• The Request for Conversion of group life insurance form needs to be completed no sooner than 31 days before and no later than 31 days after the employee’s termination date.
• If an employee has severance that includes the life coverage, they may apply within 31 days before and 31 days after the termination date of their group life coverage.

Completing the form

The Request for Conversion of group life insurance form needs to be completed by the plan administrator.

It is important the following is clearly indicated on the form:

• Group policy number
• Certificate number of the Participant (employee). Tip: often this can be the date of birth or Social Insurance Number of the employee.
• Contact information – provide the home telephone number and email address. Having an email address allows us to contact the employee in a timely manner.
• Amount of coverage for Participant (employee) and their dependents

The completed form may be sent in by:

• Fax at 1-800-522-3124
• Email at conversion@standardlife.ca

If you have any questions, please send an email to conversion@standardlife.ca and we will be happy to help.