Marketing Support & Agent Licensing: Claims, Underwriting, Cust. Svc., & Commissions: Revised HN

Transcription

1 Marketing Support & Agent Licensing: Claims, Underwriting, Cust. Svc., & Commissions: Revised HN

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3 TABLE OF CONTENTS Open Enrollment and Guarantee Issue Open Enrollment Guarantee Issue Replacement Tips for Completing the Application Submitting the Application Height / Weight Table Medical Terms on the Application Prescription Drug Guide HEARTLAND NATIONAL LIFE INSURANCE MEDICARE SUPPLEMENT UNDERWRITING GUIDE Please review this Underwriting Guide carefully. It has been designed to help you understand the Underwriting process for the Heartland National Medicare Supplement product. 1

4 OPEN ENROLLMENT AND GUARANTEE ISSUE Applicants who purchase a Medicare supplement policy during an open enrollment period or based on guarantee issue rights are not required to provide any health history information in the application. OPEN ENROLLMENT An open enrollment period is available for applicants who are: Within 6 months of turning age 65 and first enrolling in Medicare Part B. Now age 65, previously qualified for Medicare due to disability and enrolled in Medicare Part B: now eligible for a second open enrollment period. During this period, Heartland cannot deny insurance coverage, place conditions on a policy, or charge more premium due to past medical conditions. An application may be submitted up to six months in advance for applicants who are turning age 65 and will begin their open enrollment period within the next six months. The coverage effective date is the date the applicant's Medicare Part B is effective. Some states require that Medicare supplement open enrollment be offered to individuals under age 65. Refer to the chart below for details. State(s) Under Age 65 Under Age 65 Accepted Plan(s) Available Alabama, Arkansas, Arizona, Indiana, Nebraska, Nevada, New Mexico, South Carolina, Utah, Wyoming No NA Oklahoma, Texas Yes A Colorado, Delaware, Georgia, Illinois, Yes A, D, F, G, M or N Kansas,Louisiana,Mississippi, Missouri, Montana, Tennessee GUARANTEE ISSUE An applicant who is age 65 or older may be eligible for guarantee issue upon the occurrence of certain events that cause the applicant to lose their existing insurance coverage. The applicant must apply within 63 days prior to, or after, the event, or upon receiving notice of termination of the existing coverage. Proof of coverage termination must be submitted with the application: disenrollment letter, copy of schedule page or ID card or coverage verification letter with effective date and plan type. 2

5 Events that qualify an applicant for guarantee issue and plan availability: Event Client is in the original Medicare plan and has an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays, and the coverage is ending. Client is in the original Medicare plan and has a Medicare Select policy. Client moves out of the Medicare Select plan s service area. Client s Medigap insurance company goes bankrupt and the client loses coverage or client s Medigap policy coverage otherwise ends through no fault of the client. Client s Medicare Advantage plan is leaving the Medicare program, stops giving care in the client s area or the client moves out of the plan s service area. Client joined a Medicare Advantage plan when first eligible for Medicare Part A at age 65 and within the first year of joining, decides to switch back to original Medicare. Client dropped their Medigap policy to join a Medicare Advantage plan for the first time, has been in the plan less than a year, and want to switch back. Client leaves a Medicare Advantage plan because the company has not followed the rules or has misled the client. Plan(s) Available A, D, F, G, M or N (if the client s prior Medigap policy is not available from the same company) 3

6 Some states have other rules in place for guarantee issue. Please refer to the chart below for details. State Event Plan(s) Available Kansas No longer eligible for Medicaid A, D, F, G, M or N Tennessee, Texas Utah Missouri No longer eligible for Medicaid No longer eligible for Medicaid Exchange existing plan 30 days before or after policy anniversary Same plan as currently in force Nevada Colorado, Illinois, Indiana, Texas Arkansas, Kansas, Missouri, Louisiana Oklahoma, New Mexico Client voluntarily terminates employer sponsored group plan and the employer plan is primary to Medicare Client voluntarily terminates employer sponsored group plan and the employer plan is primary to Medicare Client voluntarily terminates an employer sponsored group plan Client s employer sponsored health plan s benefits are reduced substantially (i.e. increase in deductible amount or coinsurance requirements) REPLACEMENT A replacement form is required when the applicant's current health insurance is another Medicare supplement policy, including a health care service contract or HMO contract, or any other health insurance policy that provides benefits which a Medicare supplement policy would duplicate, and the applicant has a choice in whether the coverage continues. If coverage is ending and the applicant is eligible for guarantee issue, a replacement form is not required. 4

7 TIPS FOR COMPLETING THE APPLICATION Complete the application in its entirety - it is the basis for the policy and it is part of a legal contract. Applications must be received within 14 days of the date the application was signed. The application date MUST be the date the application was signed. Backdated applications will NOT be accepted. Signature on the Application: The agent must personally ask and record all answers to the application questions. No other person, including the spouse, may sign on behalf of an applicant. We do not accept Power of Attorney signatures for underwritten applications. C.O.D Business: Heartland does not accept C.O.D business. The applicant s state of residence determines the application, forms, and premium. If an applicant has more than one residence, the state where taxes are filed is considered the state of residence. An application will not be accepted if the agent is not licensed in the applicant s state of residence. The application signed state must be the applicant s state of residence. ALWAYS ü Ask each question exactly as written (don't paraphrase). ü Record each answer exactly as given. ü Complete the application legibly and in black ink. ü Have the applicant initial and date any correction or mistake. NEVER ü Use "white out" or similar substances for corrections or mistakes. ü Tell or suggest to the applicant how he or she should answer a question. ü Ask a general question (e.g: Are you in good health?"), then mark all of the medical questions on the application as "no". ü Answer questions with ditto marks (") or dashes (-). ü Answer questions with "N/A" (not applicable). ü Use abbreviations unless you are sure they are correct. 5

8 INITIAL PREMIUM We do not accept C.O.D. Business Checks, money orders or cashier checks are to be made out to Heartland National Life Insurance Company. We do not accept payment from third parties such as the Kidney Foundation. Drafting the Initial Premium Rather than submitting premium with the application, an agent can request to draft the initial monthly premium in the Premium Payment section of the application. When this is selected, unless indicated otherwise, the first premium will be drafted when the policy is issued. Note: the first premium is drafted when the policy is issued, regardless if the requested effective date is beyond the issue date. Bank Draft. For monthly Bank Draft, the Select Bank Draft Day must be within 10 days of the effective date. The actual date we draw payment from the applicant s account will either be the date chosen or a few days following that date. It will never be before the date chosen. Remember to include a voided check or a bank deposit slip with the application packet when the insured selects the bank draft option. Renewal Premium Renewal premium is by either Bank Draft (checking or savings account) or Direct Billing. The standard option for Bank Draft is monthly; but may also be paid quarterly, semi-annually, or annually. Direct Billing can be paid quarterly, semi-annually, or annually. SUBMITTING THE APPLICATION To submit an application: If an applicant is within the open enrollment or guarantee issue period, complete the application except the medical questions. If the applicant is outside the open enrollment or guarantee issue period, pre-qualify the applicant using the Health Questions in the application prior to submitting. Complete the Replacement Form, if replacing other coverage. Submit the required forms and premium for processing. 6

9 UNDERWRITING PROCESS A prescription drug check will be completed for all applications requiring underwriting. For paper applications, the prescription drug check cannot be completed until the signed Authorization and Certification is received with the application. The prescriptions found in the drug check will be compared with the prescriptions listed on the application. If the prescription drug check differs from the medications list on the application, Heartland will contact the applicant for clarification. Express Application Process To submit an application using the Express Application Process: Pre-qualify the applicant using the Health Questions in the application if the applicant is outside open enrollment or is not eligible under guarantee issue. Prior to putting your client on the phone, you MUST have your applicant read the required statements on the application (labeled Important Statements to be Read and Signed by the Applicant). The Tele-Underwriter will ask your client if they have read, or had read to them, the required statements from the application. If the client has not read these statements, the Tele-Underwriter will end the call and inform you that the statements must be read by the client prior to completing the interview. Complete the Replacement Form if replacing and the applicant is not eligible for guarantee issue. As the premium is to be paid by Bank Draft, be sure the applicant has their checkbook available to give the bank name, routing number, and account number to the interviewer. DO NOT COLLECT PREMIUM OR A VOIDED CHECK. Premiums will be deducted automatically for the first AND subsequent months. Below are two examples of how the Bank Routing Number and Account Number are presented on a check. 7

10 Call for a Point-of-Sale Interview. Call times are 7:00 a.m. to 7:00 p.m., MST, Monday through Thursday (9:00 a.m. to 9:00 p.m. EST / 8:00 a.m. to 8:00 p.m. CST / 6:00 a.m. to 6:00 p.m. PST) and Friday from 7:00 a.m. to 6:00 p.m. If your appointment is outside these hours, call to leave the following information: Your name and agent number Applicant s name Applicant s telephone number What product the applicant is applying for The best time to call the applicant DO NOT COACH THE APPLICANT! It is recommended that you explain what will take place but you must not participate in the interview. Our interviewers are trained to identify coaching and, if identified, it will only delay the issue process. Once the interview is complete, send the Home Office a copy of the Replacement Form, if required. This must be received within 14 days of the application date or commission will be charged back. UNDERWRITING HEIGHT/WEIGHT TABLE Height Minimum Weight Maximum Weight Applications will be declined for all applicants whose weight is below the Minimum weight or above the Maximum Weight. 8

11 DESCRIPTION OF RISK CLASSES For applicants outside open enrollment/guarantee issue, all health questions must be answered no to qualify. Applicants who answer yes to any part of questions 1 14 of the health questions in the application may be declined. There are two separate underwriting risk classes: Preferred and Standard. Each risk class has a separate premium rate. Preferred: Applicants who do not use tobacco products. Standard: Applicants who use tobacco products. This rate can be applied for applicants during open enrollment or who qualify for guarantee issue in certain states. (Not allowed in Arkansas, Illinois, Louisiana, Missouri, Tennessee and Utah). HEALTH QUESTIONS Applicants who apply outside of open enrollment or guarantee issue must answer the Health Questions in the application. In general, if a health question is answered yes, the application will be declined. There are some scenarios where an applicant has been receiving medical treatment or taking prescription drugs for a long-standing and controlled medical condition. Consideration will be given to offering coverage for certain conditions listed in questions 6, 8, 9 and 10 in the Health Questions portion of the application that meet this criteria. A condition is considered to be controlled if there have been no changes in treatment or medication for at least 2 years. If your applicant meets this criteria, include a detailed explanation with the application for consideration. Diabetes People with diabetes that require, or have ever required, more than 50 units of insulin daily, or people with diabetes (oral medication or insulin) who also have one or more complications as listed in question 6 on the application, are not eligible for coverage. For the purposes of this question, hypertension (high blood pressure) is considered a heart condition. Consideration for coverage may be given to persons with well-controlled hypertension and diabetes. Well-controlled means that the person is taking less than 50 units of insulin daily or no more than 2 oral medications for diabetes, and no more than 2 medications for hypertension. A combination of less than 50 units of insulin per day and one oral medication would be treated the same as 2 oral medications if the diabetes is well-controlled. To verify stability, there should be no changes in the dosages or medications for at least 2 years. Hypertension is considered stable if recent average blood pressure readings are 150/85 or lower. 9

12 Uninsurable Conditions In addition to the health conditions listed on the application, the following will also lead to a decline: Implantable cardiac defibrillator Asthma requiring continuous use of 3 or more medications, including inhalers Receiving medication that must be administered in a physician s office Chronic pulmonary disorders including Chronic Obstructive Pulmonary Disease (COPD), Emphysema, Chronic Bronchitis, Chronic Obstructive Lung Disease (COLD), Chronic Asthma, Chronic Interstitial Lung Disease, Chronic Pulmonary Fibrosis, Cystic Fibrosis, Sarcoidosis, Bronchiectasis. Cognitive disorders such as: mild cognitive impairment, delirium, organic brain disorder, or memory loss Scleroderma Diabetes in combination with diabetic retinopathy, peripheral vascular disease, neuropathy, any heart condition (except hypertension as described on page 9) or kidney disease Kidney disease requiring dialysis Organ transplant PRESCRIPTION DRUG GUIDE It is important to write down all prescription medications on the application so we can give full consideration to your applicant. Use an extra sheet if necessary and have your applicant sign and date the extra sheet. Uninsurable Medications If your applicant is taking one of the medications illustrated below for the specific "Customary Use" or condition noted, do not submit the application. Applicants treated with these medications, for the noted condition, are automatically declined. If you cannot find a medication on this list, call the TeleUnderwriting Hotline at Medication Customary Use A 3TC AIDS Acetate Prostate Cancer Alkeran Cancer Amantadine Parkinson's Apokyn Parkinson s Aptivus HIV Aricept Alzheimer's/Dementia Artane Parkinson's 10

13 Medication Customary Use Atripla HIV Avonex Multiple sclerosis Azilect Parkinson s AZT HIV/AIDS B BCG Bladder Cancer Baclofen Multiple sclerosis Betaseron Multiple sclerosis Bicalutamide Prostate Cancer C Carbidopa Parkinson s Casodex Prostate Cancer Cerefolin Alzheimer s/dementia Cogentin Parkinson's Cognex Dementia Combivent COPD/Emphysema Combivir HIV/AIDS Comtan Parkinson's Copaxone Multiple sclerosis Crixivan HIV Cytoxan Cancer D D4T HIV/AIDS DDC HIV/AIDS DDI HIV/AIDS DES Cancer DuoNeb COPD E Eldepryl Parkinson's Emtriva HIV Epivir HIV Enbrel Rheumatoid arthritis Epogen Kidney failure/hiv/aids Ergoloid Mesylate Alzheimer's/Dementia Etanercept Rheumatoid arthritis Exelon Alzheimer's/Dementia F Fuzeon HIV G Galantamine Alzheimer's/Dementia Geodon Schizophrenia Gold Rheumatoid Arthritis 11

14 Medication Customary Use H Haldol Psychosis Herceptin Cancer Hydrea Cancer Hydroxyurea Melanoma, Leukemia, Cancer Hydergine Alzheimer s/dementia I Imuran Immunosupression, Severe Arthritis Indinavir HIV/AIDS Insulin > 50 units diabetes Interferon HIV/AIDS/Cancer Invega Schizophrenia Invirase HIV/AIDS K Kaletra HIV Kemadrin Parkinson's Kineret Rheumatoid arthritis L Lasix/Furosemide (>60 mg/day) heart Disease L-Dopa Parkinson's Leukeran Cancer Letairis Pulmonary Hypertension Leuprolide Prostrate Cancer Levodopa Parkinson's Lexiva HIV Lioresal Multiple sclerosis Lomustin Cancer Lupron Cancer M Megace Cancer Megestrol Cancer Mellaril Psychosis Melphalan Cancer Memantine Alzheimer s/dementia Methotrexate > 25 mg/wk rheumatoid arthritis Metrifonate Alzheimer s/dementia Mirapex Parkinson's Myleran Cancer N Namenda Alzheimer s/dementia Natrecor CHF Navane Psychosis Nelfinavir HIV/AIDS 12

15 Medication Customary Use Neoral Immunosupression, Severe Arthritis Neupro Parkinson s Norvir HIV Novatrone Multiple Sclerosis P Paraplatin Cancer Parlodel Parkinson s Permax Parkinson's Prednisone (>10 mg/day) rheumatoid Arthritis, COPD Prezista HIV Procrit Kidney failure/hiv/aids Prolixin Psychosis R Razadyne Alzheimer's/Dementia Rebif Multiple sclerosis Remicade Rheumatoid arthritis Reminyl Alzheimer's/Dementia Remodulin Pulmonary Hypertension Requip Parkinson's Rescriptor HIV Reyataz HIV Retrovir HIV/AIDS Rilutek ALS/Lou Gehrig's disease Riluzole ALS/Lou Gehrig's disease Risperdal Psychosis Ritonavir HIV/AIDS S Sandimmune Immunosupression, Arthritis Selzentry HIV Sinemet Parkinson's Stalevo Parkinson s Stelazine Psychosis Sustiva HIV/AIDS Symmetrel Parkinson's T Tacrine Dementia Tasmar Parkinson's Teslac Cancer Thiotepa Cancer Thorazine Psychosis Trelstar-LA Prostate Cancer Triptorelin Prostate Cancer Trizivir HIV Truvada HIV 13

16 Medication Customary Use Tysabri Multiple Sclerosis V Valycte CMV HIV VePesid Cancer Videx HIV Vincristine Cancer Viracept HIV Viramune HIV/AIDS Viread HIV Z Zanosar Cancer Zaroxolyn Congestive heart failure Zelapar Parkinson s Zerit HIV Ziagen HIV Ziprasidone Schizophrenia Zoladex Cancer Zometa Hypercalcemia in Cancer If you cannot find a medication on this list, call the Tele-Underwriting Hotline at