When do I have to be offered a conversion policy?

• In the District of Columbia, if you have fully insured group HMO coverage through your employer and you leave that job, you can buy a conversion policy. This is an individual policy you get from the HMO that insured your employer’s group plan. To qualify for a conversion policy, you must apply in writing within 31 days of termination of your former group coverage.
• You also may qualify for a conversion policy if your employer drops the fully insured group HMO coverage.

What will a conversion policy cover?

• At a minimum, conversion policies are only required to provide basic health care services, so benefits may be less generous than what you received under your former group coverage.

What about coverage for my pre-existing condition?

• You will not have a new pre-existing condition exclusion period for your conversion policy. The conversion policy can only exclude coverage for pre-existing conditions that were excluded under the prior group health plan.

What can I be charged for a conversion policy?

• Premiums for conversion coverage may be higher than your prior group coverage. Premiums for conversion are determined by the insurer issuing the policy and can vary based on your age, health status, gender, and other factors..

Can my conversion policy be cancelled?

• Your conversion policy cannot be canceled because you get sick. This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the plan service area.