Hartford Voluntary LTD Conversion Form

As a terminated employee or an active employee who is no longer full-time, you may be eligible to convert to an individual policy.

Employees must complete this form if they want to convert their voluntary long term disability (LTD) coverage with Hartford. For questions about how to complete this form, contact the Disability Analyst at HR-Benefits at 681-4436.

The employer-paid Duke Disability Plan (LTD) is not eligible for conversion and this form cannot be used.

PLEASE NOTE: Conversion may be available if the policy was in effect for at least a year.

Benefits - Disability, Benefits - Voluntary Disability