When do insurers have to sell me a conversion policy?

· In Indiana, if you have coverage through a small employer’s fully insured group health plan and you leave that job, you are eligible to buy a conversion policy. This is an individual policy you get from the company that insured your employer’s group plan.

· To qualify for a conversion policy, you must have had at least 90 days of continuous coverage through an employer’s small group health plan. In addition, you must not be eligible for a group health plan, and you must request the conversion policy within 30 days of becoming eligible for it.

· You do not have to elect COBRA continuation coverage before you are allowed to buy a conversion policy. If you do elect COBRA continuation coverage, however, you will have the right to buy a conversion policy when COBRA coverage ends.

· You do not need to be HIPAA eligible to buy a conversion policy.

What does a conversion policy cover?

· The benefits under a conversion policy may not be the same as those under your former employer group health plan. The conversion policy’s benefits may be less generous than those you used to have. However, at a minimum, conversion policies must cover inpatient hospital and physician care, outpatient hospital and physician care, diagnostic laboratory services, diagnostic and therapeutic radiological services, and emergency care.

What about coverage for my pre-existing condition?

· Conversion policies cannot impose new pre-existing condition exclusion periods. However, if you were in the middle of a pre-existing condition exclusion period under your group health plan when it ended, you will have to finish it.

What can I be charged for a conversion policy?

· Premiums for a conversion policy are limited to one and one half times (150%) the rate an eligible employee would have been charged under the small employer’s health plan. If you have questions about conversion policy premiums, contact the Indiana Department of Insurance.

Can a conversion policy be canceled?

· 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.