2013 MEDIGAP BLUE
REFERENCE GUIDE
HIGHMARK SENIOR MARKETS
01/01/2013
REFERENCE GUIDE
TABLE OF CONTENTS
Section 1: How to Submit an Application ... 3
Section 2: Medical Underwriting ... 6
Section 3: Effective Date of Coverage ... 7
Section 4: Service Area and Plans ... 8
Section 5: Premiums and Billing ... 9
SECTION 1: HOW TO SUBMIT
AN APPLICATION
HOW TO SUBMIT AN APPLICATION
• Medigap Blue enrollment applications can only be submitted via mail. Highmark must receive the original signature. Note: A check for the first month’s premium does not need to be included with the enrollment application.
o Western PA enrollment applications (ENR-036) should be mailed to:
Highmark Blue Cross Blue Shield, P.O. Box 382555, Pittsburgh, PA 15250- 8555
o Central PA enrollment applications (ENR-051) should be mailed to:
Highmark Blue Shield, P.O. Box 382051, Pittsburgh, PA 15250-8051
• When an applicant seeks to enroll in a Medigap Blue plan, a signed and dated application is required. Only the current application as approved by the Pennsylvania Insurance
Department is valid. The date of the current application is 07/12.
• The signature and date on an application must be original. A photocopy of a completed application is not acceptable for enrollment purposes. A blank application may be photocopied and then completed.
• A copy of the completed application should be provided to the applicant for all DRAPP (direct response) applications. The DRAPP designation is on the bottom left of page 1 of the application, and section 3 will be pre-printed.
• Because the application contains statements about a subscriber’s understanding of benefits and regulations as well as confirmation that all information is true and correct, applications must be signed and dated by the subscriber or by a person with legal power of attorney. The power of attorney must be included with the application and verified by the legal department before the application is approved.
• Producers must complete Section 12 of the application:
o Producer name and agent number must be written on the “Print Name and I.D. Number” line (highlighted below in yellow).
SECTION 1: HOW TO SUBMIT
AN APPLICATION
o Producer general agency name and agency number must be written on the “Agency Name and Number” line (highlighted below in blue).
Commissions will not be paid on enrollments submitted without the correct Agent and Agency number written in Section 12 of the enrollment application.
HOW TO ORDER ENROLLMENT KITS
Producers can also order enrollment kits through the portal. To place an enrollment kit order:
1. Log into the Producer Portal
2. Click on “New Business” tab then “Request Enrollment Kit.”
3. A new window will open that will allow producers to order the kits supplies needed.
SECTION 1: HOW TO SUBMIT
AN APPLICATION
PLAN CHANGES
Moving subscribers between a Highmark Medigap Blue plan and another Highmark Medigap Blue plan is not commissionable. Members who wish to make a plan change between Highmark Medigap Blue plans should call Member Services (number on the back of ID card).
General Plan Change Rules
• When a subscriber is moving between plans or products, he/she must complete a new application (except for the following, plan changes will be subject to the health screening process):
o When a subscriber is moved from a plan with drug benefits to the same plan without drug benefits due to enrollment in a Medicare Prescription Drug Program (Part D), no new application, review or approval is needed.
SECTION 2: MEDICAL
UNDERWRITING
MEDICAL UNDERWRITING
Medical Underwriting (or health screening) is a health insurance term referring to the use of medical or health information in the evaluation of an applicant for coverage. As part of the underwriting process, an individual's health information may be used in making two decisions: (1) whether to offer or deny coverage and (2) what premium rate to set for the policy.
The Health Screening process will be used for all late entrants (see below) with an effective date starting January 1, 2013.
• The product rates will be based on the applicant's age and have an annual age- related premium adjustment.
• All new plans will be attained age rated with annual rate banding.
• New plans A, B, and C utilize a health questionnaire for late entrants to determine medical underwriting plan options.
• There will be a two-tier rate structure for members enrolling in the new plans A, B, and C. The tiers are: Preferred (lower premium), and Standard (higher premium).
• New plans F, F High Deductible, and N will not be medically underwritten and will not have two tiers of rates but will have annual rate banding.
WHEN HEALTH SCREENINGS APPLY
If And Then
Applicant is in the open enrollment period of 6 months after their Part B effective date or 65th birthday,
submits an application within this period,
is not subject to Health Screening Applicant is converting from a
qualified Highmark Group
applicant has a letter from the group indicating the termination date,
is not subject to Health Screening Applicant is Guaranteed the right to
purchase Medigap coverage through Federal or State law,
submits application within the Guaranteed issue period and provides documentation of eligibility,
is not subject to Health Screening Applicant is currently enrolled in
another BCBS Medigap plan,
is moving into Highmark’s service area and submits an application,
is not subject to Health Screening
Applicant is a late entrant, has no Guarantee to purchase Medigap coverage,
he/she must complete Health Screening questions The above guarantees are the
SECTION 3: EFFECTIVE DATE
OF COVERAGE
EFFECTIVE DATES
Coverage for new subscribers who enroll during the three-month period prior to their 65th birthday can be effective on the first of the Medicare Part B effective month.
Coverage will be effective the first of the month following the first contact date as long as the application is postmarked by the Return Date on the application. If the application is postmarked after the Return Date, coverage will have an effective date of the first of the month following the postmark date.
A subscriber may submit an application earlier than one month prior to the desired effective date as long as they will be eligible for the coverage as of the effective date requested. The effective date requested may be no longer than three (3) months after contact.
PLAN RESTRICTIONS
Medigap Blue restricts Plans F, F (HD), and N to applicants in the open enrollment period or who have other guarantees to purchase coverage.
• Late entrants will not be eligible to enroll in Plans F, F (HD) or N.
SECTION 4: SERVICE AREAS
AND PLANS
MEDIGAP BLUE SERVICE AREA
MEDIGAP BLUE PLANS AVAILABLE
Medigap Blue plans available are: A, B, C, F, F (HD), and N.
Plans F, F (HD), and N are only available to those applicants enrolling inside the 6 month period following enrollment into Medicare Part B or who are guaranteed the right to purchase these
SECTION 5: PREMIUMS AND
BILLING
PREMIUMS
Premiums are based on the member’s age as of January 1 or the first effective date of that year. The premium will remain in effect until December 31 of that year. The premium will reset the following January based upon the member’s age for that year.
For example:
• Applicant was 65 on January 1, but has already had a birthday and is 66 when they enroll. He/she will pay the age 66 premium rate for the remainder of the year.
• Applicant who was 66 at time of application and turns 67 later in the year will pay the age 66 premium rate for the remainder of the year.
• On January 1 of the following year, the first applicant is still 66 and will pay the age 66 premium for the next year. The second applicant will be 67 and, the premium will be adjusted to the age 67 premium rate.
FIVE-YEAR AGE BANDS ELIMINATED
Medigap Blue will no longer have five (5) year age bands for applicants enrolling in plans beginning with 2013. Instead of five (5) year bands, applicant premiums will increase annually due to age. Historic members in closed Plans E and I will remain in the 5-year age bands.
BILLING
All Medigap Blue members will be billed according to a calendar year bill cycle. New members enrolling off-cycle may receive an invoice billing them for one or two months prior to their chosen bill cycle taking effect.
