Conversion Coverage
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WHEN DO I HAVE TO BE OFFERED CONVERSION COVERAGE?
- In Wyoming, if you have coverage through an employer’s fully insured group health plan or state or local governmental plan, and you become ineligible for that coverage, you are eligible to buy conversion coverage. This is an individual health insurance policy you get from the company that insured your previous group plan.
- Conversion rights are also available to a surviving spouse and child upon the death of an insured or when they cease to be a qualified family member under a group policy.
- To qualify, for a conversion policy, you must apply within 31 days of the termination of the group plan. Also, you must first use up any COBRA or state continuation coverage.
- You do not need to be HIPAA eligible to buy a conversion policy. However, if you do elect a conversion policy, you will lose your HIPAA eligibility status.
WHAT DOES A CONVERSION POLICY COVER?
- The insurance company that provided your group plan must offer you a choice of three basic conversion policies and one major medical conversion policy. All conversion policies must cover hospital stays and surgery, however the major medical conversion policy must also cover physician and other non-hospital expenses.
- Each of the three basic conversion options offers the same hospital and room and board services, but with different levels of payable coverage (i.e. 100%, 75% and 50%).
WHAT ABOUT COVERAGE FOR MY PRE-EXISITNG CONDITION?
- A conversion policy may not impose a new pre-existing condition exclusion period. However, if you were in a pre-existing exclusion period under your old group health plan when it ended, you may have to finish it.
HOW MUCH CAN I BE CHARGED FOR CONVERSION COVERAGE?
- There is no limit on what your insurer can charge for conversion coverage. These policies often are more expensive than your prior group coverage.
CAN MY POLICY BE CANCELED?
- Conversion policies, like other individual health insurance policies, are guaranteed renewable. Your coverage cannot be canceled if you get sick.
