§ 38.2-3541. Conversion or continuation on termination of eligibility
Each group hospital policy, group medical and surgical policy or group major medical policy delivered or issued for delivery in this Commonwealth or renewed, reissued or extended if already issued, shall contain, subject to the policyholder's selection, one of the options set forth in this section. These options shall apply if the insurance on a person covered under such a policy ceases because of the termination of the person's eligibility for coverage, prior to that person becoming eligible for Medicare or Medicaid benefits unless such termination is due to termination of the group policy under circumstances in which the insured person is insurable under other replacement group coverage or health care plan without waiting periods or preexisting conditions under the replacement coverage or plan.
1. Option 1: To have the insurer issue him, without evidence of insurability, an individual accident and sickness insurance policy in the event that the insurer is not exempt under § 38.2-3416 and offers such policy, subject to the following requirements:
a. The application for the policy shall be made, and the first premium paid to the insurer within thirty-one days after the termination;
b. The premium on the policy shall be at the insurer's then customary rate applicable: (i) to such policies, (ii) to the class of risk to which the person then belongs, and (iii) to his or her age on the effective date of the policy;
c. The policy will not result in over-insurance on the basis of the insurer's underwriting standards at the time of issue;
d. The benefits under the policy shall not duplicate any benefits paid for the same injury or same sickness under the prior policy;
e. The policy shall extend coverage to the same family members that were insured under the group policy; and
f. Coverage under this option shall be effected in such a way as to result in continuous coverage during the thirty-one-day period for such insured.
2. Option 2: To have his present coverage under the policy continued for a period of ninety days immediately following the date of the termination of the person's eligibility, without evidence of insurability, subject to the following requirements:
a. The application for the extended coverage is made to the group policyholder and the total premium for the ninety-day period is paid to the group policyholder prior to the termination;
b. The premium for continuing the group coverage shall be at the insurer's current rate applicable to the group policy; and
c. Continuation shall only be available to an employee or member who has been continuously insured under the group policy during the entire three months' period immediately preceding termination of eligibility.
(1979, c. 97, § 38.1-348.11; 1982, c. 625; 1984, c. 300; 1986, c. 562; 1988, c. 551.)
Sections: Previous 38.2-3535 38.2-3536 38.2-3537 38.2-3538 38.2-3539 38.2-3540 38.2-3540.1 38.2-3541 38.2-3542 38.2-3543 38.2-3543.1 38.2-3543.2 38.2-3544 38.2-3545 38.2-3546 NextLast modified: April 16, 2009