The Group Conversion Deadline
Ravi is covered under his employer's group health plan, which includes a conversion privilege to an individual policy on termination of employment. Ravi resigns on March 1 and is told his group coverage ends March 31. He is diagnosed with a chronic condition in April and wants to convert. The plan document gives a 31-day conversion window after coverage ends, and the insurer requires written application and first premium within that window. Ravi submits his application on May 5, after the window closes, and asks the insurer to backdate the policy to April 1. He also asks whether his dependents are automatically included.
1. Is Ravi entitled to conversion, and can the policy be backdated?
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Ravi missed the 31-day window, which ended around May 1. Conversion rights are typically lost if the deadline is missed, so the insurer may deny the conversion. Backdating to April 1 would create retroactive coverage for a period when no premium was paid and would conflict with the plan's timing rules; insurers generally will not backdate to cover a known condition. Ravi should check whether the plan or applicable law provides a longer window, whether he had COBRA or state continuation rights, and whether a special enrollment opportunity exists. He should also confirm the exact coverage end date in writing.
2. What should Ravi have done differently, and what are his remaining options?
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He should have requested the conversion application immediately on termination and submitted it with the first premium before the deadline, documenting the date of submission. Remaining options may include a special enrollment period on a marketplace plan triggered by loss of coverage, state continuation, or an individual policy subject to medical underwriting. He should act quickly because special enrollment windows are also time-limited.