Open Enrollment
What is Federal Open Enrollment?
A 6 month period of time that begins on the first day of the month in which an individual is both age 65 or older, and enrolled in Medicare Part B.
Name 5 states have a special Open Enrollment period.
CA, ME, MO,OR,WA, LA, ID,IL, NV
True or False: Every state allows voluntary termination of group coverage.
False. All states allow involuntary termination. Select states allow voluntary termination (Primary and No condition)
True or False- If the person has a "no hit" pharmacy report but the Claims Cost says "Auto Issue" you may issue the policy.
False. If the case has a no hit pharmacy report you must send to MS Surge.
What is Medicare?
A social insurance program established in 1965 and distributed through the Social Security office.
What are the guidelines for individuals over age 65 who have continued to work and have delayed their Part B?
Must have group coverage to qualify for Open Enrollment. Otherwise, they can qualify during the annual OE period from Jan 1-Mar 31 with an effective date of July 1.
True or False: In CA and OR, the coverage effective date can be prior to the applicant's birthday.
False. Must be on or after the applicant's birthday.
What is involuntary termination?
When the group insurance was canceled by the employer or carrier of the coverage.
Where can you find a Claims Cost Score on a case?
Activities
What is the purpose of a Medicare Supplement policy?
To offset the additional cost of what Medicare doesn't pay on approved expensive (usually 20%--Medicare 80%).
What 2 states require an individual sign the application within 90 days prior to their Medicare Part B date?
New York and Wisconson
What type of proof is needed in MO to qualify for their Missouri Anniversary OE?
What is a "No Condition" state? Name 2 states that have this GI situation.
Individuals who have group insurance can leave that group insurance at any time and will always be in a GI situation. AR,FL,KS,MO,SD.
If the Claims Cost says "Auto Issue" what would be your next steps?
Clear all administrative errors and Issue the policy
What does the term "aging in" mean?
Someone turning 65 and and just now enrolling in their Part B coverage.
What three states have Year Round Open Enrollment?
Connecticut, New York and Vermont
If an application comes in from WA and they currently have a plan A what plan are they eligible to apply for under the CA Open Enrollment period?
A
Describe the two "trial right" situations.
Trial Right #4- Applicant joined a MA plan, when they were first eligible for Part A at 65 and within 12 months decided they want to switch to original medicare.
Trial Right #5- Applicant dropped a Medicare Supplement plan to join a MA plan for the first time. They have been in the plan less than 12 months and they want to switch back.
There is a health question answered yes and Claims Cost says "Auto Issue". What would be your next steps?
Send to MS Surge
What do OE and GI stand for?
Open Enrollment and Guarantee Issue
The application states the customer currently resides in OR and is an internal customer. Where could you find proof of the customer's current plan?
True or False: If an applicant is in a MA plan and their plan is leaving Medicare or stops providing service or they move out of the service area qualifies for GI.
True
The Claims Cost says Manual. What would be your next steps?
Send to MS Surge
What does Fully Underwritten mean?
To review the application health questions, medications, pharmacy report and claims history.