When am I eligible for a conversion policy?

• In Washington, if you are losing eligibility for a fully insured group health plan, you may be able to buy a conversion policy. This is an individual health insurance policy you get from the company that insured your employer’s group health plan

• You must meet certain qualifications to be eligible for conversion. To qualify, you must be losing eligibility for coverage under the fully insurance group plan for any reason other than misconduct. Even in the case of misconduct, an employee’s spouse and dependents are still eligible to convert. You may also be eligible for conversion coverage if you had elected continuation coverage (for example, through COBRA) and it has run out. In addition, you must not be eligible for Medicare or another group plan.

• Eligibility for a conversion policy is time sensitive. You must apply for conversion and pay your premium for the first calendar quarter of coverage within 31 days of termination of your prior group health plan or continuation coverage.

What does a conversion policy cover?

• Covered benefits under a conversion policy might not be the same as under your former group health plan. The benefits available to you under a conversion policy will depend on which type of conversion policy you buy.
• You will have the choice of at least 3 benefit plan options; a comprehensive medical plan, a basic medical plan and a major medical plan. All three plans provide coverage for hospital stays, inpatient and out patient medical care and surgical costs but the lifetime maximum varies from $75,000 to $500,000, depending on the plan. In addition, the amount of your deductible will vary depending on the plan you select.

What about coverage for my pre-existing condition?

• Conversion policies 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 a conversion policy?

• Premiums for conversion coverage are determined by the insurer issuing the policy. The cost is typically much higher than premiums you paid for your group health plan.
• Depending on your health status, you may have a choice between buying a conversion policy or a private individual health insurance policy. Check out both options to see which is best for you.

Can my conversion policy be canceled?

• Your coverage cannot be cancelled 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.