Life and AD&D Insurance Information

Massachusetts Paid Family & Medical Leave
The State of Arizona provides a Basic Life and Accidental Death and Dismemberment (AD&D) insurance at no cost to you if you are an active permanent employee who regularly works at least 20 hours each week. The Basic Life and AD&D insurance becomes effective when you are hired, provided you meet the active work requirement on that date.

The State recognizes that individuals have different needs, and has provided you the opportunity to apply for the right amount of protection for you and your family at competitive group rates. Additional Life and AD&D amounts may be elected in any multiple of $5,000, not to exceed the lesser of three times your annual earnings, to a maximum of $500,000. Dependent's Life and AD&D coverage amounts vary from $2,000 to $50,000. The Life and AD&D insurance coverage includes many Features and Provisions.
A sudden death or accident can change everything. Life insurance together with AD&D insurance helps keep you covered in case an untimely death or accident destroys your income-earning ability.

Life and AD&D Coverage Continuation

As a terminated employee – or as an active employee or retiree – losing coverage or a portion of coverage under your employer’s Group plan(s), you may be eligible to continue all or a portion of that coverage without submitting evidence of good health. Potential options are explained in the Coverage Continuation form. The specific options available to you are based on the provisions as defined in the Group plan. Based on your selection, you will receive a personalized quote, details on the specific coverage options available to you, and the necessary forms to enroll.
Please note that there is a designated time frame during which you can exercise your coverage continuation options. To continue coverage, you must mail or fax the Coverage Continuation form to request information within 15 days from the date of your COBRA notice mailed to you by your employer, or 31 days from your group coverage termination date, whichever is later. Under no circumstances, however, will continuation of coverage be available beyond 91 days from your group coverage termination date.
The coverage continuation process can be started in one of three ways:
Call The Hartford toll-free:
9 a.m.-5 p.m. Eastern Time, Monday-Friday
Mail the Coverage Continuation Form to:
The Hartford Portability and Conversion Unit
P.O. Box 248108
Cleveland, OH 44124-8108
Fax the Coverage Continuation Form to:

Life Waiver of Premium

The Waiver of Premium allows an employee who becomes totally disabled under the age of 65 the opportunity for their Life Coverage to continue until age 70 without having to continue to pay premiums. The waiver may start after the employee is disabled for 6 months. To qualify, the claimant must meet the definition of Total Disability, as determined by The Hartford and premiums must continue to be paid during the 6-month elimination period.

File a Premium Waiver Claim Form
6498 NS 09/18
Life Form Series includes GBD-1000, GBD-1100, or state equivalent. Policy Number: 395211
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including underwriting companies Hartford Life and Accident Insurance Company and Hartford Fire Insurance Company. Home Office is Hartford, CT. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the underwriting companies listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.