Moving existing participants to your new insurance carrier

There are times when you will need to move your insurance coverage for your participants, and that may be outside of your control. It could be related to an increase in premiums, change in the quality and level of service from your old provider, or there are new and better options available to you. The reasons could be multiple and varied, but whatever your reasons, you will need to carefully consider a few things to make sure participants are not left with gaps in their coverage.


Existing Participants

Your existing participants who are currently still enrolled in your insurance plan when you move will be impacted the most by any change. Insurance carriers around the world deal with existing participants in one of two ways:

  1. Move all participants off the plan when your master certificate terminates (your renewal date)
  2. Allow participants to continue coverage through their natural termination dates

Moving all participants

If your insurance carrier requests that all participants move immediately, and you have not done a pre-existing condition takeover, there is a risk that participants may have existing medical conditions not covered under your new insurance plan. As most new insurance plans in the cultural exchange and youth travel market do not include coverage for existing medical conditions, they specifically exclude pre-existing conditions, moving new participants to any new plan in the middle of their program could result in existing claims being denied. Any claims for an eligible new condition will be covered, but if a participant continues to seek medical care for a condition that started under your old plan, the new plan will no longer cover this condition.

In general, most insurance carriers that work in the cultural exchange and youth travel market are aware that asking a group to move all participants when the master certificate terminates could put your participants at risk of non-covered claims, and so most do not require this. However, carriers that have not worked in this sector much, or some foreign insurance carriers may see this as very normal. You will want to talk with your insurance carrier about this, and if they still require you to move your participants, you will need to look into a pre-existing condition takeover or work with your existing carrier to allow those you still have on your plan, to continue their coverage past your renewal date.

Pre-existing condition takeover

A pre-existing condition takeover is when your new insurance carrier will take over insurance coverage for all participants (even those who are currently insured on your existing plan) and continue to pay all new and existing claims. Typically most plans will exclude pre-existing conditions, but in a pre-existing condition takeover, the insurance company will agree to pay all claims. To do this, the new insurance company will need very detailed access to your claims and loss data as without this they will not be able to do a pre-existing condition takeover. You will also need to be prepared to pay for this coverage, as the new carrier taking over your claims will be paying existing claims and any new claims. It is not very common that this happens in the cultural exchange market, but it could be an option.

Allowing participants to continue coverage

The better solution for you and your participants is that your participants are allowed to continue coverage under their existing insurance plan. Although you will not be able to enroll new participants, you do not need to move your existing participants to a new plan and they can run out their policies to their natural termination dates.

If this is the case, you will still have to negotiate with your old insurance carrier for the ability to extend participants coverage should they need it. As your master certificate has ended, your old insurance carrier is not obligated to take any extension request you may have, so negotiating that will be needed if you want to keep participants on the same plan. The other option is moving their period of extension to the new insurance plan, however you could still run the risk of having existing medical conditions and claims not paid (if they have any existing medical conditions or claims ongoing).

Moving participants with no pre-existing takeover

There could be situations where you will need to move participants to a new plan when there is no pre-existing condition takeover in place. If this happens, you will want to dig out your old insurance master certificate and look for the policies benefit period . Generally, all insurance plans have this provision, and sometimes it can be called different things, but the policy wording will explain what happens when someone with an existing medical condition gets sick or injured, and their coverage terminates. So for example if someone's coverage expires on the 10th May, and they break their leg on the 9th May, this policy provision is designed to avoid any non-covered claims because the policy terminated.

Remember — The benefit period only applies if the member first seeks treatment while their old plan is active. If they get sick or injured during their old plan and then seek medical care on their new plan, this will not be covered.

The wording on these provisions can vary, from providing coverage for up to 180 days from the start of first treatment (regardless of whether the participants policy is currently active - as long as the initial first treatment was under an active coverage period), to providing just hospitalization treatment for up to 3 months if your plan terminates. The wording will vary, but the essence of this provision is that an existing medical condition can still be claimed for under that provision, as per the specific wording in your policy.

It is not an ideal solution to rely on this policy provision, but it could provide coverage to your existing participants if you need to move to an insurance carrier without a pre-existing condition takeover.

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