FAQ
Application Sign Dates Open Enrollment: Up to six months prior to the month the applicant turns age 65. Wisconsin: Applications can be signed no more than 90 days prior to the applicant’s Medicare Part B eligibility date. Underwritten Cases: Up to 60 days prior to the requested coverage effective date. During AEP, Annual Open Enrollment Period, underwritten cases may be submitted beginning September 15th. |
Coverage Effective Dates The effective date of the insurance can be between the 1st and the 28th day of the month. Applications written for an effective date of the 29th, 30th, or 31st of the month will be made effective on the 1st of the next month. Applications may not be backdated prior to the application signed date for any reason to save age. For Open Enrollment applications, the effective date of the insurance policy must be within the 6-month Open Enrollment window |
Replacements A “replacement” takes place when an applicant wishes to terminate an existing Medicare supplement policy, with another Medicare Supplement plan available, or any other external company and replace with a newer or different Medicare Supplement/Select policy. Internal replacements are processed the same as external, requiring a fully completed application. A current policy owner wanting to apply for a non-tobacco plan must complete a new application and qualify for coverage. The policy to be replaced must be in force on the date of replacement. All replacements involving a Medicare Supplement, Medicare Select or Medicare Advantage plan must include a completed Replacement Notice. One copy is to be left with the applicant; one copy should accompany the application. |
Reinstatements When a Medicare Supplement policy has lapsed and it is within 90 days of the last paid to date, coverage may be reinstated, based upon meeting the underwriting requirements. When a Medicare Supplement policy has lapsed and it is more than 90 days beyond the last paid to date, the coverage cannot be reinstated. The client may, however, apply for new coverage. All underwriting requirements must be met before a new policy can be issued. |
Telephone Interviews Telephone interviews may be conducted at the discretion of the Underwriter. Please advise your client that we may be contacting them to conduct an interview. Telephone interviews for health information are only conducted for underwritten policies: Open Enrollment and Guaranteed Issue applicants will not be asked any health questions. If we are unable to complete the telephone interview, we will decline the application. |
Pharmaceutical Information We have implemented a process to support the collection of pharmaceutical information for underwritten Medicare Supplement applications. In order to obtain the pharmaceutical information as requested, the Authorization and Certification page of the application must be completed and signed by the applicant. Prescription information noted on the application will be compared to the additional pharmaceutical information received. |
Policy Delivery Receipt Delivery receipts are required on all policies issued in Kentucky, Louisiana, Nebraska, South Dakota, and West Virginia. Two copies of the delivery receipt will be included in the policy package. One copy is to be left with the client. The second copy must be returned to the Company in the self-address envelope, which is also included in the policy package. |
Guarantee Issue Rules The rules listed below can also be found in the Guide to Health Insurance. These are the Federal requirements. Leaving an employer group voluntarily does not always create applicant eligibility for guarantee issues. In this situation, state laws may vary. |
Important Terms to Know
Benefit period: Starts the day you go to a hospital or skilled nursing facility and ends when you have not received hospital or skilled nursing facility care for 60 consecutive days. |
Coinsurance: The portion of charges covered but not reimbursed by Medicare, excluding the Medicare deductibles, for which you are responsible. |
Copay: A fixed fee amount that subscribers to a medical plan must pay when using specific services covered by an insurance plan. |
Deductible: Amount that you pay for Medicare approved expenses before Medicare begins to pay. |
Medicare Eligible Expenses: Health care expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare. |
Emergency care: Immediate medical care needed because of an injury or an illness of sudden and unexpected onset. |
Excess charges: The difference between what a health care provider is permitted to charge and the Medicare- approved amount. |
Hospice care: A program of care and support for someone who is terminally ill. This helps them live out the time they have remaining to the fullest extent possible. |
Hospital: A legally operated hospital.Hospital does not include a nursing home, convalescent home or extended care facility. |
Loss: The incurring of Medicare Eligible Expenses while the policy is in force. |
Medically Necessary: the service or supply that is recognized by Medicare as necessary to diagnose or treat an injury or sickness and must: (1) be prescribed by a physician; (2) be consistent with the diagnosis and treatment of such injury or sickness; (3) be in accordance with the generally accepted standards of medical practice; and (4) not be solely for the convenience of the insured or the physician. |
Medicare-approved amount: In original Medicare, the amount that a physician who accepts assignment can be paid, including what Medicare pays and any other deductibles, coinsurance, or copayments. |
Premium: The periodic payment to Medicare, an insurance company, or a health care plan for coverage. |