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Ohio Health InsuranceIndividuals and Families

Insurance Type:

Converting to an Individual Policy

Conversion to an individual policy / Purchasing your own individual policy

If you lose a job with employer-sponsored health insurance, you may be eligible for permanent individual coverage that will last as long as you continue to pay premiums.

HIPAA, the same federal law that allows you to maintain coverage when you change jobs, also established two full-service individual health plans available to people losing employer group insurance. These plans are called Basic and Standard.

When you move from employer group coverage to an individual plan, it helps to know if you are a "federally eligible individual" (or FEI) under HIPAA. In general, a person with FEI status has had no lapse in health coverage.

See the list of qualifications below; you must meet all of them to be a federally eligible individual.

Depending on your FEI status, coverage under the Basic or Standard plans may be immediate. The period of time before the new plan covers pre-existing conditions may also be reduced.

You cannot be turned down for coverage due to your health, but a plan can reject you if it has already reached its annual enrollment limit.

You qualify as an FEI only if you meet all of the following conditions:

  • Have had 18 months of creditable coverage (see below),
  • Were most recently covered by an employer group,
  • Were not terminated from your group plan due to premium nonpayment or fraud,
  • Obtained coverage by midnight of the 63rd day after your previous coverage ended,
  • Are not eligible for Medicare, Medicaid or other group coverage,
  • Have exhausted all continuation of benefit options (e.g., COBRA) and
  • Do not have any other health insurance.

Creditable coverage is proof that you were covered under your old plan. It reduces -- or eliminates -- the period of time a new plan can make you wait before it pays for your or your covered family member's pre-existing conditions.

You get credit for how long you were with the old plan; the new plan must reduce your pre-existing condition waiting period by an equal amount of time. You prove creditable coverage through a certificate from your ex-employer or its health plan.

You have creditable coverage if you were under any plan listed here:

  • A group health insurance plan
  • Medicare or Medicaid
  • Indian Health Medical Program
  • A state health risk pool
  • A health plan under chapter 89 of title 5, USC
  • A public health plan
  • A health plan under section 5(e) of the Peace Corps Act
  • A state children's health insurance program (SCHIP)

Conversion to an individual plan from the employer's insurance company

Through HIPAA, Ohio has two individual health plans called Basic and Standard. You can convert your coverage to any Basic or Standard plan offered by the employer's insurance company, unless the employer is self-insured.

You must have had continuous coverage for one year prior to conversion. If you apply within 31 days of leaving the group, you cannot be turned down for coverage due to your health. The new plan may cost more and may not have the same benefits. You can keep the policy as long as you pay premiums.

You have conversion rights if you have FEI status and:

  • You leave the employer, or
  • You are a covered family member of an insured who has died, or
  • You reach the age limit for coverage under your parent's group or
  • You divorce or separate from the insured.
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