California Individual Conversion Plans
To qualify for a California Conversion plan, all of the following requirements must be met:
- you lost your fully-insured, employer-sponsored group coverage within the last 63 days (employees of self-funded group plans are not eligible)
- you were continuously covered during the 3-month period immediately preceding the termination of your employer-sponsored group coverage
- you are not eligible for Medi-Cal or Medicare, or have any other medical coverage
- your employer's group coverage was not replaced within 15 days of the termination of coverage
- to be eligible for the PPO 2500 Conversion Plan, all enrollees must be permanent legal residents of California
If you enroll in a California Conversion Plan, your eligible dependents that were covered under you employer’s plan may also enroll, including:
- your spouse or qualified domestic partner who is not Medi-Cal or Medicare eligible
- your unmarried children under age 19
- your children (under 19 years of age), or the children (under 19 years of age) of your enrolling spouse or qualified domestic partner
- your unmarried children ages 19-23 who qualify as dependents for federal income tax purposes
- your children of any age who are totally disabled due to physical handicap or mental retardation, as long as you enroll them prior to age 23
To enroll for these California Conversion Plans, you must submit: an application, your first premium payment, and a Certificate of Creditable Coverage (indicating the last date you were covered under your employer-sponsored plan) or other documentation of prior coverage and the loss of that coverage. The insurance company must receive these within 63 days following the termination of your employer-sponsored coverage, or you become ineligible for this plan. Upon approval, coverage under your California Conversion Plan will become effective retroactively to the date your employer-sponsored group coverage was terminated.
Do you have other coverage options?
- You can apply for coverage under a medically underwritten Individual plan. These plans may be less expensive. To apply, you must fill out a health statement, which will be reviewed by the insurance company. Once the underwriting review is completed, you will be notified that your application is either approved or denied. If approved, you will be informed of the date that your coverage will begin. Some pre-existing conditions may not be covered.
- If you are 65 or older, and covered under both Parts A and B of Medicare, you can apply for a Medicare Supplement plans. If you apply as soon as you leave your group, your coverage begins immediately.
- You may have an option to continue your group coverage through COBRA or Cal-COBRA. Contact your employer for more information.