State RegulationsPA specificDifficulty 2/5
A member of a Pennsylvania group health plan is losing eligibility under the group contract. What opportunity does Pennsylvania law provide for the member to preserve coverage?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Pennsylvania's conversion provisions — 40 P.S. § 756.2 and, within the continuation framework, 40 P.S. § 981-9 — allow a person losing group eligibility to obtain an individual policy without losing health protection outright. Conversion turns the group membership into individual coverage under the conditions the Pennsylvania statutes prescribe. It is the bridge between the group and individual markets that Pennsylvania law builds for departing members.
Why the other options are wrong
- A) Indefinite free continuation is not the mechanism; continuation and conversion both carry premium and condition requirements.
- C) Retiree status is an employer design the law does not compel; the statutory remedy is conversion to an individual policy.
- D) The group contract cannot simply be re-titled; conversion issues individual coverage under the statutory terms.
Memory hook
Lose the group, gain an individual: conversion is Pennsylvania's bridge.