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UHC

Certificate Training Aid

TermDefinition
Guaranteed Issue Rights some benes who lose/drop other coverage have this
What CANT an insurance company do to a bene with GIR? What MUST the bene do prior to enrollment? deny apps, factor pre-existing conditions, charge more - bene must submit proper docs to prove GIR - ex. termination notice from prior coverage (rules vary by state)
Med Sup also know as.... Medigap policies
Two examples of what would make a bene not eligible for a Med Sup bene does not qualify for Med Sup OE/GIR AND does not pass medical underwriting (where applicable) + bene already enrolled in a Med Sup and/or MA plan and do not intend to replace (perhaps they were confused)
Memory Check: key features of Med Sup $, Freedom (no prior auth/ref/network), spans US (travelers) and in some cases outside US, auto-renews, highly regulated, enroll year round, 30 day eval
In what case can we not offer Med Sup to an MA bene? Are they ok with replacing their MA? If not, they should avoid enrolling in any Med Sup plans
Memory Check: impact of changes to MACRA legislation for Med Sup plans ELIGIBLE BEFORE 01/01/20? Bene can enroll in Plans C + F even after 01/01/20 and keep.....ELIGIBLE ON OR AFTER 01/01/20? Bene cannot enroll in Plans C+F.......ALREADY HAVE C OR F? Bene does not need to do anything and can keep if they choose
Explain Med Sup OE eligibility and what do states allow benes to do when it comes to enrolling in these plans Med Sup OE is 6 months following bene 65th birthday (must be enrolled in B as well) and most states allow benes to enroll 3 months prior to their IEP
What rights are benes guaranteed during Med Sup OE (if eligible)? purchase any plan + rates wont take into consideration pre-existing conditions
What happens if a bene does not enroll in a Med Sup plan during their OE and they decide after the fact they want a plan? They can enroll anytime, but will be charged a higher rate or even denied coverage
Key reasons why benes enroll in Med Sup plans choose any medicare doctor, predictable out-of-pocket costs, limited ER coverage outside US (some plans), guaranteed renewability
True or False: benes who do not qualify for a Med Sup OE or GIR can apply but the app will be sent for underwriting and may be issued a rating True
What age is the absolute minimum for a Med Sup plan per the Group Master Policy......50
Two types of Group Retiree Plans Employer/Union-Sponsored Group Retiree Plans and Employer Senior Supplement Group Retiree Plans
Two important things to discuss with bene about GRP how the plans work together and how the new plan may effect other types of coverage (ex. choosing to enroll in a MA plan)
Created by: cmazzariti
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