What Is It?
When an employee leaves a group benefits plan — through termination, retirement, resignation, or loss of eligibility — most Canadian insurers provide a right to convert the group plan to an individual health insurance policy without medical underwriting. This means no medical questionnaire, no physical exam, and no exclusions for pre-existing conditions.
The conversion right is a standard feature of most Canadian group health contracts and is supported by provincial insurance legislation. However, the right is time-sensitive: the application deadline is typically 31 to 60 days after the group coverage ends, and missing it means you must apply for individual health insurance through normal underwriting — where pre-existing conditions can lead to exclusions or denial.
Why This Matters
Without conversion rights, someone with diabetes, heart disease, cancer history, or other chronic conditions may be denied individual health insurance or have their prescription drug and specialist costs excluded. The conversion right guarantees coverage regardless of health status.
What is typically covered by a converted individual plan:
- Prescription drugs (formulary may differ from group plan)
- Dental care (often basic only)
- Paramedical services (physiotherapy, chiropractic, massage)
- Vision care
- Private or semi-private hospital room
What conversion typically does NOT preserve:
- The same level of coverage as the group plan — premiums are higher and benefit maximums are often lower
- Life insurance conversion (a separate right under life insurance policies)
- Disability income coverage — this requires a separate application
The Conversion Deadline
The window is typically 31 days after group coverage ends. Some insurers allow 60 days. This deadline is firm — insurers are not required to honor conversion applications received after the deadline.
Steps to take:
- Confirm your group plan’s last date of coverage — ask HR for the specific date your benefits end
- Contact your insurer immediately — your group plan’s insurer is the one with the conversion obligation; ask for the conversion application
- Apply before the deadline — even if you plan to get individual coverage elsewhere, applying for conversion preserves your rights while you compare options
What Most People Don’t Know
- Life insurance conversion is a separate right. Group life insurance policies also typically include a conversion option (to individual life insurance) that must be exercised within 31 days. This is separate from the health benefits conversion and may be valuable for those who are otherwise uninsurable.
- You don’t have to keep the converted plan forever. Applying for conversion preserves your rights. You can then compare individual plans and cancel the converted policy (subject to any waiting periods) if you find better coverage.
- Conversion premiums are much higher than group rates. Group insurance benefits from large risk pools — individual conversion plans are significantly more expensive. Budget accordingly, especially if you are between jobs or approaching retirement before government drug benefits kick in.
- COBRA-equivalent coverage doesn’t exist in Canada. Unlike the US COBRA system, there is no legal right to continue group coverage at group rates after leaving. Conversion is the closest equivalent, but it is to a new individual plan, not a continuation of the group plan.
Frequently Asked Questions
I was laid off 45 days ago and just found out about conversion rights. Did I miss the window?
Possibly — the deadline is typically 31 days from the date coverage ends, not from when you found out. Contact your group insurer immediately and explain the circumstances. Some insurers may have flexibility for genuine lack of notice; others will not. Going forward, always confirm conversion rights at the time of any employment change.
My spouse was on my group plan as a dependent. Do they have independent conversion rights?
Yes — spouses and dependents covered under a group plan typically have their own conversion rights when the group coverage ends, either because you left or because the group policy terminated. Each covered person can apply for their own converted individual plan.
The converted plan doesn’t cover my specific drug. What are my options?
Review the converted plan’s drug formulary carefully before enrolling. If your drug isn’t covered, ask whether a special exception or prior authorization process exists. Also check provincial drug benefit programs — if you have high drug costs relative to income, programs like Ontario’s Trillium or BC’s Fair PharmaCare may provide supplementary coverage.
I want to compare plans — can I apply for conversion and still shop around?
Yes — applying for conversion doesn’t obligate you to keep the plan. Apply within the deadline to preserve your rights, then compare the converted plan against marketplace options. If you find better individual coverage, you can decline or cancel the conversion plan after enrolling.