Group conversion individual coverage
Group conversion coverage is health coverage you purchase yourself when you are losing your employer's group health plan coverage. We provide a PriorityHMOSM conversion plan for members who had our HMO coverage through their employer and a PriorityPPOSM conversion plan for members who had our PPO insurance. Group conversion coverage does not include prescription drug coverage.
Who is eligible for group conversion coverage?
To be eligible for group conversion coverage:
- You must have been continuously enrolled in a Priority Health group HMO or PPO plan for at least three months.
- You must be losing group health coverage due to:
- Employment termination
- Loss of eligibility (whether you no longer meets your employer's requirements for health coverage or if your dependent no longer qualifies as a dependent)
- Group health coverage termination
- Death of your spouse (who was covered by their employer's health plan)
- You live in the Priority Health service area.
- Your COBRA coverage has expired or you and your dependents aren't enrolled in COBRA.
- You must must apply within 31 days of the day your group coverage ends.
Who is not eligible?
You are not eligible for group conversion coverage if you:
- Have not been enrolled in your group's plan for three continuous months
- Are enrolled in or eligible for any other health plan, such as through your spouse's employer, Medicare or COBRA
- Are losing coverage from a self-funded group plan
Applying for coverage
- Request an application from your employer or contact Customer Service to get an application.
- Send a completed, signed application to Priority Health within 31 days after the termination of group coverage.
-
PriorityHMO coverage begins the day after your group coverage is terminated.
- We will deduct your monthly premium from your bank account each month through electronic funds transfer (EFT).
- We will mail you a new ID card and a new "Schedule of Copayments and Deductibles."
Coverage documents
Your plan stays the same for 12 months, so if your conversion plan began in March, use the same plan document until the following March.
You'll need a recent version of Adobe® Reader software to view and print PDF files. Download it free now!
