Clarification On The Special Election Period, Please

[Frank Stastny]

I called United Health for someone not in a guar. issue period. Asked about pre-existing health issues being a concern - was told that if they qualified, they did not have to worry about pre-existing. I find qualifying for UHC the easiest - anyhoo, this statement was not correct - there is a 90 day waiting on any pre-existing. (Was not trying to be evasive)

Unless your prospect had a super unique situation, the answer you were given is correct. See below.

This information is from the "Eligibility – Florida" (AARP Underwriting Guide)

"Pre-existing conditions will be covered as of the AARP Medicare Supplement plan effective date for applicants who qualify for Open Enrollment or Guaranteed Issue (see pages 9 and 10) or who are replacing a Medicare Supplement plan or creditable coverage.* For all others, there is a 3-month waiting period after the plan effective date before pre-existing conditions are covered."

Please share with us the unique situation your prospect was in that caused him/her to have a pre-existing condition waiting period imposed.

 

[G.Gordon]

Exactly! Study on creditable coverage and it's effect on pre-x concerning medsupps, fl-girl. Both the statement from the underwriter and your interpretation of the guideline is incorrect. The pre-x application has nothing to do with qualifying and ONLY to do with their insurance status prior to buying the medsupp.

Rule of thumb = the only persons any company may apply any pre-x clause to are those that come to Medicare pick up a supplement and were not insured by any means for the six months prior.

That is why Frank is saying this client would be of a very small segment of the population that buy medsupps if they in fact had a pre-x clause effect their claims.

Keep in mind that having Medicare alone acts as creditable coverage.

 

[Frank Stastny]

Exactly! Study on creditable coverage and it's effect on pre-x concerning medsupps, fl-girl.

Rule of thumb = the only persons any company may apply any pre-x clause to are those that come to Medicare pick up a supplement and were not insured by any means for the six months prior.

That is why Frank is saying this client would be of a very small segment of the population that buy medsupps if they in fact had a pre-x clause effect their claims.

Keep in mind that having Medicare alone acts as creditable coverage.

I have represented companies that would impose a pre-existing waiting period on those new to Medicare and Med Supps who didn't have any other insurance prior to going on Medicare. (Your statement in bold above.) However, AARP underwriting guide specifically states that pre-existing will not apply if they are in their Open Enrollment period.

This implies that even though they didn't have any medical coverage prior to their Open Enrollment period, AARP will not impose the pre-existing clause.

 

[G.Gordon]

I have represented companies that would impose a pre-existing waiting period on those new to Medicare and Med Supps who didn't have any other insurance prior to going on Medicare. (Your statement in bold above.) However, AARP underwriting guide specifically states that pre-existing will not apply if they are in their Open Enrollment period.

This implies that even though they didn't have any medical coverage prior to their Open Enrollment period, AARP will not impose the pre-existing clause.

We're saying the same thing. Those are the ONLY people that will get caught up in the pre-x clause.


Companies may go above and beyond what is required. Like MOO taking pre-x off the table for anyone they issue a medsupp to no matter what their prior insurance status.

My statement of rule of thumb is the base requirement.

 

[Frank Stastny]

We're saying the same thing.

I know, sorry if it didn't sound like I was agreeing with you.

This is not something that an agent is going to run into on any kind of regular basis. Based on AARP's statement about pre-existing conditions, I would say that 99.99% of AARP applicants will not have a waiting period on pre-existing conditions.

The original point I was trying to make was when gathering information for a specific prospect it is very important that the question be asked with all of the detailed information available.

 

[bigeats]

She tells her hubby's company she no longer wants coverage as of such and such date, they give her a letter saying she no longer has coverage as of such and such date. She then goes GI with any company that starts on such and such date. Send that letter in with app. End of thread. Next.

This was my thinking, as well. Thanks.

 

[G.Gordon]

Ok, big

Here's the problem with "thinking" and taking action on what your told.
1. It may take a month or more for that letter to be issued after the date of cancellation. Some groups don't get in any hurry to issue creditable coverage letters or even cancel acknowledgment letters. Not high on their priority list.
2. It may waste more money for the client, be a wasted step, etc. I know of two carriers that all you have to do is indicate via answering the proper questions on the application properly that the client is leaving group as "date" and that's all they want. Some will want to see a request of cancel letter.. I take the id card from group, make a copy of it on the letter the client wrote to the group coverage "Please cancel my coverage as of "date"... thanks... signed "insured person's sig." And you fax/mail that along with the application.

So you see this is why we suggest getting the answers from the horses mouth.

And of course there is one VERY important step before you do what SIG suggested.

 

[bigeats]

Ok, big

Here's the problem with "thinking" and taking action on what your told.
1. It may take a month or more for that letter to be issued after the date of cancellation. Some groups don't get in any hurry to issue creditable coverage letters or even cancel acknowledgment letters. Not high on their priority list.
2. It may waste more money for the client, be a wasted step, etc. I know of two carriers that all you have to do is indicate via answering the proper questions on the application properly that the client is leaving group as "date" and that's all they want. Some will want to see a request of cancel letter.. I take the id card from group, make a copy of it on the letter the client wrote to the group coverage "Please cancel my coverage as of "date"... thanks... signed "insured person's sig." And you fax/mail that along with the application.

So you see this is why we suggest getting the answers from the horses mouth.

And of course there is one VERY important step before you do what SIG suggested.

Hopefully that step would be the analysis to determine if moving to a Med Supp is in the prospect's best interest. At this point, I am not convinced as I don't know what her drug coverage is nor waht her PDP options and costs might be.

 

[floridagirl]

Ok, my situation - Man is 70, only on Medicare. Has a fall around Thanksgiving injuring his back - write him a PDP in December and on Feb 28th, write AARPUHC Plan F. Had to wait till this date until he has been out of the hospital 90 days so he can answer NO to both UHC questions.

I questioned UHC about pre-existing and they told me they would be covered. When reading the handbook, it says 90 day waiting period. I told my client this - which he conveniently forgot - so he had a procedure done to possibly relieve pain associated with this fall and UHC did not cover it b/c it was within 90 days of policy eff date which was March 1.

So UHC is not recognizing this statement? Keep in mind that having Medicare alone acts as creditable coverage.

He was not in open enrollment or guar issue but did have Medicare prior but UHC is not recognizing this as creditable coverage?

 

[Frank Stastny]

Ok, my situation - Man is 70, only on Medicare. Has a fall around Thanksgiving injuring his back - write him a PDP in December and on Feb 28th, write AARPUHC Plan F. Had to wait till this date until he has been out of the hospital 90 days so he can answer NO to both UHC questions.

I questioned UHC about pre-existing and they told me they would be covered. When reading the handbook, it says 90 day waiting period. I told my client this - which he conveniently forgot - so he had a procedure done to possibly relieve pain associated with this fall and UHC did not cover it b/c it was within 90 days of policy eff date which was March 1.

So UHC is not recognizing this statement? Keep in mind that having Medicare alone acts as creditable coverage.

He was not in open enrollment or guar issue but did have Medicare prior but UHC is not recognizing this as creditable coverage?

When you called UHC about pre-existing conditions did you get the name of the person you spoke to and did you explain his situation in detail as opposed to asking the question in a general nature?

I hope you have not just dropped the issue. Gordon is correct when he said Medicare is considered creditable coverage.

UHC/AARP specifically states that Medicare is considered creditable coverage. This is stated further down the page in the underwriting guide that I quoted earlier. It would be helpful if you read the whole document. If you will send me your e-mail address I will send it to you.

"* Note: Medicare Parts A and B are creditable coverage. However, individuals who buy Medicare supplement insurance are keeping, not replacing, Medicare
Parts A and B."

You need to go to bat for your client and get this straightened out.