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Guaranteed Issue (GI) / Conversion

Guaranteed Issue (GI) or Conversion refers to an insurance option that allows individuals leaving a group benefits plan to obtain personal coverage without completing medical questionnaires or providing evidence of insurability. This feature guarantees approval as long as the individual applies within a specific time frame, usually 60 to 90 days after group coverage ends. It ensures continuity of protection and prevents gaps in coverage during employment changes, retirement, or loss of eligibility under a group plan.

Guaranteed Issue or Conversion plans typically offer moderate levels of health and dental insurance. They are designed to provide essential coverage rather than replicate the full scope of a group plan. Premiums are generally higher, and benefit maximums lower, compared to medically underwritten plans that require health information. These plans are especially valuable for people with pre-existing medical conditions who might otherwise be declined for new insurance.

Example:

If your employment ends on June 30, you can apply for a Guaranteed Issue health and dental plan by August 29 to continue coverage. You will be automatically accepted without medical questions, and your new plan will begin as soon as your previous coverage ends.

What to Watch For:

Apply within the insurer’s stated conversion window to qualify for guaranteed approval. Missing the deadline usually means you must apply for a medically underwritten plan, which may require health questions or result in exclusions. Review the new plan’s coverage limits, as conversion plans often focus on core benefits like prescription drugs, dental care, and vision, with potentially lower maximums than group plans.

Related Terms

Generic Substitution

Generic substitution means your plan reimburses prescription drugs based on the cost of the lowest-priced equivalent generic medication rather than the brand-name drug, unless a doctor indicates “no substitution” for medical reasons.

Government Health Insurance Plan (GHIP)

A Government Health Insurance Plan (GHIP) is the publicly funded healthcare program administered by each Canadian province and territory. It provides residents with access to medically necessary hospital and physician services at no direct cost, funded through provincial taxes and federal health transfers. GHIP ensures that all eligible residents receive essential medical care regardless of income or health status, forming the foundation of Canada’s healthcare system.

Grace Period

A grace period is the additional time granted after a premium payment is due during which an insurance policy remains active, even though payment has not yet been received. It provides policyholders with a short window to make late payments without losing coverage. The grace period ensures continuity of protection and helps prevent accidental policy lapses caused by missed or delayed payments.

Group Insurance

Group insurance is a type of coverage that provides benefits to a defined group of people, typically employees of a company or members of an organization, under a single master policy. Instead of each person purchasing an individual policy, the group is insured collectively, which allows members to access broader coverage at lower rates. The employer or organization acts as the contract holder, while individual participants receive a certificate of insurance outlining their specific benefits.

Group Policyholder

A group policyholder is the organization or employer that owns and administers a group insurance plan on behalf of its members or employees. The group policyholder holds the master policy issued by the insurer, manages enrollment, collects premiums, and ensures that the plan complies with contractual and regulatory requirements. In most cases, the policyholder is the employer, while the insured members are the employees and their eligible dependents.

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