California Insurance Code 12673 – Conversion coverage shall be required to be made available to an …
Conversion coverage shall be required to be made available to an employee or member unless such coverage under the group policy terminates for one or more of the following reasons:
(a) The group policy or the policyholder‘s participation in the group policy terminates and the insurance is replaced by similar coverage under another group policy within 60 days of the date of termination of the group coverage or the policyholder’s participation.
Terms Used In California Insurance Code 12673
- Group policy: means a group health insurance policy providing medical, hospital, surgical, major medical, or comprehensive medical coverage issued by an insurer, a group contract issued by a hospital service corporation, or medical, hospital, surgical, major medical, or comprehensive medical coverage otherwise provided by a policyholder to its employees or members, except for self-insurance programs provided by employers that are not exempt from the federal Employee Retirement Income Security Act of 1974 (ERISA), as specified in subdivision (i). See California Insurance Code 12671
- Insurance: refers to health insurance, major medical, or comprehensive coverage paid by premium or contribution under a group policy, a hospital service contract, or as otherwise provided by a policyholder to its employees or members other than by self-insuring except in the case of a plan that is exempt from ERISA, but does include an employer plan that is exempt from ERISA as specified in subdivision (i). See California Insurance Code 12671
- Policyholder: means the holder of a group policy issued by an insurer, a holder of a group contract issued by a hospital service corporation or an employer, employee association, or other entity otherwise providing medical, hospital, surgical, major medical, or comprehensive medical coverage on a group basis to its employees or members. See California Insurance Code 12671
- Premium: means contribution or other consideration paid or payable for coverage under a group policy or converted policy. See California Insurance Code 12671
(b) The employee or member has failed to make any required payment of the premium or contribution when due.
(c) The employee or member had not been continuously covered during the three-month period immediately preceding the employee’s or member’s termination of coverage.
(Amended by Stats. 1982, Ch. 1186, Sec. 5.)