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Conversion Privilege

Conversion privilege is the right to transfer your existing group insurance coverage to an individual policy without providing medical evidence of insurability when your group coverage ends. This option allows you to maintain continuous protection during life transitions such as leaving a job, retiring, or losing eligibility under an employer-sponsored plan. It is a key feature that helps individuals avoid coverage gaps, especially if they have pre-existing medical conditions that could make new insurance difficult to obtain.

The conversion privilege applies to several types of insurance, including health, dental, and life insurance. To exercise this right, you must apply within a specific time frame, usually between 30 and 90 days after your group coverage ends. The new individual plan may have different benefits and premiums, but it guarantees acceptance without requiring medical underwriting.

Example:

If you retire and your employer-sponsored health and dental coverage ends, you can apply for a personal health plan within 60 days through the insurer’s conversion privilege. Your application will be automatically approved, and coverage will begin without any health questions.

What to Watch For:

Apply as soon as possible after losing group coverage, as missing the conversion window will require you to apply for new insurance with medical underwriting. Review the differences between your new individual plan and your former group plan, as benefit maximums and premiums may change. Keep a copy of your group termination letter or benefits summary, as it is often required for conversion approval.

Related Terms

Coverage / Benefit

Coverage, sometimes referred to as a benefit, is the range of health or dental services, supplies, or treatments that your insurance plan agrees to pay for under its terms and conditions. Each benefit represents a category of care, such as prescription drugs, dental services, vision care, or paramedical treatments.

Coordination of Benefits

Coordination of benefits (COB) is the process used by insurance companies to determine the order in which multiple plans will pay for the same claim when a person is covered under more than one policy. The goal is to ensure that combined reimbursements do not exceed 100 percent of the eligible expense, while allowing the insured to receive the maximum possible coverage across all plans.

Individual Insurance

Individual insurance is a personal policy purchased directly from an insurance company to provide financial protection for a single person or family, rather than through an employer or group plan. It allows you to customize coverage according to your health needs, lifestyle, and budget. Common types of individual insurance include health, dental, life, critical illness, and disability coverage.

Effective Date

The effective date is the day your insurance coverage officially begins. From this date forward, you are eligible to receive benefits for covered health, dental, life, or disability expenses under the terms of your policy. The effective date is established once your application has been approved, all requirements are met, and the first premium payment has been received, unless otherwise specified in the policy.

Optional Benefit / Rider / Add-On

An optional benefit, also called a rider or add-on, is an additional feature that can be purchased to enhance your existing health, dental, life, or disability insurance plan. Optional benefits allow you to customize coverage by adding protection that suits your personal needs, rather than relying only on the base plan design.

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