When do insurers have to sell me conversion coverage?

• In New Mexico, if you have coverage through an employer’s fully insured group health plan 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. You must apply for conversion coverage and pay your first premium within 30 days after receiving notice of your conversion rights. To qualify for a conversion policy, you first must have used up any COBRA or state continuation coverage and cannot be eligible for Medicare or any other federal or state insurance program.
• Conversion rights are also available to a surviving spouse and children upon the death of the insured, to a child who reaches that age at which dependent coverage is terminated, and to a former spouse and children at divorce.

What will conversion policies cover?

• Conversion policy benefits must be similar to those provided under your previous group policy.

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 conversion coverage?

• Premiums for conversion coverage may be much more costly than your former group plan premiums. There are no limits on what can be charged for conversion policy premiums (although there are general requirements that premiums be set according to reasonable actuarial standards). If you have questions about conversion policy premiums, contact the New Mexico Division of Insurance.

Can a conversion policy be cancelled?

• Your conversion coverage 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.