HMFP Coverage Retention Form

Waiver of Rights to Retain Coverage

Your HMFP policy was issued under very special terms that can’t be replicated in today’s market. Please acknowledge the following statements to proceed. I recognize the individual policy purchased by HMFP was provided to me:

Without any consideration of current or pre-existing medical conditions.
With a permanent rate discount that is unavailable to individual consumers
Using gender-neutral rates that are substantially lower than the gender-specific rates that would be charged if I purchase coverage as an individual
With rates based upon my age when I was employed at HMFP and that the cost of purchasing today will be significantly higher.

I do not wish to retain this protection

Waiver of Rights to Retain Coverage

HMFP Coverage Retention Form

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