This guide outlines the eligible products, rules, procedures, and underwriting criteria for converting term policies issued by Transamerica Life Insurance Company (TLIC),Transamerica Financial Life Insurance Company (TFLIC, only available in New York) and qualifying policies from Transamerica-affiliated companies to permanent life insurance policies.* The document is organized in sections:
TABLE OF CONTENTS
Part 1: Term Conversion Overview ...1
Part 2: TLIC Conversion Options by Product ...2
Trendsetter® Super and Trendsetter Series Prior to 2012 ...2
Trendsetter® Express ...4
Trendsetter® LB ...6
Qualifying Affiliated Company Term Products ...8
Part 3: TFLIC Conversion Options by Product ...10
Part 4: Rules and Restrictions ...12
Part 5: How to Submit Business ...13
Part 6: Required Forms Checklist ...13
Part 7: Tips for Easier Conversion ...15
Please note that the provisions in this document are not guaranteed and, therefore, subject to change. Policy (or Rider) must be inforce and within the contractual conversion period to qualify.
Part 1: Term Conversion Overview
While term life insurance can provide protection for clients’ loved ones over a period of time, it is generally not a permanent solution. The conversion privilege on an inforce term policy is an important benefit that allows policy owners to exchange their term policy for a permanent policy, and do so without additional underwriting. With conversion, clients can receive lifetime protection, the potential to build cash value and the peace of mind that comes with a permanent life insurance policy.
We are pleased to present enhancements to our term conversion program that include additional permanent product options for eligible term policies converting within their first five policy years. Such policies may now convert across specific Transamerica or affiliated issuing companies, and may be eligible to convert to previously unavailable product optionsif the new premium is greater than the level term premium and provided the client’s current term policy:
■
■ Was NOT issued under the TOP or similar program; ■
■ Is rated no higher than Table D; ■
■ Has a face amount of $1,000,000 or less;
■
■The insured is age 75 (attained age) or younger and is
within the contractual conversion period (which may be shorter) of the original term product, and
■
■ Is accompanied by a conversion application that has
been signed, completed and included along with all other required paperwork and received in good order. Term policies issued with a substandard table rating are not eligible for 8-year flat extra substitutions when converting.
*Affiliated companies that may be eligible for enhanced conversion options include: Transamerica Premier Life Insurance Company (formerly Monumental Life Insurance Company and Western Reserve Life Assurance Co. of Ohio) and Stonebridge Life Insurance Company.
If requirements outlined in this document are met, any of the term policies listed below may be converted to eligible permanent policies, where indicated, subject to the rules of conversion in both the existing term policy and the availability of the permanent policy.
TRANSAMERICA LIFE (TLIC) TERM PRODUCTS ELIGIBLE TO CONVERT
■ Trendsetter® Super Series ■ Trendsetter® Express
■ Trendsetter® LB*
■ Trendsetter Products sold prior to 2012
Part 2: TLIC Conversion Options by Product
Policies are subject to the conversion provision contained in the existing term policy. Policies within their first five years must meet additional criteria listed in this section.
Trendsetter
®Super
(including Trendsetter® Series sold prior to 2012)
CONVERSION OPTIONS AVAILABLE AT ANY TIME (within the contractual conversion period)
Fully Underwritten Policies May Convert to Non-Med Policies May Convert to TransACE® CV Guaranteed Whole Life (GWL)
NOTE: Fully underwritten policies are those policies that have included medical or paramed in the underwriting process. Non-med policies are fluidless and do not include a paramed exam.
SPECIAL OPTIONS IF CONVERSION OCCURS WITHIN THE FIRST FIVE POLICY YEARS
Fully Underwritten Policies May Convert to Non-Med Policies May Convert to
TransACE® CV Guaranteed Whole Life
Transamerica JourneySM ** TransNavigator® ** Guaranteed Whole Life
Trendsetter Super may be converted to the above products in the first five policy years if the new premium is greater than the level term premium and provided the client’s current term policy:
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The new policy will be issued with the same underwriting risk class and rating as the original or the most similar underwriting risk class if risk classes are categorized differently on the new policy. In order to achieve the most similar risk class, the converted face amount may be increased by $1 to meet the minimum requirements.
TERM POLICY
PERMANENT POLICIES
Trendsetter® Super TransACE® CV
Transamerica JourneySM
TransNavigator®
Preferred Plus u Preferred Plus Preferred Nonsmoker Preferred Nonsmoker u Preferred Nonsmoker Preferred Nonsmoker Standard Plus u Standard Plus Standard Nonsmoker Standard Nonsmoker u Standard Nonsmoker Standard Nonsmoker Preferred Smoker u Preferred Smoker Preferred Smoker Standard Smoker u Standard Smoker Standard Smoker
Trendsetter
®Express
CONVERSION OPTIONS AVAILABLE AT ANY TIME (within the contractual conversion period)
Fully Underwritten Policies May Convert to Non-Med Policies May Convert to TransACE® CV Guaranteed Whole Life (GWL)
NOTE: Fully underwritten policies are those policies that have included medical or paramed in the underwriting process. Non-med policies are fluidless and do not include a paramed exam.
SPECIAL OPTIONS IF CONVERSION OCCURS WITHIN THE FIRST FIVE POLICY YEARS
Fully Underwritten Policies May Convert to Non-Med Policies May Convert to
TransACE® CV Guaranteed Whole Life
Transamerica JourneySM * TransNavigator® * Guaranteed Whole Life
NOTE: For Trendsetter® Express policies issued with the Standard Express risk class, only GWL is available.
Trendsetter Express may be converted to the above products in the first five policy years if the new premium is greater than the level term premium and provided the client’s current term policy:
■ Is within five years of issue when all conversion paperwork is received in good order; ■ Was NOT issued under the TOP program;
■ Is rated no higher than Table D;
■ Has a face amount of $1,000,000 or less, and
■ Covers an insured who has not yet reached the earlier of the end of the initial level premium period or their
70th birthday (75th birthday for Preferred Plus).
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The new policy will be issued with the same underwriting risk class and rating as the original policy or the most similar underwriting risk class if risk classes are categorized differently on the new policy. In order to achieve the most similar risk class, the converted face amount may be increased by $1 to meet the minimum requirements.
TERM POLICY
PERMANENT POLICIES
Trendsetter® Express TransACE® CV
Transamerica JourneySM
TransNavigator®
Preferred Plus u Preferred Plus Preferred Nonsmoker Preferred Choice u Preferred Nonsmoker Preferred Nonsmoker Preferred Nonsmoker u Preferred Nonsmoker Preferred Nonsmoker Standard Plus u Standard Plus Standard Nonsmoker Standard Nonsmoker u Standard Nonsmoker Standard Nonsmoker Preferred Smoker u Preferred Smoker Preferred Smoker Standard Smoker u Standard Smoker Standard Smoker
Standard Express Nonsmoker u N/A N/A
Standard Express Smoker u N/A N/A
NOTE: Standard Express risk classes are available to convert to Guaranteed Whole Life policies. All Guaranteed Whole Life policies are issued at the Standard risk class.
Trendsetter
®LB
CONVERSION OPTIONS AVAILABLE AT ANY TIME (within the contractual conversion period)
Fully Underwritten Policies May Convert to Non-Med Policies May Convert to TransACE® CV Guaranteed Whole Life (GWL)
NOTE: Fully underwritten policies are those policies that have included medical or paramed in the underwriting process. Non-med policies are fluidless and do not include a paramed exam.
SPECIAL OPTIONS IF CONVERSION OCCURS WITHIN THE FIRST FIVE POLICY YEARS
Fully Underwritten Policies May Convert to Non-Med Policies May Convert to
TransACE® CV Guaranteed Whole Life
Transamerica JourneySM * TransNavigator® * Guaranteed Whole Life
NOTE: Accelerated Death Benefits for Critical and Chronic Illness on Trendsetter® LB cannot be converted. For
Trendsetter LB policies issued with the Standard Express risk class, only GWL is available.
Trendsetter LB may be converted to the above products in the first five policy years if the new premium is greater than the level term premium and provided the client’s current term policy:
■ Is within five years of issue when all conversion paperwork is received in good order; ■ Was NOT issued under the TOP program;
■ Is rated no higher than Table D;
■ Has a face amount of $1,000,000 or less, and
■ Covers an insured who has not yet reached the earlier of the end of the initial level premium period or their
70th birthday (75th birthday for Preferred Plus).
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The new policy will be issued with the same underwriting risk class and rating as the original policy or the most similar underwriting risk class if risk classes are categorized differently on the new policy. In order to achieve the most similar risk class, the converted face amount may be increased by $1 to meet the minimum requirements.
TERM POLICY
PERMANENT POLICIES
Trendsetter® LB TransACE® CV
Transamerica JourneySM
TransNavigator®
Preferred Plus u Preferred Plus Preferred Nonsmoker Preferred Choice u Preferred Nonsmoker Preferred Nonsmoker Preferred Nonsmoker u Preferred Nonsmoker Preferred Nonsmoker Standard Plus u Standard Plus Standard Nonsmoker Standard Nonsmoker u Standard Nonsmoker Standard Nonsmoker Preferred Smoker u Preferred Smoker Preferred Smoker Standard Smoker u Standard Smoker Standard Smoker
Standard Express Nonsmoker u N/A N/A
Standard Express Smoker u N/A N/A
NOTE: Standard Express risk classes are available to convert to Guaranteed Whole Life policies. All Guaranteed Whole Life policies are issued at the Standard risk class.
Qualifying Affiliated Company Term Products
Products from Transamerica-affiliated issuing companies are eligible to be converted to other affiliated issuing companies’ products. Please note that if the policy is converted to a different issuing company’s product, the owner will need to complete the Conversion Application available for cross-stat company conversions.
Products issued by Transamerica Life Insurance Company (TLIC) are eligible to convert across affiliated issuing companies subject to jurisdictional rules.
AFFILIATED COMPANIES THAT MAY BE ELIGIBLE FOR ENHANCED CONVERSION OPTIONS INCLUDE:
■ Transamerica Premier Life Insurance Company ■ Stonebridge Life Insurance Company
SPECIAL OPTIONS IF CONVERSION OCCURS WITHIN THE FIRST FIVE POLICY YEARS
Fully Underwritten Policies May Convert to Non-Med Policies May Convert to
TransACE® CV Guaranteed Whole Life
Transamerica JourneySM * TransNavigator® * Guaranteed Whole Life
The existing affiliated company term policy may be converted to the above products in the first five policy years if the new premium is greater than the level term premium and provided the client’s current term policy:
■ Is within five years of issue when all conversion paperwork is received in good order; ■ Was NOT issued under the TOP or similar program;
■ Is rated no higher than Table D;
■ Has a face amount of $1,000,000 or less;
■ The insured is age 75 (attained age) or younger and is within the contractual conversion period (which may be
shorter) of the original term product, and
■ Is accompanied by the Conversion Application (CONREQ 2014) that has been signed, completed and included
along with all other required paperwork and received in good order.
Term policies issued with a substandard table rating are not eligible for 8-year flat extra substitutions when converting. For policies over five years old, please contact the affiliate company directly for conversion product options.
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The new policy will be issued with the same underwriting risk class and rating as the original policy or the most similar underwriting risk class if risk classes are categorized differently on the new policy. In order to achieve the most similar risk class, the converted face amount may be increased by $1 to meet the minimum requirements. For a complete list of Transamerica affiliated Term Policy Risk Class Comparisons please call the Sales Desk.
TERM POLICY
PERMANENT POLICIES
Champion Term Champion Term II Ultima Elite Term II Ultima Elite Term Preferred Term Plus II
Stonebridge Term & Term w/ROP
WRL Term Plus &
WRL Term Plus II TransACE® CV
Transamerica JourneySM
TransNavigator® GWL
Preferred Elite or Preferred Plus u Preferred Plus Preferred Nonsmoker Standard Preferred Nontobacco u Preferred Nonsmoker Preferred Nonsmoker Standard Standard Plus u Standard Plus Standard Nonsmoker Standard Standard Nontobacco u Standard Nonsmoker Standard Nonsmoker Standard Preferred Tobacco u Preferred Smoker Preferred Smoker Standard Standard Tobacco u Standard Smoker Standard Smoker Standard
Part 3: TFLIC Conversion Options by Product
TFLIC products are only available in New York. Policies are subject to the conversion rules outlined in the contract that governs the existing term policy. In addition to those rules, policies within their first five years must meet additional criteria listed in this section.
Trendsetter
®Super NY
(including Trendsetter® Series NY sold prior to 2012)
CONVERSION OPTIONS AVAILABLE AT ANY TIME (within the contractual conversion period)
Fully Underwritten (Paramed or Medical)
Policies May Convert to Non-Med Policies May Convert to TransACE® CV NY Guaranteed Whole Life (GWL) Guaranteed Whole Life (GWL)
SPECIAL OPTIONS IF CONVERSION OCCURS WITHIN THE FIRST FIVE POLICY YEARS
Fully Underwritten (Paramed or Medical)
Policies May Convert to Non-Med Policies May Convert to TransACE® CV NY Guaranteed Whole Life
Transamerica JourneySM NY * Guaranteed Whole Life
Trendsetter Super NY may be converted to the above products in the first five policy years if the new premium is greater than the level term premium and provided the client’s current term policy:
■ Is within five years of issue when all conversion paperwork is received in good order; ■ Was NOT issued under the TOP program;
■ Is rated no higher than Table D;
■ Has a face amount of $1,000,000 or less, and
■ Covers an insured who has not yet reached the earlier of the end of the initial level premium period or their
70th birthday (75th birthday for Preferred Plus).
t r a n s a m e r i c a | 11
The new policy will be issued with the same underwriting risk class and rating as the original or the most similar underwriting risk class if risk classes are categorized differently on the new policy. In order to achieve the most similar risk class, the converted face amount may be increased by $1 to meet the minimum requirements.
TERM POLICY
PERMANENT POLICIES
Trendsetter® Super NY TransACE® CV NY Transamerica JourneySM NY Guaranteed Whole Life (GWL)
Preferred Plus u Preferred Plus Preferred Nonsmoker Standard Preferred Nonsmoker u Preferred Nonsmoker Preferred Nonsmoker Standard Standard Plus u Standard Plus Standard Nonsmoker Standard Standard Nonsmoker u Standard Nonsmoker Standard Nonsmoker Standard Preferred Smoker u Preferred Smoker Preferred Smoker Standard Standard Smoker u Standard Smoker Standard Smoker Standard
Part 4: Rules and Restrictions
CONVERSION RULES
These company practices will not supersede any more favorable contractual guarantees Underwriting Rules:
■ Fully underwritten policies are those that include paramed or medical underwriting. Non-med policies do not include
paramed exams, and may only convert to Guaranteed Whole Life except where noted in this guide. Simplified, Jet, guaranteed issue and Standard Express risk class policies are NOT fully underwritten, and those policies can only convert to GWL.
■ The underwriting of the original policy must have been within the product’s published Age & Amount Evidence
Guidelines; that is, NO underwriting exceptions were made.
■ The published underwriting guidelines of the converted-to product must not be more restrictive than the
underwriting guidelines applied to the original policy.
■ Unless otherwise noted, the new contract will be issued with the same or most similar underwriting risk class,
including any ratings.
■ In order to achieve the most similar risk class, conversions may be increased by $1 where necessary.
Policies issued under the TOP program are not eligible for the enhancements that may be available to policies in their first five policy years.
Base Insured Term Conversion Rules:
■ Conversion may be to a base/base insured rider (BIR) blend if conversion minimum premium exceeds original level
term rate.
■ Riders need to be converted or dropped upon full conversion of base term. ■ Riders not listed are not convertible.
Term Riders Attached to Term, UL, IUL and VUL products BIR/Primary Insured Rider (PIR), Additional Insured Rider (AIR)/Other Insured Rider (OIR) and Child Conversion Rules:
■ A rider may not convert to a base/BIR blend if the original rider rate exceeds that of the BIR.
■ PIR may convert to new policy or increase the base coverage. BIR must opt to convert to a new policy. ■ Partial conversions are allowed for BIR/PIR and AIR/OIR (NOT for Child – must be 100%).
■ A rider may convert to the equivalent rider with a base term conversion.
t r a n s a m e r i c a | 13
may either be returned to the owner or used to fund the new policy.
■ Term policies with inherent ROP can be fully but NOT partially converted.
■ Term policies with ROP riders can be partially converted only if the ROP rider is dropped prior to conversion.
Long Term Care (LTC) Conversion Rules:
■ A conversion to a UL policy with a Long Term Care Rider is only allowed in year one of the term policy. ■ Additional underwriting will be required for adding Long Term Care.
Part 5: How to Submit Business
To help avoid delays and ensure cases are processed as quickly as possible, please keep this information in mind. STEP 1: DETERMINE CLIENT NEED
The first step is to work with the policy owner to determine if he or she is interested in conversion, and if the current Transamerica (or affiliated issuing company) term product is eligible for conversion. Once this is determined, depending on the client’s needs, they can select the desired permanent insurance policy to convert to, and determine whether they want to convert all or part of their existing term policy.
STEP 2: RUN ILLUSTRATION ON NEW CONVERSION PRODUCT
Run a new illustration using TransWare®. The TransWare illustration software can be found at www.tatransact.com. This
new illustration will provide you with the new premium that is to be submitted with the conversion paperwork. STEP 3: DOWNLOAD NECESSARY PAPERWORK
Forms to complete a term conversion can be downloaded from tatransact.com. A list of forms is included in Part 6 “Forms Checklist” in this document.
STEP 4: COMPLETE PAPERWORK WITH ALL NEEDED SIGNATURES
Be sure to complete all of the applicable paperwork, with appropriate signatures, and submit it to New Business. For help converting a term policy to a permanent policy, please contact your Sales Desk.
Part 6: Forms Checklist
General Forms: Applicable forms are dependent on the original issue state. The insured/owner can sign the conversion application in their current resident state, but all conversion documents must be based on the original issue state.
Basic Forms
Must be completed entirely and signed by policy owner and licensed producer or agent. 1. Completed and signed Conversion Application
■ Licensed producer or agent information must be present on application. Include name, producer or agent
2. Completed and signed illustration
■ Licensed producer or agent information must be present on illustration. Include producer or agent name,
producer or agent number, and address.
3. Completed and signed Accelerated Death Benefit disclosure form and/or State Replacement form (if applicable).
What You’ll Need to Start:
1. Existing term policy number 2. New WL, UL, IUL or VUL policy 3. Insured’s name
4. Owner’s name
Forms Checklist
Form Guaranteed Whole Life TransACE® CV TransNavigator® Transamerica JourneySM
Conversion/Exchange Form TOS370M1008T or MPS11008T (if converting from a TLIC product to a TLIC product, depending on underwriting requirements.)
X X X X
Conversion Application CONREQ 2014 (if converting across
Transamerica-affiliated companies) X X X X
Pre-Authorized Check Form X X X X
IUL Statement of Understanding N/A N/A X N/A
Signed Illustration N/A X X N/A
Beneficiary/Additional Insured
Information Form - DMF 2014 X X N/A N/A
Supplement Application with Premium Fund
Allocations (SAIUL0114T) N/A N/A X N/A
t r a n s a m e r i c a | 15
To help avoid delays and ensure cases are processed as quickly as possible, please keep this information in mind. APPLICATION REMINDERS
Completing Applications: Use the “Conversion Checklist” provided at the end of this Guide to ensure applications are processed as quickly as possible. Include current producer or agent number on all applications.
Application Remarks Section: Note any details to the processing of the case on the cover sheet and/or remarks section of the application.
Beneficiary Form: A Beneficiary/Additional Insured Information supplemental form (DMF 2014) is required with all change/ conversion applications for TransACE CV and GWL life insurance policies.*
PAC Form: If paying by PAC, ensure form is filled out completely. APPLICATION COMPLETION REMINDERS
Include the following information to help prevent the need for an amendment or other requirements:
■ Policy ■ Lump Sum
■ Face amount ■ Total Initial Premium
■ Kind code/rate class ■ Full or Partial Conversion
■ Planned Periodic Premium ■ Required Premium (if applicable) ■ Mode of payment (must match the mode
specified on illustration)
Policy Owner: The Proposed Owner’s title must be listed on all applicable forms. If the owner is a corporation, an
authorized officer other than the proposed insured must sign as Owner and list a corporate title. If the owner is a trust, the full name of the trust, including the date the trust was established, should be noted on the signature line for “Owner other than the insured.” The trustee must sign the application with the title “Trustee” following the signature.
INITIAL REQUIREMENTS
Initial Premium: Submit initial premium with the application if possible. Money may be taken with application(s), provided the total of all face amounts applied for does not exceed $2,000,000.
PAC Form/Void Check: If paying by Pre-Authorized Checking (PAC), the PAC form must be clear and complete. Please include the account and routing numbers. A voided check would be helpful to have, but will not be required if the PAC information is complete.
ILLUSTRATIONS FOR UL OR IUL
■ Either the presented illustration or an illustration certification form must be signed and submitted with the application. ■ If submitting for TransACE® CV Guaranteed Universal Life:
■ The illustration must reflect the most current interest rates.
■ If backdating to save age, please use the illustration software to indicate the “B” on the illustration next to the
first year premium and ensure that the save age date in the body of the illustration is accurate. If you need assistance running a backdated illustration, please contact the Sales Desk at 866-545-9058.
DELIVERY REQUIREMENTS
Revised Illustrations: If the applicant is “Approved Other Than Applied For,” a REVISED illustration must be submitted immediately. Signatures on either the illustration or the illustration certification form will be required but can be obtained on delivery if a signed illustration or illustration certification form was submitted with the application. If you need assistance running a REVISED illustration, please contact the Sales Desk at 866-545-9058.
Requesting Extensions: If the end of the delivery period is nearing and you think an extension will be needed, please request the extension prior to the approaching End of Delivery (EOD). This way, once the delivery requirements are finally received in the home office, the policy EOD has already been extended and they will not need to be resubmitted to underwriting at the time the policy is placed inforce.
TRUST OWNERSHIP
Policy Owner: The Proposed Owner’s title must be listed on all applicable forms. If the owner is a trust, the full name of the trust, including the date the trust was established, should be noted on the signature line for “Owner other than the insured.” The trustee must sign the application with the title “Trustee” following the signature.
The Notice of Replacement Form needs to be signed and dated by the owner of the policy being replaced.
For trust or business owned policies, a current VTA or corporate resolution is required if there will be a reduction to the policy, such as a lower face amount, as part of the conversion.
If the trust is owner and there is more than one trustee, one trustee can sign on behalf of the trust IF the existing VTA indicates that the trustees can act individually. If the VTA indicates they must act jointly, all trustees must sign.
Check to make sure all forms in the conversion consistently indicate whether or not it is a replacement. For example, if the replacement forms say they are replacing, please make sure the application states the same.
t r a n s a m e r i c a | 17
State Life Insurance – U/W not required Life Insurance – Fully Underwritten Conversion Application ADB Form (All are 2 pgs) for trust-owned policies) AL TOS370M1008T MPS11008T ICC14CONREQ DIS 94-197 TON-205 1008T
AK TOS370M1008T MPS11008TAK ICC14CONREQ TON-205 1008T
AR TOS370M1008T MPS11008TAR ICC14CONREQ DIS 95-197 TON-205 1008T AZ TOS370M1008TAZ MPS11008TAZ CONREQ 2014 AZ TON-205 1008T CA TOS370M1008T MPS11008TCA CONREQ 2014 CA TON-205 1008T
CO TOS370M1008T MPS11008TCO ICC14CONREQ TON-205 1008T
CT TOS370M1008T MPS11008TCT CONREQ 2014 CT REV DIS 94-197 TON-205 1008T DC TOS370M1008T MPS11008TDC CONREQ 2014 DC TON-205 1008T
DE TOS370M1008T MPS11008T CONREQ 2014 TON-205 1008T
FL TOS370M1008TFL MPS11008TFL CONREQ 2014 FL REV1 TON-205 1008T
GA TOS370M1008T MPS11008TGA ICC14CONREQ TON-205 1008T
GU TOS370M1008T MPS11008T CONREQ 2014 TON-205 1008T
HI TOS370M1008T MPS11008T ICC14CONREQ TON-205 1008T
IA TOS370M1008T MPS11008TIA ICC14CONREQ TON-205 1008T
ID TOS370M1008T MPS11008T ICC14CONREQ TON-205 1008T
IL TOS370M1008T MPS11008T ICC14CONREQ TON-205 1008T
IN TOS370M1008T MPS11008T ICC14CONREQ DIS 95-197 TON-205 1008T KS TOS370M1008T MPS11008TKS ICC14CONREQ DIS 95-197 TON-205 1008T KY TOS370M1008T MPS11008TKY ICC14CONREQ DIS 97-197 TON-205 1008T LA TOS370M1008T MPS11008TLA ICC14CONREQ DIS 95-197 TON-205 1008T MA TOS370M1008TMA MPS11008TMA ICC14CONREQ DIS 95-197 TON-205 1008T MD TOS370M1008TMD MPS11008TMD ICC14CONREQ TON-205 1008T
ME TOS370M1008T MPS11008TME ICC14CONREQ TON-205 1008T
MI TOS370M1008T MPS11008T ICC14CONREQ DIS 97-197 TON-205 1008T MN TOS370M1008T MPS11008TMN ICC14CONREQ DIS 95-0707 TON-205 1008T
MO TOS370M1008T MPS11008TMO ICC14CONREQ TON-205 1008T
MS TOS370M1008T MPS11008T ICC14CONREQ DIS 94-197 TON-205 1008T MT TOS370M1008T MPS11008T ICC14CONREQ DIS 96-197 TON-205 1008T NC TOS370M1008T MPS11008TNC ICC14CONREQ DIS 95-197 TON-205 1008T ND TOS370M1008T MPS11008TND CONREQ 2014 ND TON-205 1008T
NE TOS370M1008T MPS11008T ICC14CONREQ TON-205 1008T
NH TOS370M1008T MPS11008TNH ICC14CONREQ TON-205 1008T
NJ approval pending MPS11008T ICC14CONREQ TON-205 1008T NM TOS370M1008TNM MPS11008TNM ICC14CONREQ TON-205 1008T NV TOS370M1008TNV MPS11008TNV ICC14CONREQ TON-205 1008T
NY MPS 1NY-107 MPS 1NY-107 TON-205NY 1203
State
Change/Conversion App For Individual Life Insurance – U/W not required
Change/Conversion App For Individual Life Insurance – Fully Underwritten
Cross Stat Company Conversion
Application ADB Form (All are 2 pgs)
VTA (if required, for trust-owned policies) OK TOS370M1008T MPS11008TOK ICC14CONREQ DIS 95-197 TON-205 1008T OR TOS370M1008T MPS11008TOR ICC14CONREQ DIS 94-197 TON-205 1008T
PA TOS370M1008T MPS11008TPA ICC14CONREQ TON-205 1008T
PR TOS370M1008TPR MPS11008TPR ICC14CONREQ TON-205 1008T
RI TOS370M1008T MPS11008T ICC14CONREQ TON-205 1008T
SC TOS370M1008T MPS11008TSC ICC14CONREQ TON-205 1008T
SD TOS370M1008T MPS11008T CONREQ 2014 TON-205 1008T
TN TOS370M1008T MPS11008TTN ICC14CONREQ TON-205 1008T
TX TOS370M1008T MPS11008T ICC14CONREQ TON-205 1008T
UT TOS370M1008T MPS11008T ICC14CONREQ DIS 95-197 TON-205 1008T VA TOS370M1008T MPS11008TVA ICC14CONREQ DIS 95-197 TON-205 1008T
VT TOS370M1008T MPS11008TVT ICC14CONREQ TON-205 1008T
WA TOS370M1008T MPS11008TWA ICC14CONREQ DIS 95-197 TON-205 1008T
WI TOS370M1008T MPS11008TWI ICC14CONREQ TON-205 1008T
WV TOS370M1008T MPS11008TWV ICC14CONREQ TON-205 1008T
WY TOS370M1008T MPS11008TWY ICC14CONREQ TON-205 1008T
FOR MORE INFORMATION ON THE TERM CONVERSION PROGRAM,
PLEASE CONTACT THE SALES DESK AT 866-545-9058.
The rules of the program found in this guide are not contractual or guaranteed, and program and product availability can be discontinued in the future.
Owner’s name: ______________________________________________________
REQUIRED FORMS
Must be completed entirely and signed by policy owner and licensed producer or agent. 1. Completed and signed Change of Plan Option/ Conversion Application
■ Licensed producer or agent information must be present on application. Include Name, Office ID, and Producer
or Agent number.
2. Completed and signed illustration
■ Licensed producer or agent information must be present on illustration. Include Name, Office ID, and Producer
or Agent number and address.
3. Completed and signed Accelerated Death Benefit disclosure form (if applicable, see the State Specific Application Guide for details).
APPLICATION COMPLETION REMINDERS
Include the following information to help prevent the need for an amendment or other requirements:
■ Policy ■ Lump Sum
■ Face amount ■ Total Initial Premium
■ Kind code/rate class ■ Full or Partial Conversion
■ Planned Periodic Premium ■ Required Premium (if applicable) ■ Mode of payment (must match the mode
specified on illustration) OWNERSHIP
Is the ownership between the existing and new policies the same?
■ New policy must have the same owner as the existing term coverage, unless an ownership change is to be
processed on the existing policy prior to submittal of conversion application. Is existing policy owned by a trust or business entity?
■ If so, new policy must also be owned by the same trust or corporation.
■ If the conversion is not same for same (e.g., the new policy will have a lower face amount than the existing term
