When do insurers have to sell me a conversion policy?

• In West Virginia, if you or your dependents have coverage through an employer’s fully insured group health plan and you lose that coverage, you may be eligible to buy conversion coverage. This is an individual policy that you get from the company that insured your former plan.
• To qualify for a conversion policy, you must have had at least 3 months of continuous coverage through an employer’s group health plan. In addition, you must not be eligible for group health coverage, and you must request the conversion policy and pay the premium within 31 days of becoming eligible.

What does a conversion policy cover?

• The insurance company that provided your group plan must offer you the choice of at least three basic conversion policies covering hospital stays and surgery. Each of the three basic options offers the same hospital room and board services, but with different levels of coverage (i.e. the policy will pay 100%, 75%, or 50% of covered charges). In addition, if you were eligible for a major medical policy under your group health plan, you must also be given the opportunity to convert that coverage.

What about coverage for my pre-existing condition?

• You will not have a new pre-existing condition exclusion period, though you may have to satisfy any unexpired exclusion period from your prior coverage.

How much can I be charged for conversion coverage?

• West Virginia does not restrict the amount that insurance companies can charge for individual health insurance policies. Conversion policies are usually more expensive than your former group coverage.

Can my conversion coverage be cancelled?

• 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.