conversion coverage

If you lose employer-sponsored group health insurance and have a medical history that makes you uninsurable in the individual health insurance market, there are several options available that may guarantee access to individual health insurance. To be eligible for these guaranteed access plans, first you have to use all of the COBRA continuation health coverage for which you are eligible.

COBRA

COBRA continuation health coverage from an employer is normally available for 18 months after termination of employment. The price of COBRA is the full cost of the insurance plan which was formerly subsidized by the employer plus up to an additional 2% allowed for administrative costs.

For example, while I paid only about $50 per month for a premium coverage health insurance plan for myself while I was working for a large corporation, I paid about $550 per month for the same plan while on COBRA. The full price of the medium coverage plan at my company, still a very good plan, for a single person was about $275 per month.

Cal-COBRA

In California, Cal-COBRA extends similar protections to employees of smaller businesses with 2 to 19 employees to which federal COBRA law does not apply. It also extends the length of eligibility for continuation health coverage to 36 months.

Note that Cal-COBRA does not apply to employers with self-insured plans. Many large corporations are self-insured. In this case, you would have 18 months of continuation health coverage instead of 36 months.

Conversion Coverage

Some group health insurance plans may have conversion coverage where your plan is converted from a group plan to an individual plan without being underwritten.

HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) provides some protections for people after they lose employer-sponsored group insurance coverage. In California, all health insurance carriers that sell individual plans must offer their two most popular individual plans to people who qualify under HIPAA.

The rates are expensive, for example, ranging from about $300 per month for an individual in his 20s to about $1000 per month for an individual in his 60s for a plan from Anthem Blue Cross, depending on the plan and region. Information about the plans and rates is available at the Web sites linked above and below.

Dave Fluker is an insurance agent in California who specializes in guaranteed-issue health insurance plans which are not underwritten.

The application process is quick and simple. I faxed my application to the agent, received an e-mail confirmation of receipt from Anthem Blue Cross three days later, and received an e-mail notification of approval from Anthem two days after that.

MRMIP

If one is not eligible for HIPAA, California has a high-risk insurance pool, the Major Risk Medical Insurance Program (MRMIP). There is often a wait list and the benefits are limited.

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