When am I eligible for conversion coverage?
- In North Dakota, if you have coverage through an employer’s fully insured group health plan and you leave that job, you may be eligible to buy conversion coverage. This is an individual policy you get from the company that insured your employer’s group plan.
- Fully insured group health plans must offer conversion privileges to spouses and dependent children of a policyholder in case of divorce or annulment. The spouse and children must apply within 30 days. Others may be eligible only if their group health plan contract includes conversion rights.
Fully insured group health plans can - but are not required to - provide conversion rights to other people. If your plan does, you must be offered conversion when your group coverage terminates. Ask your employer if your group health plan includes conversion rights.
In most instances, you must have exhausted any state continuation coverage before you can purchase a conversion policy.
What does a conversion policy cover?
- Coverage under a conversion policy probably will not be the same as under your prior group health plan, and will probably offer fewer benefits.
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.
Can my 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.
