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When am I eligible for conversion coverage?

  • In Ohio, if you have coverage through an employer’s fully insured group health plan and you leave that job, you can buy conversion coverage. This is an individual policy you get from the company that insured your employer’s group plan. To qualify, you must have been continuously covered under the group plan for at least one year. If you are covered by a HIC/HMO, the one year coverage requirement does not apply. In addition, you first must use up any COBRA or state continuation coverage. Finally, you must apply for conversion coverage and pay your premium for the first calendar quarter of coverage within 30 days of termination of your former group (or continuation) coverage.
  • You can also buy a conversion policy if you lost your group health plan due to death or divorce of the covered employee, or if you no longer qualify as a dependent child of the covered employee.

What does conversion coverage cover?

  • Covered benefits under conversion coverage may not be the same as under your former group health plan. Benefits covered under the conversion plan available to you will vary depending on your situation.

If you are HIPAA eligible, you must be offered a choice of a basic or standard plan (see page 13).  Insurers can offer you other conversion plans as well.

If you are not HIPAA eligible, the insurer can decide which conversion type of conversion coverage to offer, which may or may not include a basic or standard plan (see page 13). Either way, conversion plan benefits might be very different from those covered under your former group health plan.

What about coverage for my pre-existing condition?

  • Your conversion coverage 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?

  • If you are HIPAA eligible, premiums for standard and basic conversion plans are limited to twice the rate insurers charge other individuals or groups buying that plan.
  • Generally if you are not HIPAA eligible, there are few limitations on how much you are charged for conversion coverage. However, if you are offered a basic or standard conversion plan, there are limits to how much insurers can charge you (see page 15).
  • Depending on your health status, you may have a choice between buying conversion coverage or a private individual insurance policy. Check out both options to see which is best for you.

Can my policy be canceled?

  • Conversion coverage, like other individual health insurance is guaranteed renewable.

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