State RegulationsNC specificDifficulty 2/5
After a member's group health coverage under a North Carolina group policy terminates, he wants an individual policy under the conversion privilege. What does the conversion right provide?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under G.S. 58-53-45, an employee or member whose group coverage terminates is entitled to a converted individual policy without evidence of insurability. Under G.S. 58-53-55, the written application and first premium must be submitted no later than 31 days after termination of group coverage, and the converted policy takes effect the day after the later of the end of the 31-day window without replacement or the end of the continuation period.
Why the other options are wrong
- B) Conversion requires no evidence of insurability and no medical examination under G.S. 58-53-45, and the statutory deadline is 31 days, not 60.
- C) The conversion right is a statutory entitlement under G.S. 58-53-45 with a firm 31-day application deadline under G.S. 58-53-55; it is not left to insurer discretion.
- D) 10 days is the hospitalization return-right figure under G.S. 58-51-10; the conversion application deadline is 31 days under G.S. 58-53-55.
Memory hook
Convert with no medical questions, but apply and pay within 31 days.