Form Required August 1, Model Replacement Form

Model Replacement Form Required Aug. 1, 2017

Effective August 1, 2017, NGL will be following the state-mandated Model Replacement rule for the state in which you are licensed.

Your state’s Model Replacement rule required a form to be submitted with applications whenever a proposed insured states they have existing insurance coverage, even if they don’t plan on replacing that coverage.

Two simple questions are asked on the form:

  1. Are you considering discontinuing making premium payments, surrendering, forfeiting, assigning to the insurer, or otherwise terminating your existing policy or contract?  O YES  /  O NO
  2. Are you considering using funds from your existing policies or contracts to pay premiums due on the new policy or contract?  O YES  /  O NO

The form needs to be completed and submitted with paperwork when proposed insureds answer yes to either of these questions.


  • Between now and August 1, 2017, NGL is providing an implementation period without pending business while you become familiar with this requirement.
  • Effective August1, 2017, policy issuance will be delayed if the form is not included with submitted paperwork.

As of today, the following states are requiring Individual Life and Annuities agents to submit the form: AL, AK, AZ, AR, CO, CT, HI, IA, KY, LA, ME, MD, MS, MT, NE, NH, NJ, NM, NC, OH, OR, RI, SC, SD, TX, UT, VT, VA, WV, and WI.

By early June 2017, the required Model Replacement form will be included in application kits and will be available on your Supplies site on

Please contact the dedicated NGL Life Product Support team at 800-762-9883 or with questions.