Guaranteed Issue When Leaving an Employer Med Supp?

Jul 9, 2015

  1. BuckNasty
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    BuckNasty Super Genius

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    I have a prospect who is currently has a Medicare Supplement Plan (F) which is paid for by his wife's employer. The wife is retiring next month and the employer will no longer be paying for this. I want to move him to Plan G with Aetna.

    He is anticipating a shoulder surgery in a few months so I think that would be a decline on the question which asks, "Have you been advised to get surgery in the next 12 months." So I would prefer for him to be able to avoid underwriting.

    Obviously if he was losing group coverage it would be Guaranteed Issue, but would it still be GI if he is losing his employer paid for Med Supp Coverage?

    I called Aetna and spoke to someone who was unsure of himself who stated that, "If your prospect has a GROUP Medicare Supplement Plan and is losing that, he would be Guaranteed Issue, but if it is an individual Med Supp policy that the employer was paying for it would not be."

    I've never heard of a Group Medicare Supplement Plan. Is there such a thing? Did I receive correct advice from the Aetna phone jockey? Thanks in advance.
     
  2. JimmyUt
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    JimmyUt Guru

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    There are such things as group medicare supplements, although I don't think supplement is the correct term. I have moved many a client via GI when losing this.
     
    JimmyUt, Jul 9, 2015
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  3. vic120
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    vic120 Guru

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    You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.

    You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.


    G is not an option
     
    vic120, Jul 9, 2015
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  4. bill3173
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    There are group med supp plans and group MA plans, and when the coverage is terminated by the employer, or the individual retiring (which is essentially involuntary termination of the plan), the individual is GI into any med supp or MA plan.

    I've had several cases of both, and never had a problem. The CS at Aetna, may not have understood your question. Group Med Supp premiums that I have replaced have been outrageously priced, so it's usually a win for the client.
     
  5. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    Even if GI was an option, he would still have to go through UW for Plan G.
     
  6. JimmyUt
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    JimmyUt Guru

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    That is true, but it doesn't list N either, and Oxford will do it GI
     
    JimmyUt, Jul 9, 2015
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  7. BuckNasty
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    BuckNasty Super Genius

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    Thanks everybody. As usual, the brain trust here on the forum have proven to be an invaluable resource.

    Incidentally, in a scenario where someone MIGHT get an elective surgery like my prospect who will may choose to get the shoulder surgery done in the next few months, how do you guys handle that question about having "been advised to have surgery done in the next 12 months."? I've run into this a couple times lately where the surgery is optional. Such as in cataracts, where people are on the fence about getting them done.

    Obviously if someone is told they need a valve replaced or they will die, that is not really an optional surgery, but what about the gray area scenarios like I outlined?
     
    Last edited: Jul 9, 2015
  8. GreenSky
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    Most likely he has an individual Plan F paid by the employer. Since he isn't losing a group plan he has no GI available.

    Rick
     
  9. insuranceconceptscindy
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    insuranceconceptscindy Guru

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    Usually the client will shoot themselves in the foot during the underwriting call. I have had this happen before. Client tells me the whole story about how doc wants her to have X procedure, but it's not an immediate need. I say, OK, answer the question one more time- yes or no. Answer- no. I tell the client not to elaborate on the call- yes or no. That's it.
    Underwriting call comes and they tell the whole story to the underwriter!! Of course, the underwriter will check that box yes and decline it. Anytime I've had one decline it's because the client can't keep their trap shut. And then I say- I told you so.
     
  10. senior-advisor-indiana
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    Depends how the question reads and how long ago they were advised to have the surgery. Just tell them to answer honestly as it is asked.

    ----------

    Are you arguing with me?:mad:
     
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