In Nevada you are given the right by law to enroll in individual health insurance after losing a group health plan. This is called a conversion policy, and implies that you are converting from one plan to another. Rather than switching from one provider to another, you are only changing from group health insurance to individual health insurance under the same plan.
In Nevada, Indemnity health insurance companies must provide conversion policies with their group health plans. HMO’s are not required to offer conversion policies, but many of them do anyway. All of the rules and guidelines for conversion policies are the same, regardless of whether it is under an HMO or Indemnity.
You are eligible for a conversion policy if you were covered by the group plan for at least three months. You have to pay the first premium within 31 days of being given the conversion information. You cannot have other health insurance, including Medicare, or be qualified to have it.
If an insured person dies, the family members or dependents may obtain conversion rights. Conversion is also available to children of divorce or former spouses, as well as to a child who loses dependent status. There is no federal requirement for obtaining conversion policies, so if you meet these criteria then you will generally be able to obtain one.
Conversion policies vary, as you can choose different plans. Usually you will get a choice of two different plans. One is basic and one is a standard health benefit plan. You will receive nursing services, X-rays, emergency care, physician services, prescription drug coverage and rehabilitation. Unlike continuation coverage and COBRA, the coverage will probably not be the same as it is under the group plan.
Conversion policies do not use pre-existing condition exclusions, but if you were in an exclusion period under your former group health plan, you may need to finish the exclusion period before obtaining the conversion coverage.
Conversion policy premiums are usually much more expensive than normal premiums, but there are limits on how much you can be charged. Premiums may be less or more depending on your state of health, how old you are and other similar factors that may determine your need for healthcare.
For more information on conversion policies, refer to the Nevada Division of Insurance.