If you or your dependents are covered under a FlexSolutions Medical Plan and your group or COBRA coverage ends, you or your dependents may be eligible to convert this medical coverage into an individual plan of some type, as explained in the sections below. You may not "convert" the benefits provided through the Dental or Vision Plans.
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For HMSA Participants
You or your dependents may transfer to another HMSA plan for which you are eligible when coverage under your FlexSolutions HMSA Medical Plan ends due to your termination (or any other separation from A&B) or cancellation for non-payment of premium.
This transfer must occur within 30 days after you have received a notice that your coverage has ended. You and each of your dependents requesting transfer must meet the requirements of the other HMSA plan in which you are enrolling.
If your dependents are seeking transfer coverage due to your death, and they are unable to qualify for any group coverage, your spouse/domestic partner may become a new member under an individual HMSA plan and your dependent children may be enrolled as though they were dependents of your spouse/domestic partner.
Note:
When you or your dependents transfer from this Plan to another HMSA plan, the benefit maximum carryover rules of that new plan will apply.
Out-Of-State Transfers
As a member of the Western Conference of Prepaid Medical Service Plans and the Blue Cross and Blue Shield Association, HMSA participates in the Inter-Plan Transfer Agreement. This agreement allows plan participants to transfer their coverage to a participating plan providing coverage in another state.
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For CIGNA Participants
If you or your dependents are covered under the CIGNA Low Option PPO, the CIGNA PPO, or the CIGNA Network HMO Medical Plans offered through FlexSolutions, and your group or COBRA coverage ends, you or your dependents may be eligible to convert the coverage into an individual plan of some type, as long as the plan remains in force for active employees and a conversion option is available.
To convert your medical coverage, you will not need to provide "evidence of insurability" unless the benefits provided through the conversion coverage are greater than those provided under this Plan. In this instance, you will be asked to provide evidence of insurability for the increased coverage only.
Depending on where you live, you will either be issued an individual health insurance policy, or your conversion coverage will be provided through a conversion trust. In the case of the trust, you will receive a certificate of insurance instead of an individual policy.
Specifically, you may convert your group medical coverage to individual coverage (for you and any covered dependents) if...
However, if your group coverage ends because this Plan ends, you will not have the right to any conversion coverage.
Your dependents may convert their group medical coverage to individual coverage if...
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You die, in which case your surviving spouse/domestic partner may obtain conversion coverage for all covered dependents;
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You divorce or end your domestic partnership, in which case your former spouse/domestic partner and eligible dependent children may obtain conversion coverage when:
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the marriage or domestic partnership is dissolved, or
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at the end of any period of continuation of coverage, but only if this Plan is in force on that date; or
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The dependent:
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ceases to be eligible, or
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is at least age 19 when you obtain your conversion coverage (only dependents under age 19 may be covered under any conversion family coverage).
How To Obtain Conversion Coverage Through CIGNA
To obtain conversion coverage through CIGNA, you must...
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Apply for conversion coverage within 31 days of the date your group coverage ends,
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Complete the application—applications are available from CIGNA, and
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Pay the required premium—you must pay the first premium before the conversion coverage is effective.
The conversion coverage will take effect the date your group or COBRA coverage ends, as long as this Plan is still in force on that date.
If you die within the 31-day conversion period, your surviving spouse/domestic partner, or any guardian of your dependent children, may apply for conversion coverage for your covered dependents.
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About The Conversion Coverage
The benefits provided through the conversion coverage may be less than the benefits available under this Plan. Also, the cost for this conversion coverage may be significantly higher than the cost for coverage under this Plan. In most cases, the benefits will be limited to hospitalization and surgery. The benefit amounts under the conversion coverage will be governed by the...
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Rules of the Claims Administrator, and
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Laws of the state in which you live at the time you apply for conversion coverage.
The Claims Administrator may limit the benefits of the conversion coverage if you or a dependent has other coverage, or may deny an application for conversion coverage. If these rules apply to you, you will be notified by the Claims Administrator.
A copy of the individual policy or certification is on file with the state insurance authority, where required. You may also obtain a copy by contacting the Claims Administrator.
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For Kaiser Participants
You or your dependents may transfer to another Kaiser HMO Plan for which you are eligible when coverage under your FlexSolutions Kaiser HMO ends due to your termination (or any other separation from A&B) or cancellation for non-payment of premium.
This transfer must occur within 30 days after your coverage has ended. You and each of your dependents requesting transfer coverage become members under individual Kaiser plans. (As such, the benefits for which you will be eligible may change.)
If your dependents are seeking transfer coverage due to your death, and they are unable to qualify for any group coverage, one dependent may become a new member under an individual Kaiser plan and your other dependents may be enrolled as though they were dependents of that new member.
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