Health Summary Plan Description

Conversion Options

Hospital and Medical

A conversion policy for hospital and medical coverage is available to you and your qualified dependents upon termination of eligibility. No test of insurability is required, although the carrier may request information about your medical history in order to provide you with more favorable premium rates.

You may purchase a hospital and medical conversion policy upon termination of Earned Eligibility or you can enroll in the Self-Pay Program first. If you enroll in the Self-Pay Program you will have another opportunity to purchase conversion coverage at the end of your maximum term of self-pay coverage.

For conversion information call Anthem Blue Cross at (888) 756-7542. They will refer you to the appropriate local Blue Cross Blue Shield office. You must submit an application and payment to the carrier within 31 days of the date you lose coverage.

Dependent children who lose dependent status when they turn age 26 may also convert their hospital and medical coverage, as may your spouse or same-sex domestic partner in the event of divorce, dissolution of your civil union or partnership, or your death. Applications and payment must be submitted within 31 days of the loss of coverage.

Life Insurance

A life insurance conversion policy is available to the participant only at the time Plan I Earned Eligibility terminates. You may convert $5,000 if you are losing Plan I Earned Eligibility and gaining Senior Performers coverage. You may convert $2,000 if you have received an accelerated life insurance payment. Otherwise you may convert $10,000.

You must submit an application and payment to Metropolitan Life Insurance Company (MetLife) within 31 days of the date you lose coverage. For applications call MetLife at (877) 275-6387 or email solutions@metlife.com.