Life Insurance

GROUP TERM LIFE INSURANCE (AD&D)
Hartford Life Insurance Group #: 677313 Contact: Group Benefit Claims Sacramento Life Claims Office Group Life/ADD Claims PO BOX 537028 Sacramento, CA 95853-7028 (888) 563-1124 office (877) 447-9370 fax Website: www.thehartford.com (an overview-see SPD below for FHDA plan) Group and Supplemental Life Highlights Group Life Summary Plan Description (Insurance Cert)	FORMS
	Hartford Insurance Death Claim form Hartford Beneficiary Designation Form Hartford Life Portability Application Form Hartford Notice of Conversion Form
SUPPLEMENTAL LIFE INSURANCE (AD&D)
Hartford Life Insurance Group #: 677313 Contact: Group Benefit Claims Sacramento Life Claims Office Group Life/ADD Claims PO BOX 537028 Sacramento, CA 95853-7028 (888) 563-1124 office (877) 447-9370 fax Website: www.thehartford.com (an overview-see SPD below for FHDA plan) Group and Supplemental Life Highlights Supplemental Life Summary Plan Description (Insurance Cert) Supplemental Life Group Rates (through June 2012) Supplemental Life Conversion Rate* *Applicable only after termination of employment	FORMS
	Supplemental Life and AD&D Application-Personal Health Form* Hartford Beneficiary Designation Form* Hartford Insurance Death Claim form *NOTE: these forms are mandatory

Last Updated: Friday, June 3, 2011 at 2:47:06 PM
©2012 Foothill-De Anza Community College District