Forms Required for a Conversion 1) New Term Conversion Application – Form # TRMCONV (REV 6/17). 2) A Needs Analysis 3) Certificate Illustration Routing Sheet and the Illustration 4) Bank Draft Authorization (if required) and a copy of a voided check only if a check was not submitted, unless you complete the routing and account numbers on the bank draft authorization. 5) Decrease Coverage Form – only used if member is doing partial decrease and keeping a minimum of $50,000.
**PLEASE NOTE** HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA) form is not required. SEND THE OLD CERTIFICATE if the member still has it. AN APPLICATION FOR DECREASE OF INSURANCE is also required if you are doing a partial conversion.
Do not collect a premium until the conversion has been approved by underwriting. At that time underwriting will let you know what the correct premium is to collect.
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CLIENT RESOURCE SECTION
Revised 05/01/2023
