When am I eligible for conversion coverage?
· In Montana, if you have had coverage through an employer’s fully insured group health plan for at least 3 months and you leave that job, you are eligible to buy conversion coverage. This is an individual policy you get from the company that insured your employer’s group plan. If you had family coverage under your prior group plan, your dependents can elect conversion coverage, as well.
· You do not need to be HIPAA eligible to buy a conversion policy.
What does a conversion policy cover?
· It depends on the plan you select. The insurance company must offer as a conversion policy a choice of any group health plan or individual policy it customarily sells.
· The insurance company also must offer you a conversion policy with the same coverage as the lowest-cost basic group health plan it sells to small employers. (see Small Employer or Self-Employed Person)
What about coverage for my pre-existing condition?
· Your conversion policy cannot impose a new pre-existing condition exclusion period. However, if you were in the middle of an exclusion period under your former group health plan coverage, you may have to finish it.
How much can I be charged for conversion coverage?
· Conversion policy premiums may be much more expensive than your former group plan premiums. The premium for a conversion policy cannot be more than twice as high as the premium customarily charged by the insurer for that policy. If you choose the conversion policy with the same coverage as the lowest cost basic group health plan for small employers, your premium cannot be more than 150% of the premium customarily charged by the insurer for that health plan.
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.
