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If Your Group Health Insurance or COBRA Ends, Right To Convert

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To be federally eligible for purposes of HIPAA, you must meet all of the following:

  • You must have had 18 months of "continuous creditable coverage," at least the last day of which was under a group health plan. "Continuous creditable coverage" means that there is no break in coverage of 63 or more consecutive days under any of the following health insurance plans:
    • A group health plan
    • An individual health plan
    • Medicare
    • Federal Employees Health Benefits Program (FEHB)
    • Indian Health Service
    • Peace Corps
    • COBRA Continuation Coverage
    • A state health insurance risk pool
  • You must have used up any COBRA or state continuation coverage for which you were eligible.
  • You must not be eligible for Medicare, Medicaid, or another group health plan.
  • You must not have health insurance.
  • You must apply for the health insurance for which you are federally eligible within 63 days of losing your prior coverage.

Your federally eligible status ends as soon as you enroll in an individual health plan because the last day of your continuous health coverage must have been in a group plan. You can become federally eligible again by rejoining a group health plan.

For Example: Henry continued on his former employer's COBRA plan for the full 18 months. After that, he exercised his rights as federally eligible under HIPAA to purchase an individual HMO health policy. However, twelve months later, he moved to Georgia which his HMO does not serve so he lost his individual coverage. He has no federal eligibility to get another health plan, because his last health coverage was individual. If Henry goes to work and gets the employer's group coverage, he will again become federally eligible if he leaves that employer, or when COBRA coverage ends.

Certificate of Creditable Coverage

When group health insurance coverage ends, the administrator or insurance company is required to give you a statement which includes the dates your coverage began and ended.

If the company doesn't send the certificate, you're entitled to request it at any time up to 24 months after coverage under the plan ends. See Certificate of Creditable Coverage if you want more information about this Certificate.

The Policy To Which You Can Convert

Once you are eligible for the HIPAA right to convert health insurance regardless of your health condition, the question of what coverage is available depends on what state you live in.

HIPAA requires that each state have at least one insurance plan to which people can convert, but doesn't specify which one. To learn about the guarantee issue policies available in your state, see the website of the Disability Rights Legal Center by clicking here.

No matter what state you live in, when you convert from group health insurance, there will not be a waiting period for pre-existing conditions. Keep in mind that to take advantage of this guaranteed right to individual health insurance, the individual plan must start within 63 days of the termination of the group coverage.

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