Guaranteed Issue Rights Question.

[vic120]

I don't usually write too much GI buisness, But I need to now, I have a woman who just lost group and has kidney issue's, However her group plan has paid first and medicare was secondary.

I am looking at Medicare.gov and it says losing group pays after medicare? Does this mean people who's group pays first can't get GI?

If So what is the logic or reasoning behind that?

This case is in ILL, But I do work other states if this a state to state thing?

 

[goillini52]

I don't usually write too much GI buisness, But I need to now, I have a woman who just lost group and has kidney issue's, However her group plan has paid first and medicare was secondary.

I am looking at Medicare.gov and it says losing group pays after medicare? Does this mean people who's group pays first can't get GI?

If So what is the logic or reasoning behind that?

This case is in ILL, But I do work other states if this a state to state thing?

I would think she'd still get GI. Call the company and ask.

Since she's in Illinois, I'd go with Cigna Health since they're competitively priced and pay full commission on GI in Illinois.

If they won't do it, go with BCBS. They're GI in Illinois and pay 10%.

 

[vic120]

I would think she'd still get GI. Call the company and ask.

Since she's in Illinois, I'd go with Cigna Health since they're competitively priced and pay full commission on GI in Illinois.

If they won't do it, go with BCBS. They're GI in Illinois and pay 10%.

Yes I am going to do Cigna, She is looking to see if she can find letter from company although she says she does not remember getting a letter that mentions GI rights, I know Cigna will want the letter, I will have her call and get them to send,

The concern was When I went to start the online App it states specifically losing group "When Medicare pays first" But She had cov that paid first and medicare 2nd

I thought I really need to understand this more, If her plan payed first would She not get GI and why is that even significant, or is it something to not be too concerned with? I would imagine it states that way for a reason

 

[goillini52]

Yes I am going to do Cigna, She is looking to see if she can find letter from company although she says she does not remember getting a letter that mentions GI rights, I know Cigna will want the letter, I will have her call and get them to send,

The concern was When I went to start the online App it states specifically losing group "When Medicare pays first" But She had cov that paid first and medicare 2nd

I thought I really need to understand this more, If her plan payed first would She not get GI and why is that even significant, or is it something to not be too concerned with? I would imagine it states that way for a reason

Yeah, it's not real clear. Different companies interpret it differently, that's why I mentioned calling them to make sure they'd be ok with it.

 

[LostDollar]

It's vocabulary and definition technicalities.

Small employer, less than 20 employees.
Large employer, 20 or more.

SEP (Special Enrollment Period)
https://www.medicare.gov/sign-up-ch...parts-a-and-b/when-sign-up-parts-a-and-b.html

GI (Guaranteed issue.)
https://www.medicare.gov/supplement...edigap/guaranteed-issue-rights-scenarios.html

(In regard to the GI info-this is my opinion-The scenario described for group paying secondary to Medicare is small employer coverage and the group plan is essentially functioning just like a Medigap plan would. So when you loose that, you are given a GI right for 63 days to get "another Medigap policy".

If clients group plan was paying primary to Medicare, it was/is a large employer plan (over 20 emps). You want to look at the special enrollment period - 8 months.) And note-in this SEP situation COBRA DOES NOT COUNT AS ACTIVE EMPLOYEE COVERAGE. You have to be within the 8 month window from (I think) the month after loosing the group plan.

Also note, in this situation I am not sure about the PDP, whether it can also wait as long as 8 months, or if the PDP has to be in place 63 days after the group plan ends.

 

[somarco]

Look at the wording under number 2 on this link. It also says Medicare pays first. However I have never known a carrier to ask who paid first when reviewing a GI app.

 

[LostDollar]

Assuming we are talking about coming off the original group plan, and not a cobra extension of it, wouldn't it be a better deal for the client to use the special enrollment period and have a plan G?

 

[vic120]

Assuming we are talking about coming off the original group plan, and not a cobra extension of it, wouldn't it be a better deal for the client to use the special enrollment period and have a plan G?

I dont understand what you mean special enrollment period and have a plan G?

 

[kgmom219]

Let me add to this one, because I am going in a circle on it.

Client is 67. Client is a spouse on a group plan and the group has less than 20 ee's.

Client needs to enroll in Part B. (She got A upon turning 65)

Does client pay the LEP or not?

Vic...What's her Part B eff date? If its now, its open enrollment, not GI.

If its past 8 months, its GI.

(2 caveats: I only sell in TX. And I do these all the time, with a Part B eff date that starts the next month)

 

[vic120]

Let me add to this one, because I am going in a circle on it.

Client is 67. Client is a spouse on a group plan and the group has less than 20 ee's.

Client needs to enroll in Part B. (She got A upon turning 65)

Does client pay the LEP or not?

Vic...What's her Part B eff date? If its now, its open enrollment, not GI.

If its past 8 months, its GI.

(2 caveats: I only sell in TX. And I do these all the time, with a Part B eff date that starts the next month)

Def would have used OE if possible she is 70 has had medicare since 65 years old and Medicare pays 2nd group pays first