Conversion

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When do insurers have to sell me a conversion Policy?

  • In Wisconsin, if you have coverage through an employer’s fully insured group health plan and you leave that job, you are eligible to buy conversion coverage. This is an individual policy 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 within 30 days of becoming eligible.
  • You do not have to elect COBRA continuation coverage or state continuation coverage before you are allowed to buy a conversion policy. If you do elect COBRA continuation coverage or state continuation coverage, however, you will have the right to buy a conversion policy when continuation ends.
  • You may also be eligible for conversion coverage, if you lose coverage under an individual policy due to divorce or annulment. Insurers must provide notice of this option 30 days prior to the date that your former spouse’s coverage would terminate. You must provide payment for your conversion coverage within 30 days of receiving notice of this option.

What will conversion policies cover?

  • You must be offered a policy similar to your previous coverage. Your insurer may choose to offer you either a high-limit comprehensive policy or a choice of three standardized conversion policies, including basic coverage and two major medical expense policies. Wisconsin insurance regulations specify the amount of benefits in each type of conversion policy. Contact the Wisconsin Department of Insurance for more details.

What about coverage for my pre-existing condition?

  • Conversion policies cannot impose new pre-existing condition exclusion periods. However, if you were in the middle of a pre-existing condition exclusion period under your group health plan when it ended, you will have to finish it.

What 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 the cost of group coverage. If you have questions about conversion policy premiums, contact the Wisconsin Department of insurance.

Can a conversion policy be cancelled?

  • Your conversion policy 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.


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