This California law aims to make sure that if people lose their group health insurance coverage, they can still get individual health insurance. This means employers and other groups have to provide options for people to switch to individual plans. The law also focuses on offering the most common type of individual health plan, the preferred provider organization plan, which aligns with federal standards from the Health Insurance Portability and Accountability Act of 1996. Additionally, it encourages keeping group health insurance for widows, widowers, divorced spouses, and dependents when their existing group coverage ends.

This section explains key terms related to group health insurance. A "group policy" refers to health coverage offered to employees or members by insurers or hospital service corporations. "Conversion coverage" is health insurance for individuals who switch from group policies. "Converted policy" covers individuals under such conversion coverage. An "insurer" is any entity providing this coverage.

"Insurance" in this context refers to certain health coverage that excludes specific plans like short-term health insurance, Medicare supplements, vision, dental, and accident-only insurance, among others. A "policyholder" is an entity providing group health coverage. "Premium" is the payment for such policies. "Medicare" is the federal health program. An "employer plan exempt from ERISA" refers to specific plans not under certain federal regulations, with a "self-insured governmental plan" being one set up by public entities for their employees.

This California law required group insurance policies issued or renewed after January 1, 1983, to allow employees or members whose coverage ends to convert their group insurance into individual policies without needing to prove they’re insurable. This rule does not apply to policies only covering specific diseases or accidental injuries. Originally, this requirement was set to become inactive on January 1, 2014. However, if the federal mandate for individual health insurance is changed or repealed, this rule could come back into effect. The federal mandate is part of the Affordable Care Act, which may influence the operation of this law.

This law requires that conversion coverage be offered to an employee or member whose group insurance policy ends, except in certain situations. These exceptions include if the group policy is replaced with similar coverage within 60 days, if the employee or member didn't pay their share of the premium on time, or if they weren't continuously covered for the three months before their policy ended.

If you lose your group insurance coverage, you can switch to an individual policy. To do this, you must apply in writing and pay your first premium within 31 days after your group coverage ends. If the insurer agrees to waive these requirements in writing, you might have more flexibility.

This law states that when a policyholder switches to a new insurance plan (conversion coverage), the cost will be based on the insurance company's rates, considering the person's age, risk category, and the type and amount of coverage they want.

This law requires that when a group insurance policy ends, the insurance company must offer continued coverage to the employee or member and their dependents who were covered at the time of termination. The insurer can choose to give a separate policy to any dependent.

If someone is eligible for Medicare, the insurance company does not have to provide them with a converted insurance policy.

This law states that an insurance company doesn't have to provide a new individual policy to someone if they're already covered by another similar insurance plan. This applies if the person has a similar individual policy, is covered by or eligible for a similar group policy, or has group coverage through any other arrangement, regardless if it's insured or not.

This law talks about when an insurance company can decide not to continue a converted policy. A converted policy is a new policy someone gets when they lose group insurance. The insurer can ask the insured if they have similar benefits elsewhere. They can refuse to renew the policy if the insured: doesn't provide requested information, commits fraud or makes big false statements, qualifies for Medicare or similar government benefits, doesn't pay their premiums, has similar benefits through another policy, or qualifies for group coverage, whether arranged or insured. Any other reasons need approval from the Insurance Commissioner.

This law explains how insurance companies can manage overlapping insurance benefits. If a person has two sets of insurance coverage, including conversion coverage and another kind of benefit, the insurer can adjust the conversion coverage so that the total coverage does not go over 100% of the healthcare costs. Basically, insurers can't let people be overpaid for their medical expenses because of overlapping benefits. The priority of which coverage to use first depends on their start dates; the one that started first gets priority.

This law means that if you are switching from a group insurance policy to an individual insurance policy (a 'converted policy'), the new individual policy does not have to offer more benefits than what your group policy had.

This law says that when you switch from a group insurance policy to an individual or "converted" policy, the converted policy cannot exclude coverage for any medical conditions that were covered under the group policy. However, the converted policy might reduce its benefits if any benefits are still payable under the old group policy after your insurance ends. During the first year, the total benefits from both policies cannot be higher than what you would have received if the group policy had stayed active.

This law discusses policies for employees or group members transitioning from group health insurance to individual coverage without proving they are insurable. It doesn't apply to policies that mainly supplement Medicare. Employees whose group health coverage ends due to job termination can switch to individual plans without needing to prove insurability, but this doesn't apply to everyone. For example, if their group plan transitions seamlessly to another plan, or if the employee is terminated with cause, they can’t switch. Similarly, if they're already eligible for other group or individual coverage, or haven’t been covered for three months before termination, they’re ineligible. Employers have to inform employees about conversion options within 15 days of the plan termination, unless the plan continues beyond that time. From January 1, 2014, these provisions won’t apply unless the individual mandate under the federal Affordable Care Act is repealed or modified to exclude the individual market.

This law requires insurers to notify policyholders at least 60 days before their individual health insurance policy renewal date if their policy won't be renewed. The notice must explain the availability of new health coverage options through Covered California, highlight that people can't be denied coverage based on their health, and inform them of potential eligibility for financial subsidies. It also notes that coverage must be obtained during specific enrollment periods. Additionally, insurers must provide details about a comparable replacement policy and its cost.

By September 1, 2013, uniform model notices were to be developed by the commissioner for insurers to use, ensuring the notices are clear and comprehensive. These notices must meet certain vital document standards under existing regulations.

This law ensures that if an employee or member has a group insurance policy covering basic hospital or surgical expenses, they can switch (convert) to an individual policy providing certain minimum benefits. Plan A offers up to $200 per day for 70 days of hospital room and board, plus extra for other hospital expenses, and up to $4,800 for surgeries. Plan B and Plan C offer reduced benefits at 75% and 50% of Plan A, respectively. The Insurance Commissioner can adjust these maximums every three years, but limitations apply. The coverage also extends to expenses related to pregnancy, as long as the pregnancy started while the group policy was still active, the expenses would have been covered under that policy, and the conversion policy is in effect when the expenses occur.

This section states that if you have a group medical insurance policy and it gets converted to an individual policy, your new policy should provide at least a certain level of medical benefits. These benefits include coverage of up to $100,000 for lifetime medical expenses, but only up to $10,000 for mental illness. Generally, the policy will cover 75% of medical expenses, but if you're receiving outpatient mental health care, it may be only 50%. You have a choice of deductibles, from $200 up to $1,000, but not less than what you had before. Hospital room costs are covered but there are daily limits, which can be adjusted every three years. Finally, expenses related to pregnancy can be covered if certain conditions are met, but dental and vision are not necessarily included.

This section allows insurance companies the option to provide alternative plans for converting group health insurance, beyond what is already required by law. This means insurers can offer a variety of plans to suit different needs.

This law allows employees or members covered by a group insurance policy to choose a conversion right when they retire and are not yet eligible for Medicare. Instead of continuing their group insurance, they can switch to a converted policy as if their coverage ended because they left the job.

The converted policy can reduce or stop coverage when a person becomes eligible for Medicare or gets similar benefits from other laws. However, this doesn't include certain welfare or Medicaid benefits. Additionally, conversion options are available to dependents whose coverage ends due to the employee's or member's death or marital changes.

The converted policy may mirror existing group benefits if those exceed state-mandated levels, and insurers can use group policies or another insurance company to offer these conversion options.

If an employee or member has the option to choose between different types of conversion policies after their group benefits end, they must make that decision within 31 days of their last day of eligibility for the group policy.

This section allows a hospital service corporation or insurer to offer a different type of health coverage when someone converts their insurance from group to individual coverage. Instead of following the usual rules for conversion coverage, the insurer can provide a service-based coverage option. However, this alternative must still meet the part's intent and be approved by the insurance commissioner.

This law requires that information about conversion coverage (the ability to switch from group insurance to individual insurance) must be included in every document that explains insurance coverage. However, it is the policyholder's responsibility, not the insurer's, to inform employees or members about conversion coverage. They must do this within 15 days after the group insurance coverage ends. Group coverage is considered terminated only after any extensions of it have expired. Importantly, the policyholder is not acting as the insurer's agent when notifying about conversion coverage.

This section allows insurance companies to create different groups or 'pools' of policies for people converting their insurance. These pools help manage and issue the new or revised insurance policies.

If an insurance policy is converted and delivered in a different state, it can be in the format allowed in that state as if the original group policy was issued there.

This law requires insurance providers and non-profit hospital plans to offer a continuation benefit for at least 90 days after federal continuation benefits end. This applies to group policies covering hospital, medical, or surgical expenses. The continuation benefit helps widows, widowers, divorced or legally separated spouses, and dependents, including children who lose their dependent status, to maintain coverage after the usual end of their benefits.

Eligibility for this continued coverage requires that individuals stay in California, remain unmarried, are not eligible for other comparable benefits, do not join an employer's group plan, and do not provide false information. They must also pay the required premiums and the group's policy must remain active. Notification about this option must be communicated as required by law.

This law says that certain rules listed in Sections 12672 to 12692.5 don't apply to group insurance policies that are issued, changed, or renewed after September 1, 2003. This means those policies operate under different rules and do not have to follow the specific regulations from those sections.