Group Life Eligibility and Conversion Case Questions

A company’s master policy covers full-time employees after 30 days of active work. Lena is a newly hired full-time employee on day 12 and has not completed an enrollment form. Which statement is most accurate?

1. A. She is covered because every employee is insured from the first workday.
2. B. Her eligibility and effective date depend on satisfying the plan’s 30-day condition and any required enrollment steps.
3. C. She is covered only if she proves individual insurability to the insurer.
4. D. Her employer’s master policy makes her the policyholder.

An employer offers group life coverage for which employees pay part of the premium. Omar is eligible but never elects coverage or authorizes payroll deductions. What should the agent check before describing him as insured?

1. A. Whether the plan requires an election and whether Omar completed it.
2. B. Whether the employer has named Omar as beneficiary.
3. C. Whether Omar has owned an individual policy for three years.
4. D. Whether the master policy lists Omar as policyholder.

A fully employer-paid plan is described as noncontributory. It covers employees in a defined occupational class after a 60-day waiting period. Priya belongs to that class but is on day 20. Which conclusion follows?

1. A. She is automatically covered because noncontributory plans have no eligibility rules.
2. B. She does not yet meet the stated waiting period, even though she need not contribute premium.
3. C. She must pay the entire premium herself.
4. D. She can elect any amount without reference to the plan.

A certificate says an employee has $80,000 of group life coverage, while the employer’s master policy defines a benefit reduction at age 65. The insured turns 65. Which document is the primary contract for determining the reduction?

1. A. The master policy, read with the certificate and applicable plan terms.
2. B. The certificate alone, because it always overrides the policy.
3. C. The beneficiary’s application for benefits.
4. D. The employee’s payroll record, regardless of policy wording.

A covered Texas employee’s employment terminates on August 1. The person applies for an individual conversion policy and pays the first premium on August 25. Assuming the other statutory and policy conditions are satisfied, which statement best reflects §1131.110?

1. A. The application is within the 31-day period measured after termination.
2. B. The employee must wait five years before applying.
3. C. Conversion is available only if the former employer continues paying premiums.
4. D. The deadline is 31 business days after the employee receives a certificate.

An employee leaves work and asks whether the 31-day conversion period means the old group coverage necessarily remains in force for 31 additional days. Which answer is most precise?

1. A. Yes; every group plan must continue the same coverage for 31 extra days in all circumstances.
2. B. The conversion deadline and the end date of group coverage are distinct questions; check the policy and applicable continuation rules.
3. C. The employee has converted automatically without applying.
4. D. Conversion applies only after the insured dies.

A group policy terminates, ending coverage for a class of insured employees. Devon has been continuously insured under that group policy for six years. Which statutory route should the agent examine?

1. A. Section 1131.111, which addresses termination of the group policy or cessation of class coverage and generally requires five years of coverage for this route.
2. B. Section 1131.110 only, because the employee resigned yesterday.
3. C. A rule allowing conversion only after the employee reaches age 65.
4. D. No route exists whenever the employer terminates its master policy.

An employee loses $120,000 of group life coverage and timely elects conversion. The employee asks to convert $200,000 without health evidence. Which answer is the best exam response?

1. A. The statutory conversion amount may not exceed the amount of group coverage that ceased, subject to statutory details and applicable exceptions.
2. B. The employee can always choose any amount because conversion removes all limits.
3. C. The employee may convert only $1,000.
4. D. Conversion requires the former employer to insure the excess amount.

A former employee meets the conversion deadline and applies for an individual policy under the statutory privilege. The insurer asks for a medical exam and says the application will be declined if the applicant’s health is poor. Which statement best captures the conversion feature?

1. A. A qualifying conversion policy is generally available without evidence of insurability, subject to the statute’s terms and the application/premium requirements.
2. B. Conversion is simply a new fully underwritten application.
3. C. The insurer may require a health exam because every group certificate is term insurance.
4. D. The applicant must prove better health than when initially covered.

After leaving employment, Rafael converts $75,000 of group life coverage to an individual permanent policy. He is surprised that its premium is higher than the payroll deduction for the group plan. Which explanation is most accurate?

1. A. The conversion premium generally uses the insurer’s individual rate basis for the selected policy, amount, and age, rather than the former group rate.
2. B. Texas requires the employer to keep paying the group rate after termination.
3. C. The individual policy cannot charge a premium.
4. D. A higher premium proves the conversion was invalid.

An employer offers both a conversion option and a separate portability feature. The departing worker wants to keep similar coverage. What should the agent explain first?

1. A. Compare each feature’s eligibility, available form and amount, cost, deadline, underwriting rules, and continuation terms; they are not interchangeable labels.
2. B. Portability and conversion always create identical individual whole-life contracts.
3. C. Conversion always has the lower premium and no deadline.
4. D. Portability always requires surrendering the certificate for cash value.

A certificate lists an employee and spouse as insureds. The employee’s job ends. The spouse asks whether the employee’s conversion right automatically converts the spouse’s coverage too. Which action is best?

1. A. Check the master policy and spouse/dependent conversion provisions, including who must apply and the deadline for each insured.
2. B. Assume the spouse is covered for life because the certificate lists the spouse.
3. C. Assume the spouse can never have a conversion right.
4. D. Name the spouse as beneficiary and treat that as conversion.