends to convert coverage without proof of good health. Once converted, your coverage remains in force until the date noted in your benefit summary.

Questions? Contact a Principal disability specialist at 515-452-4047.

Portability of Critical Illness Insurance

If you participate in critical illness insurance , you have the option of porting the coverage, without proof of good health. This helps protect your financial security if you’re diagnosed with a covered illness. You may also elect to continue coverage for any covered dependents if you continue your coverage. Refer to your certificate of coverage or the portability application to see if you may qualify.

Your scheduled benefit will be the same as it was previously although the continued coverage may have provisions that differ from your prior coverage (wellness/screening benefits will not be available).

To continue this coverage, complete the portability application. You must apply for this coverage within 60 days of losing coverage.

  • Portability Application (PDF) – Enter account number: 1234
  • Rates (PDF) (GP61077WC)

After completing the application, send it and your check for the first month's premium to the address listed on your application. 

Portability of Accident Insurance

If you participate in accident insurance , you have the option of porting the coverage, without proof of good health. This helps protect your financial security if you have an accidental injury. You may also elect to continue coverage for any covered dependents if you continue your coverage. Refer to your certificate of coverage or the portability enrollment form to see if you may qualify.

Your scheduled benefits will be the same as they were previously although the continued coverage may have provisions that differ from your prior coverage. Only accidental injuries incurred off-the-job will be covered, and wellness/screening benefits will not be available.

To continue this coverage, complete the portability enrollment form. You must enroll for this coverage within 60 days of losing coverage.

After completing the application, send it and your check for the first month's premium to the address listed on your application. 

You'll receive a letter from Principal Life once your enrollment is processed. Benefits information and a bill will be mailed separately.

Dental Discount Plan

Not everyone has dental coverage. That’s where New Dental Choice comes in. New Dental Choice is a comprehensive dental discount plan brought to you by Principal. Available to anyone at any age, it’s a great fit for people who are no longer covered by an employer’s policy, don't have access to dental insurance or need a procedure their policy doesn’t cover. Members receive immediate, unlimited access to affordable dental care from their choice of more than 100,000 participating dentist locations nationwide.

It’s easy to start saving!

  • Join today. Just complete a quick online form and you can start saving on your dental care today.
  • Find a New Dental Choice dentist. Our network dentists are located across the country. A general dentist or specialist near you is just a search away. In fact, your current dentist may already participate. If not, you can nominate him or her to join the network. New Dental Choice will contact your dentist for you.
  • Get fixed, discounted rates on the quality dental services you need. For one low membership fee, you receive access to more than 300 dental procedures discounted between 15% and 60% over dentists’ usual charges.
  • Present your membership card for discounted rates. New Dental Choice is different than insurance—there are no deductibles, no waiting periods, no spending limits and no paperwork. Just provide your New Dental Choice membership card to any participating dentist and pay the office directly when you receive your care.

Visit newdentalchoice.com to learn more and sign up for your membership.

Contact us

Questions regarding the coverages you have and the amounts you are eligible for should be directed to 800-843-1371. Then select the extension option and enter 44335#. Have your account number handy.

ACCIDENT AND CRITICAL ILLNESS INSURANCE PROVIDE LIMITED BENEFITS. 

This is not an insurance contract or plan document, and does not summarize all provisions. If any provision presented here is found to conflict with federal or state law, that provision will be applied to comply with federal or state law. The group policy or plan document determines all the rights, benefits, limitations and exclusions of the coverage described here. For details, refer to your benefit booklet. Insurance products issued by Principal National Life Insurance Co. (except in NY) and Principal Life Insurance Company®. Securities offered through Principal Securities, Inc., Member SIPC and/or independent broker/dealers. Referenced companies are members of the Principal Financial Group®, Des Moines, IA 50392. Accidental death and dismemberment insurance provides limited benefits.

The dental discount plan is not insurance. New Dental Choice provides discounts at certain healthcare providers for dental services. The plan does not make payments to the provider. Members must pay for all dental services but will get a discount from contracted providers. The range of discounts varies based on type of provider, region and services received. For a list of participating dentists, visit NewDentalChoice.com and select “dentists.” Dentists and specialists may not be available in all areas. Services in progress or provided before the membership effective date are excluded. Cancel within the first 30 days for a full refund, less the activation fee. Activation fees are refundable in AR and MD. This plan is not available in all states. New Dental Choice is a product of First Dental Health, the discount plan organization (specialized health care service plan in CA) located at 5771 Copley Drive #101 San Diego, CA, 92111. For more information, call 888-632-7558 or visit newdentalchoice.com. First Dental Health is a member of the Principal Financial Group®.

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