When am I eligible for a conversion policy?

· In Illinois, if you have coverage through an employer’s fully insured group health plan and you lose that coverage, you are eligible to buy a conversion policy. A conversion policy is an individual policy you get from the company that insured your previous group plan.

Conversion rights are also available to a surviving spouse and child upon the death of an insured or in the case that they cease to be qualified family member under a group policy.

· To qualify for a conversion policy, you must have had at least 3 months of continuous coverage through an employer’s fully insured group health plan. In addition, you must not be covered under, or eligible for coverage under Medicare or another group health plan. Finally, you must apply within 31 days of the termination of the group plan or 15 days after notice of the privilege, whichever is later, but in no case later than 60 days after termination.

· You do not need to be HIPAA eligible to buy a conversion policy. However, if you do elect a conversion policy, you will lose your HIPAA eligibility status.

What does a conversion policy cover?

· Conversion policy benefits must meet certain minimum benefit requirements, which may not be the same as those under your former plan.

What about coverage for my pre-existing condition?

· A conversion policy may not impose a new pre-existing condition exclusion period. However, if you were in a pre-existing exclusion period under your old group health plan when it ended, you may have to finish it.

How much can I be charged for a conversion policy?

· There is no limit on what your insurer can charge for a conversion policy. Premiums are determined based on the age and classification of risk of each person applying for a converted policy. These policies often are more expensive than your prior group coverage.

Can my conversion policy be canceled?

· Conversion policies, like other individual health insurance policies, are guaranteed renewable. Your coverage cannot be canceled if you get sick. 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. Also, if you become eligible for Medicare or other insurance with similar benefits, you will no longer be eligible for a conversion policy.