Extension & Conversion Rights

If your group coverage terminates under certain, specifically defined circumstances, you may be eligible to have that group coverage extended for a period of time, or converted to coverage under an individual policy. For employment groups of fewer than twenty employees, state law provides for continuation of group coverage for up to twelve months, with the option to convert to an individual plan subsequent to the extension — or, the converted coverage can be selected outright if no interim group extension is provided by the employer. For groups larger than twenty employees, Federal COBRA provisions allow extension of the group benefits for longer periods of time, depending on the events which brought about the loss of coverage for any given individual or family. Contact your employer, insurance or benefits representative, or the appropriate governmental agency to learn more about these options to continue health insurance coverage.

State Extension Rights

n addition to the right of the employee to have a converted policy issued, the employee has the right to continue coverage under the group policy for a period of 12 months.

State Extension Requirements and Applicable Code Sections

Utah mini-COBRA

The employer is responsible for providing the terminated insured written notification of the right to continue group coverage and the payment amounts required to continue coverage. This notice should be provided to the terminated insured within 30 days after the date group coverage terminates, and should specify the manner, place, and time in which the payment shall be made.


The payment amount for continued group coverage may not exceed 102% of the group rate.

Rules and procedures

Continuation of coverage is elected and premiums must be given to the employer within 30 days after receiving notice.

The terminated insured continues coverage without interruption unless:

  1. The terminated insured ceases to reside in this state.
  2. The terminated insured fails to make timely payment.
  3. The terminated insured violates a material condition of the contract.
  4. The terminated insured becomes eligible for similar coverage under another group policy.
  5. The employer’s coverage is terminated.

If the employer replaces coverage with coverage under another group policy, the terminated insured has the right to obtain coverage under the replacement group plan.

At the end of the extension of benefit period the covered person is eligible for a conversion policy.

HIPAA Federal Register citations

  • Health Insurance Portability for Group Health Plans; Interim Rules and Proposed Rule. Federal Register / Vol. 62, No. 67/ Tuesday, April 8, 1997 / Rules and Regulation.

State Conversion Rights

An individual may convert employer group coverage to an individual policy after being on state extension or Federal COBRA extension, however, conversion maybe chosen without taking the state extension or COBRA first.

Conversion Requirements and Applicable Code Sections


  • An individual whose insurance under the group policy has been terminated for any reason.
  • The individual has previously been insured under the group policy or its predecessor.
  • The individual’s termination of group coverage did not occur because of their failure to pay required contribution.
  • The individual does not acquire other group coverage covering all preexisting conditions.
  • The individual is not eligible to continue coverage under existing group policy in accordance with the terms of the policy.

Rules and procedures

  • Written application for the converted policy must be made and the first premium must be paid to the insurer no later than 60 days after termination of the group insurance.
  • The converted policy shall be issued without evidence of insurability.
  • The initial premium for the first 12 months and subsequent renewal premiums shall be in compliance with the Utah Code Annotated (UCA) Section 31A-30-106.5.
  • The premium is payable as required by the insurer for the policy selected unless another mode of payment is mutually agreed upon.
  • The converted policy becomes effective at the time the group policy terminates.
  • The converted policy covers the employee and dependents who where covered by the group policy at the date of termination of insurance.

Conversion policy provisions

  • A converted policy may include a provision which allows the insurer to request information whether there is other coverage in advance of any premium payment due date.
  • The insurer may refuse to renew the policy for any of the following reasons:
    • Nonpayment of premiums.
    • Fraud or intentional misrepresentation of material fact under the terms of the coverage.
    • If the insurer is ceasing to offer coverage in the individual market.
    • If the individual no longer resides, lives or works in the service area.
  • No insurer may be required to issue a converted policy, which provides benefits in excess of those provided under the group policy from which conversion is made.
  • No converted policy may exclude a preexisting condition not excluded under the group policy.

Conversion health benefit pan

  • The employee or member must be offered basic coverage as defined in UCA 31A-30-103(4).

HIPAA sections

  • P.L. 104-191, 110 Stat. 1979 Sec. 2741(e)(2)
  • Health Insurance Portability for Group Health Plans; Interim Rules and Proposed Rule. Federal Register / Vol. 62, No. 67/ Tuesday, April 8, 1997/ Rules and Regulation.
  • Section 148.122(2)
  • Section 148.102,(a)(1)

US Department of Labor’s Employee Benefits Security Administration