Medicare Supplement 2016-2017 Policy Year
Agent Reference Guide
Beginning in June 2016, Security Health Plan will implement several changes to the way it handles the Medicare Supplement 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 Medicare Supplement
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 Medicare Supplement: 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 1st 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 10th of each month for their premiums, including the 1st month premium.
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4. Underwriting guidelines
The Application for Medicare Supplement 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 Medicare Supplement plan Previously covered by a Medicare Advantage plan and
o Not 1st
time on a Medicare Advantage plan or
o Did not drop a Medicare Supplement 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
Intense Underwriting scrutiny will occur
End-stage renal disease (ESRD) (1E) 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 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
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 5 years
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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. Email notification: Please check your email inbox confirming our final decision on your client’s acceptance into the Medicare Supplement plan (i.e. Approved, Not Approved). This will be sent to your email 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 email address on record.
6. Multiple coverages considerations
If your clients have other Medicare Supplement insurance that they don’t intend to cancel, they would not be eligible for this Security Health Plan Medicare Supplement policy.
Your client does not need more than one
Medicare Supplement ● Medicare Cost Medicare Advantage ● Medicare Select
If purchasing Security Health Plan’s Medicare Supplement, 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.
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7. Base premium calculations – New Members
(a) Manual premium quote
Rating Approach
NEW
business
Based on the age of the applicant as of the 1st 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 1st, 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 70-74 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.
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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 1st to premium calculation) ACH discount: less $5 per month (applied 2nd 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 Medicare Supplement policy Set up recurring credit card payments
Base premium $106.29
Part A Deductible rider 18.78 Part B Deductible rider 13.83 Subtotal monthly premium
$138.90
less 5% Household discount (apply 1st) (6.95) less $5 ACH discount (apply 2nd) (5.00) Final monthly premium$126.95
Household discount and Security Health Plan coverage scenarios Discount applies
Husband and wife are both enrolled in Medicare Supplement Both Member enrolled in Medicare Supplement, spouse is enrolled in
Medicare Advantage plan or Secure Saver MSA
Medicare Supplement member only Member enrolled in Medicare Supplement, spouse is enrolled in
Senior Security Medicare Select
Medicare Supplement member only Member enrolled in Medicare Supplement, one or more family
members are enrolled in Individual or Family Plan (under 65)
Medicare Supplement member only Member enrolled in Medicare Supplement, one or more family
members are enrolled in a Group Plan
Medicare Supplement member only Member enrolled in Medicare Supplement, one or more family
members covered by Medicaid or Family Health Center
Discount not applicable
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.
ONLY the Medicare Supplement member will receive the household discount when the spouse is on a Security Health Plan “non” Medicare Supplement plan
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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 715-486-5356 Robin Huff 715-897-3942 Mike Kissinger 715-650-0734 Rick Kuhn 705-207-5097 Kevin Meyers 715-486-5347
Retention Team: Consumer Enrichment Advocates 1-800-622-7790 Julie Heck
Pat Olson Janelle Radant Sara Solinsky
