Date

Employee Name

Address

City, State Zip

Re: Termination of Coverage & Continuation of Benefits

Dear <Employee Name>:

Enclosed is a benefits termination packet, which includes the following forms:

  • Continuation of Benefits form
  • UNUM Conversion Form to convert your group life policy without medical underwriting
  • UNUM Portability Form to convert your group life policy

Due to your termination of employment, your coverage under the group health plan and life insurance as well as any dependent coverage under the health plan terminate on <Last Day of the Month following Employment>. The Continuation of Benefits form must be completed and returned within 30 days to the Office of Human Resources with the first month’s premium should you desire to continue your medical, dental and vision coverage. Your extension will begin the day following the above termination date. All future premiums for the continuation of benefits are due in advance and must be paid to the Diocese of Knoxville. Please see address for payments on the enclosed form. If the premiums are not paid when due, your coverage lapses retroactively to the last date for which a premium payment was received. The premium is subject to increases every January. The new rate will be reflected on your payment coupons.

There may be other coverage options for you (and your family). When key parts of the health care law take effect, you’ll be able to buy coverage through the Health Insurance Marketplace. In the Marketplace, you could be eligible for a new kind of tax credit that lowers your monthly premiums right away, and you can see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll. Being eligible for Continuation of Benefits does not limit your eligibility for coverage for a tax credit through the Marketplace. Additionally, you may qualify for a special enrollment opportunity for another group health plan for which you are eligible (such as a spouse’s plan), even if the plan generally does not accept late enrollees, if you request enrollment within 30 days.

If you choose to convert your Life Insurance policy, the forms must be submitted to UNUM Insurance Company within 30 days of the above termination date, or the date of this notice. Please keep a copy for your records.

Should you have any questions, please contact the Office of Human Resources at (865) 584-3307.

Blessings & Peace,

<Authorizing Individual>

<Title>

cc: Human Resources

August 2015