MetLife Election of Portable Coverage Form

Metropolitan Life Insurance Company, New York, NY 10166 How You Can Continue Your Group Term Life Insurance – (Portability) What is Portability? Portability or porting is an optional feature chosen by your former employer. It allows employees and dependents to continue their Group Term Life and Accidental Death and Dismemberment (AD&D) insurance under a separate group policy. Once enrolled MetLife will mail you a portable certificate and your initial bill including instructions on how to set up the monthly Electronic Funds Transfer (EFT). The instructions to set up EFT can be found on the back of your bill. Ø Your first bill will also include any retroactive premium due from the effective date of your portable coverage and an administrative fee. The current administrative fee is $1.00 per statement. Why is Portable Coverage Important? Portable coverage provides security and helps eliminate gaps in coverage that you may experience during a time of transition, even if your employment ends. How Much Time Do I Have To Elect Portability? • If the Date of This Notice (see Part A on page 1 of the attached Election of Portable Coverage Form) is within 15 days after your coverage ends, you will have 31 days after your coverage ended to enroll. Example: if coverage ended Date of This Notice to enroll for portable coverage, your portable coverage you will have until will be effective July 31 August 8 August 31 September 1 July 31 August 15 August 31 September 1 • If the Date of This Notice (see Part A on page 1 of the attached Election of Portable Coverage Form) is given more than 15 days after your coverage ended, you will have 45 days from the Date of This Notice to enroll. Example: if coverage ended Date of This Notice to enroll for portable coverage, your portable coverage you will have until will be effective July 31 August 16 September 30 September 1 July 31 August 23 October 7 September 1 • Under no circumstances will the option to port be extended past 91 days after the date coverage ended under your former employer’s plan. EPORT NW INSTRUCTIONS EPORT (07/19)