(FIRST, SECOND OR THIRD AND FINAL) | ||
NOTICE OF TRANSFER | ||
IMPORTANT: THIS NOTICE AFFECTS YOUR CONTRACT RIGHTS. PLEASE READ IT CAREFULLY. | ||
TRANSFER OF POLICY | ||
The (name of assuming insurance company) has agreed to replace us as your insurer under (insert policy/certificate name and number) effective (insert date). The (assuming insurance company's) principal place of business is (insert address) and certain financial information concerning both companies are attached, including: (1) ratings for the last five years if available or for such lesser period as is available from two nationally recognized insurance rating services; (2) balance sheets for the previous three years if available or for such lesser period as is available and as of a date no later than ninety days prior to the current date; (3) a copy of the management's discussion and analysis that was filed as a supplement to the previous year's annual statement; and (4) an explanation of the reason for the transfer. You may obtain additional information concerning (name of assuming insurance company) from reference materials in your local library or by contacting your state insurance director at (insert address). The (name of assuming insurance company) is licensed to write this coverage in your state. | ||
Your Rights | ||
You may choose to accept or reject the transfer of your policy to (name of assuming insurance company). If you want your policy transferred, you must notify us in writing immediately by signing and returning the enclosed preaddressed, postage-paid or by writing to us at: (Insert name, address and facsimile number of contact person.). Payment of your premiums to the assuming company will also constitute acceptance of the transaction. However, a method will be provided to allow you to pay the premium while reserving the right to reject the transfer. If you reject the transfer, you may keep your policy with us or exercise any option under your policy. If we do not receive a written rejection from you within thirty months of our first notice of transfer, (insert date of initial mailing), you will, as a matter of law, have consented to the transfer. However, before this consent is final, you will be provided a second notice, twelve months after our first notice, and a third and final notice, twenty-four months after our first notice. After the third and final notice is provided, you will have only six months to reply. If you have paid your premium to (the assuming insurance company) without reserving your right to reject the transfer, you will not receive a subsequent notice. | ||
Effect of Transfer | ||
If you accept this transfer, (name of assuming insurance company) will be your insurer. It will have direct responsibility to you for the payment of all claims, benefits and for all other policy obligations. We will no longer have any obligations to you. If you accept this transfer, you should make all premium payments and claims submissions to (name of assuming insurance company) and direct all questions to (name of assuming insurance company). If you have any further questions about this agreement, you may contact (name of transferring insurance company) or (name of assuming insurance company). | ||
Sincerely, ______ | ||
(Name of Transferring | (Name of Assuming | |
Insurance Company | Insurance Company | |
Address | Address | |
Telephone Number) | Telephone Number) | |
For your convenience, we have enclosed a preaddressed postage-paid response card. Please take time now to read the enclosed notice and complete and return the response card to us. | ||
(Notice Date) | ||
RESPONSE CARD | ||
______ Yes, I accept the transfer of my policy from (name of transferring company) to (name of assuming company). | ||
______ No, I reject the proposed transfer of my policy from (name of transferring company) to (name of assuming company) and wish to retain my policy with (name of transferring company). | ||
(Date) ______ | (Signature) ______ | |
Name: ______ | ||
Street Address: ______ | ||
City, State, Zip: ______ |
§ 375.1287, RSMo