Preexisting Condition Question

[rhcbp]

Going to see someone tomorrow who is 71 and is covered through a retirement plan. Paying over $500 a month now. She wants a med supp and a pdp, like her sister. she just got out of the hospital because of a stroke and will need outpatient therapy. she is also legally blind.

Will she be covered from day one? I believe she will because she is leaving an employer sponsored plan.

Do I need for her niece to sign anything because the lady I am seeing is legally blind, her Aunt?

Thanks in advance for your answers.

 

[retread]

Going to see someone tomorrow who is 71 and is covered through a retirement plan. Paying over $500 a month now. She wants a med supp and a pdp, like her sister. she just got out of the hospital because of a stroke and will need outpatient therapy. she is also legally blind.

Will she be covered from day one? I believe she will because she is leaving an employer sponsored plan.

Do I need for her niece to sign anything because the lady I am seeing is legally blind, her Aunt?

Thanks in advance for your answers.

Don't assume that because they are "legally" blind that they can't sign for themselves. I have a client that is "legally" blind (how he is able to see at all is a marvel) and he can sign his own sig. It isn't pretty, but then I have a lot of seniors that can see perfectly well with just as bad handwriting... You may have to place your finger where they are to sign and let them follow your finger down to the sig. line.

Secondly, just having another family member sign for them won't work. They must Power of Attorney (POA). If her sister has POA, you will need to make a copy of it and send that copy along with the app. (as well as her sig. on the app, of course.)

 

[rhcbp]

I was thinking that the niece could sign as a witness, not for her Aunt.

 

[Frank Stastny]

Will she be covered from day one?

I suggest you call the carrier and ask an underwriter. Guaranteed Issue may vary from state to state. Is she leaving the plan or is the plan no longer being offered to her?

 

[Newby]

I have to disagree with retread. The issue is not whether they can sign their name or not. The issue is whether they can read what they are signing.

 

[Josh]

I have to disagree with retread. The issue is not whether they can sign their name or not. The issue is whether they can read what they are signing.

I think the issue is whether or not they understand what they're signing, I don't know that them being able to read it is absolutely necessary.
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I suggest you call the carrier and ask an underwriter. Guaranteed Issue may vary from state to state. Is she leaving the plan or is the plan no longer being offered to her?

States can add more, like NY is GI regardless of age or time. At the federal level, these are all mandatory:

1. You have employer or union coverage that pays AFTER Medicare, and that coverage is ending.
2. You are enrolled in a Medicare Advantage plan, and this plan is leaving the Medicare program, stops servicing your area, OR you are moving out of the plan's specific service area.
3. You have a Medicare SELECT policy, and you are moving out of the plan's service area. You can keep your current policy, but you do have the right, on a GI basis, to switch to a new policy.
4. Your Medicare Supplement company goes bankrupt, which causes you to lose coverage. OR, you lose Medicare Supplement plan coverage through no fault of your own.
5. You enrolled in a Medicare Advantage plan or PACE when you were first eligible to enroll, and within a year of joining, you wish to switch back to "original" Medicare (and a Medicare Supplement plan).
6. You dropped a Medicare Supplement to switch to a Medicare Advantage or Medicare SELECT policy for the first time. You have been in that plan for less than a year and wish to switch back to Medigap.
7. You decide to drop a Medigap policy or leave a Medicare Advantage plan because the company hasn't followed the rules or misled you in some way.

 

[rhcbp]

she is leaving because of cost. I called the carrier and they said she would be covered with no preexisting conditions. even though i took down the persons name and time of call i get nervous on these cases. just want to make sure i have everything covered, so the client gets what they need.

 

[Frank Stastny]

I think the issue is whether or not they understand what they're signing, I don't know that them being able to read it is absolutely necessary.
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States can add more, like NY is GI regardless of age or time. At the federal level, these are all mandatory:

1. You have employer or union coverage that pays AFTER Medicare, and that coverage is ending.
2. You are enrolled in a Medicare Advantage plan, and this plan is leaving the Medicare program, stops servicing your area, OR you are moving out of the plan's specific service area.
3. You have a Medicare SELECT policy, and you are moving out of the plan's service area. You can keep your current policy, but you do have the right, on a GI basis, to switch to a new policy.
4. Your Medicare Supplement company goes bankrupt, which causes you to lose coverage. OR, you lose Medicare Supplement plan coverage through no fault of your own.
5. You enrolled in a Medicare Advantage plan or PACE when you were first eligible to enroll, and within a year of joining, you wish to switch back to "original" Medicare (and a Medicare Supplement plan).
6. You dropped a Medicare Supplement to switch to a Medicare Advantage or Medicare SELECT policy for the first time. You have been in that plan for less than a year and wish to switch back to Medigap.
7. You decide to drop a Medigap policy or leave a Medicare Advantage plan because the company hasn't followed the rules or misled you in some way.

I am very familiar with all seven of the above. However, none of them specifically address the question. In some states she would have GI is she is electing to drop the group plan, in other states she will not have the option of GI issue unless the employer group is dropping her.

I believe that was his specific question. Since he did not give us the state it is not possible to answer his question as to whether or not she will be covered let alone from day one. She doesn't sound like she will be able to answer the health questions on the app if she is required to have to go through underwriting.

 

[retread]

I have to disagree with retread. The issue is not whether they can sign their name or not. The issue is whether they can read what they are signing.

Power of Attorney is for someone unable to make their own decisions due to incapacity of some sort. This is not the case for blind people... they just can't read for themselves. An agent can read the disclosure(s) for them... this is the way all MA apps are set up. I nearly always read the disclosure statements because many seniors have difficulty reading, even if they aren't blind.

Besides, when you do an app over the phone, you read the disclosure for them, don't you? So do the carriers if the client calls them direct....
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Let me just add something here:

If the client can't understand the disclosure(s), for example they don't read English, and in the case a foreign language translator is involved, the translator must testify and there is a form for that (unless the application is provided in his language). If it is due to mental incapacity, the POA rep must sign and the copy of the POA submitted with the app.

If the person is incapable of writing a signature, but uses an "X", THEN a witness is needed that indeed he was signing as "X". In this case, he understands the disclosure, he just can't sign his name... either illerate, and/or never sighted and never learned to write, etc.... POA is not needed as long as he understands the disclosure. However, IF a POA is recorded, then the POA should sign for him, etc....

 

[rhcbp]

She lives in New Jersey
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I asked the witness question for this reason. I do not want to be put in a position where someone says I thought I was signing up for J and he put me in C or something to that effect. This morning her daughter and niece where there and I had them sign a witness form.

I assume when someone does a telephonic application it is recorded.