Eligibility Window (Guaranteed Issue)
An eligibility window in a guaranteed issue (GI) plan is the period after losing group benefits during which you can enroll in personal health coverage without completing medical questions. This window is typically 60 to 90 days. Applying within it ensures uninterrupted protection for prescription drugs, dental care, and health services that were previously employer-sponsored.
How It Works
When your employment ends, your employee group benefits are terminated, and that loss of coverage is what opens the guaranteed issue eligibility window. Guaranteed issue, sometimes called group conversion, lets people leaving a group benefits plan obtain personal coverage without completing medical questionnaires or providing evidence of insurability, as long as they apply within the specified time frame. These group conversion plans are available in Canada to those who have lost employee benefits coverage in the last 60 days. Because the plan accepts all applicants regardless of health history, it generally covers pre-existing conditions, though it may include benefit caps.
Example:
Say your workplace benefits end on June 30. You generally have until late August to apply for a guaranteed issue plan and keep continuous coverage for prescription drugs, dental, and other services that your provincial health plan does not cover. Because you applied inside the window, the insurer accepts you without medical questions even if you have a pre-existing condition.
What to Watch For:
If you miss the eligibility window, future applications will usually require medical underwriting and could be declined based on your health history. Some insurers also ask for documentation, such as proof of prior insurance, to confirm that you qualify for a guaranteed issue plan, so keep those records on hand.
