General Rules
The basic rule of guaranteed issue is that an insurer must make private health insurance available to any individual who has lost employer-provided group health coverage if the individual meets the following conditions:

•  Exhaustion of Group Coverage. The individual’s group coverage must be exhausted. Generally, this means that the individual must have lost group coverage and exhausted federal COBRA and Cal-COBRA coverage. In certain circumstances, an individual can lose group health coverage and not be eligible for COBRA. In that case, the individual is not required to have exhausted COBRA.
• 63 Day Time Limit. The individual must acquire the guaranteed issue coverage within 63 days of having exhausted group coverage (including COBRA and Cal-COBRA, if offered).
• 18 Month Continuous Coverage. The individual must have been covered continuously during the 18 month period immediately prior to the effective date of the guaranteed issue coverage, and the most recent coverage must have been group coverage.
• Not Eligible for Government Programs. The individual must neither be enrolled in nor eligible for Medicare Parts A or B, Medicaid or MediCal or covered by another group health insurance plan.

Guaranteed issue coverage will be most useful for individuals who are otherwise uninsurable due to one or more significant health conditions. Generally healthy individuals will ordinarily wish to avoid guaranteed issue because it is more expensive to maintain that regular private coverage for comparable policy benefits.

California law requires all carriers that sell individual plans to offer at least two guaranteed issue plans. However, once you have enrolled under a guaranteed issue policy, you are generally locked into that carrier with that coverage. It may then be difficult or impossible for you to make carrier or coverage changes, though you might later become eligible under a group health plan that would allow you to drop guaranteed issue coverage safely.

Certificate of Creditable Coverage
In order to obtain guaranteed issue coverage, you must prove to the carrier that you meet the 18 month continuous coverage rule described above. HIPAA requires employer plans and insurance carriers to provide an individual (including dependents) losing group health coverage a “certificate of creditable coverage,” showing the individual’s recent coverage under the plan. Most of the time, the certificate will come from the insurer and not the plan.

Applicants for guaranteed issue should include the certificate of creditable coverage with the completed application form.

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