When do I have to be offered conversion coverage?

• Each employer chooses whether its employees and their dependents are offered a conversion policy or a continuation policy when they are no longer eligible for coverage under the employer’s fully insured plan. The insurer is only required to provide one of these policies, not both. Most employers choose the conversion policy, not the continuation policy. A conversion plan is an individual policy from the insurance company that covered your former group.
• To qualify for a conversion policy, you must apply for a conversion policy within 31 days after your group coverage was terminated.

What will a conversion policy cover?

• Conversion coverage may differ from your prior group plan. Virginia does not require that conversion policies provide the same or similar benefits as your old policy, so the benefits you receive from a conversion policy might be less generous than those you had through your group plan.

What about coverage for my pre-existing condition?

• You will not have a new pre-existing condition exclusion period for your conversion policy. The conversion policy can only exclude coverage for pre-existing conditions that were excluded under the prior group health plan.

What can I be charged for conversion coverage?

• Premiums for conversion coverage may be much higher than your prior group coverage. Premiums for conversion coverage are determined by the insurer issuing the policy and can vary based on your age, health status and other factors. Virginia places few limits on what you can be charged for a conversion policy.

Can my conversion policy be canceled?

• Your 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.