NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105)

What this document is

NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105) is a naic model law published by National Association of Insurance Commissioners (NAIC). It is one of the documents that insurance license exam questions are written from, including life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 4.D

  “Written application for the converted policy shall be made and the first premium paid to the health carrier no later than thirty-one (31) days after the date of termination of coverage under the group health benefit plan.”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 14.B

  “The conversion privilege provided in this Act shall be available to: (1) The surviving spouse at the death of an employee or member, with respect to the spouse and any dependent children whose coverage under the group health benefit plan terminates by reason of that death or, if the group health...”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 14.A

  “If coverage would have been continued for an employee under the group health benefit plan following the employee’s retirement prior to the time the employee is or could be covered by Medicare and provided that the employee would have been eligible for continuation of coverage under the group health...”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 4.C

  “An employee or member or a dependent of an employee or member shall not be entitled to a converted policy if termination under the group health benefit plan occurred because: (1) The employee or member failed to pay any required premium or contribution; (2) The employee or member or dependent...”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 4.A

  “Any health carrier providing coverage under a group health benefit plan shall provide that an employee or member whose coverage under the plan has been terminated for any reason, including discontinuance of the group health benefit plan in its entirety or with respect to an insured class, and who...”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 7.A

  “A health carrier shall not be required to issue a converted policy covering an individual if the individual: (1) Is or could be covered by Medicare; (2) Is covered for similar benefits by another individual health benefit plan; or (3) Is or could be covered for similar benefits under any...”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 9.A

  “A converted policy may permit the health carrier to refuse to renew the policy or the coverage of any individual covered under the policy for any of the following reasons only: (1) The individual failed to pay premiums or contributions in accordance with the terms of the converted policy, including...”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 11

  “A health carrier shall not be required to issue a converted policy that provides benefits in excess of those provided under the group health benefit plan from which conversion is made.”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 7.B

  “The health carrier’s standards for overinsurance, referenced under Subsection A(3), shall bear some reasonable relationship to actual health care service costs in the area in which the individual lives at the time of conversion and shall be filed with the commissioner prior to their use in denying coverage.”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 6

  “The converted policy shall cover the employee or member and any dependents, who were covered under the group health benefit plan on the date of termination of coverage. At the option of the health carrier, a separate converted policy may be issued to cover any dependent.”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 12

  “The converted policy shall not exclude a preexisting condition not excluded by the group health benefit plan. However, the converted policy may provide that any hospital, surgical or medical benefits payable under the policy may be reduced by the amount of any such benefits payable under the group...”

• NAIC Group Health Insurance Mandatory Conversion Privilege Model Act (#105), Section 5.C

  “The frequency of premium payment shall be the frequency customarily required by the health carrier for the policy form and plan selected, provided that the health carrier shall not require premium payments less frequently than quarterly.”

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Questions about this source

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