Jurris.COM
Section 1358.18 Of Article 3.5. Additional Requirements For Medicare Supplement Contracts From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 3.5.
1358.18
. In the interest of full and fair disclosure, and to ensure
the availability of necessary consumer information to potential
subscribers or enrollees not possessing a special knowledge of
Medicare, health care service plans, or Medicare supplement
contracts, an issuer shall comply with the following provisions:
(a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medi-Cal coverage, or another health insurance policy or certificate or plan contract in force or whether a Medicare supplement contract is intended to replace any other disability policy or certificate, or plan contract, presently in force. A supplementary application or other form to be signed by the applicant and solicitor containing those questions and statements may be used. "(Statements)
(1) You do not need more than one Medicare supplement policy or contract.
(2) If you purchase this contract, you may want to evaluate your existing health coverage and decide if you need multiple coverages.
(3) You may be eligible for benefits under Medi-Cal or Medicaid and may not need a Medicare supplement contract.
(4) If, after purchasing this contract, you become eligible for Medi-Cal, the benefits and premiums under your Medicare supplement contract can be suspended, if requested, during your entitlement to benefits under Medi-Cal or Medicaid for 24 months. You must request this suspension within 90 days of becoming eligible for Medi-Cal or Medicaid. If you are no longer entitled to Medi-Cal or Medicaid, your suspended Medicare supplement contract or, if that is no longer available, a substantially equivalent contract, will be reinstituted if requested within 90 days of losing Medi-Cal or Medicaid eligibility. If the Medicare supplement contract provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your contract was suspended, the reinstituted contract will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.
(5) If you are eligible for, and have enrolled in, a Medicare supplement contract by reason of disability and you later become covered by an employer or union-based group health plan, the benefits and premiums under your Medicare supplement contract can be suspended, if requested, while you are covered under the employer or union-based group health plan. If you suspend your Medicare supplement contract under these circumstances and later lose your employer or union-based group health plan, your suspended Medicare supplement contract or, if that is no longer available, a substantially equivalent contract, will be reinstituted if requested within 90 days of losing your employer or union-based group health plan. If the Medicare supplement contract provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your contract was suspended, the reinstituted contract will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.
(6) Counseling services are available in this state to provide advice concerning your purchase of Medicare supplement coverage and concerning medical assistance through the Medi-Cal or Medicaid Program, including benefits as a qualified Medicare beneficiary (QMB) and a specified low-income Medicare beneficiary (SLMB). Information regarding counseling services may be obtained from the California Department of Aging.
(Questions) If you lost or are losing other health insurance coverage and received a notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement insurance contract or that you had certain rights to buy such a contract, you may be guaranteed acceptance in one or more of our Medicare supplement plans. Please include a copy of the notice from your prior insurer with your application. PLEASE ANSWER ALL QUESTIONS. [Please mark Yes or No below with an "X."] To the best of your knowledge,
(1) (a) Did you turn 65 years of age in the last 6 months Yes____ No____
(b) Did you enroll in Medicare Part B in the last 6 months Yes____ No____
(c) If yes, what is the effective date ___________________
(2) Are you covered for medical assistance through California's Medi-Cal program NOTE TO APPLICANT: If you have a share of cost under the Medi-Cal program, please answer NO to this question. Yes____ No____ If yes,
(a) Will Medi-Cal pay your premiums for this Medicare supplement contract Yes____ No____
(b) Do you receive benefits from Medi-Cal OTHER THAN payments toward your Medicare Part B premium Yes____ No____
(3) (a) If you had coverage from any Medicare plan other than original Medicare within the past 63 days (for example, a Medicare Advantage plan or a Medicare HMO or PPO), fill in your start and end dates below. If you are still covered under this plan, leave "END" blank. START __/__/__ END __/__/__
(b) If you are still covered under the Medicare plan, do you intend to replace your current coverage with this new Medicare supplement contract Yes____ No____
(c) Was this your first time in this type of Medicare plan Yes____ No____
(d) Did you drop a Medicare supplement contract to enroll in the Medicare plan Yes____ No____
(4) (a) Do you have another Medicare supplement policy or certificate or contract in force Yes____ No____
(b) If so, with what company, and what plan do you have [optional for Direct Mailers] Yes____ No____
(c) If so, do you intend to replace your current Medicare supplement policy or certificate or contract with this contract Yes____ No____
(5) Have you had coverage under any other health insurance within the past 63 days (For example, an employer, union, or individual plan) Yes____ No____
(a) If so, with what companies and what kind of policy ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________
(b) What are your dates of coverage under the other policy START __/__/__ END __/__/__
(If you are still covered under the other policy, leave "END" blank)."
(a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medi-Cal coverage, or another health insurance policy or certificate or plan contract in force or whether a Medicare supplement contract is intended to replace any other disability policy or certificate, or plan contract, presently in force. A supplementary application or other form to be signed by the applicant and solicitor containing those questions and statements may be used. "(Statements)
(1) You do not need more than one Medicare supplement policy or contract.
(2) If you purchase this contract, you may want to evaluate your existing health coverage and decide if you need multiple coverages.
(3) You may be eligible for benefits under Medi-Cal or Medicaid and may not need a Medicare supplement contract.
(4) If, after purchasing this contract, you become eligible for Medi-Cal, the benefits and premiums under your Medicare supplement contract can be suspended, if requested, during your entitlement to benefits under Medi-Cal or Medicaid for 24 months. You must request this suspension within 90 days of becoming eligible for Medi-Cal or Medicaid. If you are no longer entitled to Medi-Cal or Medicaid, your suspended Medicare supplement contract or, if that is no longer available, a substantially equivalent contract, will be reinstituted if requested within 90 days of losing Medi-Cal or Medicaid eligibility. If the Medicare supplement contract provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your contract was suspended, the reinstituted contract will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.
(5) If you are eligible for, and have enrolled in, a Medicare supplement contract by reason of disability and you later become covered by an employer or union-based group health plan, the benefits and premiums under your Medicare supplement contract can be suspended, if requested, while you are covered under the employer or union-based group health plan. If you suspend your Medicare supplement contract under these circumstances and later lose your employer or union-based group health plan, your suspended Medicare supplement contract or, if that is no longer available, a substantially equivalent contract, will be reinstituted if requested within 90 days of losing your employer or union-based group health plan. If the Medicare supplement contract provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your contract was suspended, the reinstituted contract will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.
(6) Counseling services are available in this state to provide advice concerning your purchase of Medicare supplement coverage and concerning medical assistance through the Medi-Cal or Medicaid Program, including benefits as a qualified Medicare beneficiary (QMB) and a specified low-income Medicare beneficiary (SLMB). Information regarding counseling services may be obtained from the California Department of Aging.
(Questions) If you lost or are losing other health insurance coverage and received a notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement insurance contract or that you had certain rights to buy such a contract, you may be guaranteed acceptance in one or more of our Medicare supplement plans. Please include a copy of the notice from your prior insurer with your application. PLEASE ANSWER ALL QUESTIONS. [Please mark Yes or No below with an "X."] To the best of your knowledge,
(1) (a) Did you turn 65 years of age in the last 6 months Yes____ No____
(b) Did you enroll in Medicare Part B in the last 6 months Yes____ No____
(c) If yes, what is the effective date ___________________
(2) Are you covered for medical assistance through California's Medi-Cal program NOTE TO APPLICANT: If you have a share of cost under the Medi-Cal program, please answer NO to this question. Yes____ No____ If yes,
(a) Will Medi-Cal pay your premiums for this Medicare supplement contract Yes____ No____
(b) Do you receive benefits from Medi-Cal OTHER THAN payments toward your Medicare Part B premium Yes____ No____
(3) (a) If you had coverage from any Medicare plan other than original Medicare within the past 63 days (for example, a Medicare Advantage plan or a Medicare HMO or PPO), fill in your start and end dates below. If you are still covered under this plan, leave "END" blank. START __/__/__ END __/__/__
(b) If you are still covered under the Medicare plan, do you intend to replace your current coverage with this new Medicare supplement contract Yes____ No____
(c) Was this your first time in this type of Medicare plan Yes____ No____
(d) Did you drop a Medicare supplement contract to enroll in the Medicare plan Yes____ No____
(4) (a) Do you have another Medicare supplement policy or certificate or contract in force Yes____ No____
(b) If so, with what company, and what plan do you have [optional for Direct Mailers] Yes____ No____
(c) If so, do you intend to replace your current Medicare supplement policy or certificate or contract with this contract Yes____ No____
(5) Have you had coverage under any other health insurance within the past 63 days (For example, an employer, union, or individual plan) Yes____ No____
(a) If so, with what companies and what kind of policy ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________
(b) What are your dates of coverage under the other policy START __/__/__ END __/__/__
(If you are still covered under the other policy, leave "END" blank)."
