CARD T218
Conversion Privilege
A right to change eligible coverage to an individual policy under specified conditions. Deadlines and available products depend on the coverage and law.
How it works
A conversion privilege can permit eligible group coverage to become an individual policy without new evidence of insurability, within specified conditions. Group life commonly uses a 31-day application-and-premium period, but the contract and state rules govern. New premiums generally reflect attained age and the available individual product. Conversion is different from portability, COBRA continuation, or a Marketplace special enrollment right; health coverage rules must be analyzed separately. [10] [18]
An employee losing eligible group life applies and pays the first premium within the stated conversion period to obtain the available individual policy without a new medical exam.
Conversion does not guarantee the same premium or the same product.
CARD T219
Eligibility Period
A window during which an eligible group member may enroll under specified terms. Delayed enrollment may trigger different requirements.
How it works
An eligibility period is the plan’s window for an eligible member to elect coverage under specified terms. It may follow an employment waiting period. A late election can be restricted until open enrollment or another permitted opportunity; underwriting consequences depend on product and law. Do not assume group health can impose prohibited health-status restrictions merely because enrollment was late. [10] [17]
After becoming eligible, a new employee has the plan’s stated election window to choose coverage and dependents.
Becoming eligible, making an election, and the coverage effective date are distinct steps.
CARD T220
Probationary Period
An initial period before specified coverage or eligibility begins. It differs from an elimination period following a qualifying claim event.
How it works
A probationary or initial waiting period can delay eligibility or specified benefits at the start of coverage, depending on the product. It is different from an elimination period following a disability or other claim event. Under the federal group-health waiting-period rule, once a person is otherwise eligible, a waiting period generally cannot exceed 90 days; permissible eligibility conditions and other coverage types require separate analysis. [10] [17] [35]
A newly hired worker waits through the employer health plan’s permitted initial period before coverage begins. A later disability claim’s 90-day elimination period is a different clock.
Two periods can both use 90 days while measuring entirely different events.
APPLY THE TERMS
Practice questions
Select an answer, then check it to see why each option is right or wrong.
T218 · Conversion Privilege
0 of 3 answered
T219 · Eligibility Period
0 of 3 answered
T220 · Probationary Period
0 of 3 answered
Sources & further reading
Original explanations and practice scenarios informed by the following regulatory, legal, and product resources. State examples are not presented as nationwide deadlines or requirements.