Agent Reference Guide

Transcription

1 Policy Year Agent Reference Guide Beginning in June 2016, Security Health Plan will implement several changes to the way it handles the application and effectuation process. The enhancements summarized below will simplify the submission process and encourage you to think of us as your go-to for Medicare Supplement placement. 1. Key selling points for Offers additional coverage for costs not covered by Original Medicare alone Product is competitively priced Non-network product with the freedom to see any provider, in Wisconsin or nationwide, that accepts Medicare assignment Coverage is guaranteed if purchased when joining Medicare o Purchase riders to meet your personal and financial needs o Just pay the premiums and you can never be dropped due to health problems o You will never pay a higher premium than others in the same age group with the same plan options Available in all Wisconsin counties 2. Competitive assessment When compared to leading competitors, Security Health Plan s : Is competitively priced, offering comparable premiums Offers competitive benefits. o A new feature this policy year: Part B Benefits, Preventive medical care benefit not covered by Medicare is unlimited; several competitors cap it at $1,000 per policy year 3. 1st premium payment no longer required in advance Agents are no longer required to secure the 1 st month s premium payment up front from applicants in order for coverage to be effectuated. New members will be billed directly by Security Health Plan on the 10 th of each month for their premiums, including the 1 st month premium.

2 4. Underwriting guidelines The Application for Insurance Section G Health questions should be completed in full by any client who is not in his or her (1) initial enrollment period (turning 65) or (2) eligible for a special enrollment period. This applies to individuals: Voluntarily terminating an individual policy or another plan Previously covered by a Medicare Advantage plan and o Not 1 st time on a Medicare Advantage plan or o Did not drop a to join a Medicare Advantage plan Who did not have other health insurance in past 63 days If the above conditions apply to your client, all the health questions on the application must be completed. Should your client indicate yes to any of the following conditions, please consider proposing alternative coverage to your clients: Coverage will be declined End-stage renal disease (ESRD) (1E) Intense Underwriting scrutiny will occur In the past 2 years Hospitalized for treatment of mental or nervous disorders, including alcohol and drug abuse (1B) Kidney disease or kidney dialysis (1E) Diabetes that requires insulin (1D) Broken bones due to osteoporosis (1D) In the past 5 years Treatment or surgery for cancer, Hodgkin s disease, leukemia or melanoma (2A) Received a recommendation for any organ transplant other than cornea transplant (2B) Chronic diseases of Alzheimer s disease, amyotrophic lateral sclerosis (ALS/Lou Gehrig s disease), cerebral palsy, cystic fibrosis, emphysema, hemophilia, multiple sclerosis, muscular dystrophy, myasthenia gravis, Parkinson s disease, sickle cell anemia, systemic lupus (3) In the past 2 years Hospitalized more than 24 hours, 3 times or more, in the past 2 years (1A) Recommended for inpatient surgery that hasn t yet been performed (1A) Aneurysm, carotid artery disease, congestive heart failure, coronary artery disease (hardening or narrowing of the artery or arterial blockage), enlarged heart, heart attack, heart rhythm disorder, heart valve disorder, stroke, or peripheral vascular disease (1C) Liver disease (1D) In the past 5 years Currently confined to a skilled nursing facility (4) Page 2 of 6

3 5. Improved Agent Communication We aim to be as transparent as possible during the application review process. We will ensure our agents are kept in the loop on any additional information requests made by Security Health Plan to your client. Agents will receive two forms of communication: 1. notification: Please check your inbox confirming our final decision on your client s acceptance into the plan (i.e. Approved, Not Approved). This will be sent to your address on file. 2. Carbon copy regular mail: We will keep you informed of any written requests for additional information made to your client. You can expect copies of our correspondence to be sent by U.S. mail to your current mailing address on record. You be notified as expeditiously as possible. Please contact our Broker Coordinator, Barb Kuhn, kuhn.barbara@securityhealth.org, to ensure we have your most current address on record. 6. Multiple coverages considerations If your clients have other insurance that they don t intend to cancel, they would not be eligible for this Security Health Plan policy. Your client does not need more than one Medicare Cost Medicare Advantage Medicare Select If purchasing Security Health Plan s, your clients may want to evaluate their existing health coverage and decide if multiple coverages are needed when they also have the following type of policies: Individual Employer or Union-based If they opt to retain multiple coverages, Security Health Plan would ensure coordination of benefits with the other carriers. Page 3 of 6

4 7. Base premium calculations New Members (a) Manual premium quote NEW business Rating Approach Based on the age of the applicant as of the 1 st of the month AFTER the selected effective date If age is 65, the 65 year rate will be applied o If turning 65 any day during the month when the policy is to be effective, apply 65 year rate If age is anything other than 65, the applicant s age, as of requested effective date, will be used Example 1: Fred Rice is currently 64 years of age ( T65) Requested effective date 8/1/2016 Birthdate is 9/1/2016, when Fred turns 65 What is Fred age as of 9/1? use Age 65 rate Example 2: Sonia Black is currently 64 years of age ( T65) Requested effective date 4/1/2016 Birthdate is 4/15/2016, when Sonia turns 65 Use Age 65 rate Example 3: Jane Waters is currently age 67 (>65) Requested effective 12/1/2016 Birthdate is 12/5/2016, when Jane turns 68 Use Age 67 rate RENEWAL business Based on the age of member on July 1 st, policy renewal date Example 1: Mae Belle, currently age 67 Effective date 7/1/2016 Date of Birth: 9/1/1948, turning 68 years of age Mae s age as of 7/1/2016: 67 years Use Age 67 Rate Example 2: Robert Door, current age is 70 years Effective date 7/1/2016 Date of Birth: 5/19/1946 Robert s age as of 7/1/2016: 70 years Use Age Rate (b) Online DRX premium quote The quoting screens of our DRX online enrollment form now reflect the correct gross premiums, before any applicable discount is applied. Printing quotes: Premium quotes can be printed from web browsers such as Internet Explorer, Mozilla Firefox and Chrome using File/Print command or Ctrl p keys. Page 4 of 6

5 8. Final premium, including discounts Agents can determine the final monthly premium for clients, including the household and automatic premium payment (ACH) discounts. When calculating this final monthly premium, the following methodology should be applied: Household discount: less 5% per month (applied 1 st to premium calculation) ACH discount: less $5 per month (applied 2 nd to premium calculation) Example Jane Doe, age 66, Wausau resident Base policy + Part A Deductible & Part B Deductible Riders Husband also enrolled in a Security Health Plan policy Set up recurring credit card payments Base premium $ Part A Deductible rider Part B Deductible rider Subtotal monthly premium $ less 5% Household discount (apply 1 st ) (6.95) less $5 ACH discount (apply 2 nd ) (5.00) Final monthly premium $ Household discount and Security Health Plan coverage scenarios Husband and wife are both enrolled in Member enrolled in, spouse is enrolled in Medicare Advantage plan or Secure Saver MSA Member enrolled in, spouse is enrolled in Senior Security Medicare Select Member enrolled in, one or more family members are enrolled in Individual or Family Plan (under 65) Member enrolled in, one or more family members are enrolled in a Group Plan Member enrolled in, one or more family members covered by Medicaid or Family Health Center Discount applies Both Discount not applicable ONLY the member will receive the household discount when the spouse is on a Security Health Plan non plan Note: The $5 monthly ACH discount is applicable when a member sets up automatic premium payments through checking account, savings account, debit card or credit card. Page 5 of 6

6 9. Reach out to Security Health Plan For any additional questions or clarifications, please feel free to reach out to Consumer Sales Executives: Kay Brubaker Robin Huff Mike Kissinger Rick Kuhn Kevin Meyers Retention Team: Consumer Enrichment Advocates Julie Heck Pat Olson Janelle Radant Sara Solinsky Broker Coordinator: Barb Kuhn Page 6 of 6