Back to all terms

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

Calendar Year

The calendar year defines a benefit period that runs from January 1 to December 31. Many annual maximums, deductibles, and claim resets follow this schedule. It provides a consistent framework across most insurers and simplifies tax reporting for medical expenses.

Certificate of Insurance

A certificate of insurance is an official document issued by an insurance company that summarizes the key details of your coverage. It serves as proof that you are insured and outlines the essential terms of your policy, including the type of coverage, effective dates, benefit limits, exclusions, and any dependents or beneficiaries listed under the plan.

Claim

A claim is a formal request you or your healthcare provider submit to your insurance company to receive reimbursement or direct payment for eligible medical or dental expenses covered under your plan. Submitting a claim provides the insurer with the necessary information - such as receipts, treatment details, and provider information - to verify the service and determine the amount payable according to your policy’s terms.

Claim Submission Deadline

The claim submission deadline is the final date by which an insured person must submit a claim to their insurance company for reimbursement of eligible expenses. After this date, the insurer is not obligated to pay the claim, even if the expense itself would have been covered. This deadline ensures timely processing, accurate recordkeeping, and proper financial reporting for both the insurer and the policyholder.

Claimant

A claimant is the person who submits a request for reimbursement or payment under an insurance policy. In health and dental insurance, the claimant is usually the insured individual who received the service, such as a medical treatment, prescription, or dental procedure. However, a claimant can also be a parent, spouse, or legal guardian submitting a claim on behalf of a covered dependent.

Have questions about your insurance coverage?

Our licensed advisors can help you understand your options and find the right plan for your needs.

Contact Us