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MEDICAL CONVERSION PRIVILEGE <br /> This benefit applies only if indicated on the Schedule . <br /> An employee whose coverage under the Employee Benefit Plan ends solely due to termination of <br /> employment or change in classification may be eligible for an individual medical conversion policy. A <br /> dependent whose coverage under the Employee Benefit Plan ends solely due to loss of dependency <br /> status or change in classification may also be eligible . <br /> Eligibility for conversion is determined as follows : <br /> a . the person must have been covered for medical benefits under the Employee Benefit Plan for at <br /> least 3 months ; <br /> b . proof of good health will not be required ; <br /> c. the person must be under the age of 65 ; <br /> d , the person must be a resident of the United States ; <br /> e . the person 's coverage under the Employee Benefit Plan must end prior to termination of the <br /> Participating Employer's coverage under this Policy ; and <br /> f. the person must not currently have an individual medical conversion policy issued through <br /> SAFECO . <br /> SAFECO , or its designee , will issue an individual medical conversion policy, subject to the following : <br /> a . the eligible person must apply for conversion , and the application and first premium payment must <br /> be received by SAFECO at its Home Office within 31 days after the date coverage under the <br /> Employee Benefit Plan terminates ; <br /> b , a then current individual medical conversion policy will be issued at the rate in use <br /> on the <br /> conversion effective date ; and <br /> c , the effective date of the individual medical conversion policy will be the day after coverage <br /> terminates under the Employee Benefit Plan . <br /> LGC 8820 03/02 <br />