PDF MEDICARE SUPPLEMENT UNDERWRITING GUIDELINES - New Era Life

MEDIC ARE SUPPLEMENTUNDERWRITING G UIDELINES

Intro duc tio n The p urp o se o f this d o c um e nt is to a ssist yo u in d e te rm ining e lig ib ility fo r yo ur c lie nts fo r a Me d ic a re Sup p le m e nt p o lic y. Yo u will find info rm a tio n o n ho w to c o m p le te a n a p p lic a tio n a nd o ur c o m p a ny p o lic ie s a nd p ro c e d ure s to a ssist in e xp e d iting the und e rwriting p ro c e ss. This Und e rw riting G uid e line a lso g ive s yo u a g uid e to fo llo w fo r c o nd itio n, he a lth a nd o the rwise , whic h m a y no t b e a c c e p ta b le . The se g uide line s a re no t a ll inc lusive . The re m a y b e c o nditio ns tha t a re no t liste d in this g uide tha t m a y b e de c lina b le . O ur te le p ho ne inte rvie w is a n inte g ra l p a rt o f the und e rwriting p ro c e ss, a nd is re q uire d fo r e a c h a p p lic a tio n.

C o nta c t Info rm a tio n

Ne w Era Life Insura nc e C o m pa ny/ Phila de lphia Am e ric a n life Insura nc e C o m pa ny PO Bo x 4884 Ho usto n, TX 77210-4884

Physic a l a ddre ss (fo r O ve rnig ht Ma il) 11720 Ka ty Fre e wa y Suite 1700 Ho usto n, TX 77079

Pho ne Num b e rs Ne w Busine ss (Se nio r Divisio n)- 1 (800) 552-7879 Ext. 1122 Ma rke ting - 1 (877) 368-4692 Fa x fo r Ap p lic a tio ns- 1 (281) 368-7344 Ne w Busine ss Fa x- 1 (281) 368-7148

La st Up d a te d 3/ 4/ 16

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Autho rity o f Ag e nts Ag e nts a re a utho rize d b y the C o m p a ny to so lic it a p p lic a tio ns, c o lle c t initia l p re m iums a nd d e live r p o lic ie s. No a g e nt is a utho rize d to d e te rm ine a c c e p ta nc e o f risk, a lte r p o lic ie s o r in a ny wa y wa ive o r m o d ify a ny o f the C o m p a ny' s rig hts.

Ba sic Applic a tio n G uide line s The fo llo wing a re b a sic g uid e line s fo r writing o ur Me d ic a re Sup p le me nt. Ple a se no te : the se a re o nly g uid e line s a nd a re sub je c t to c ha ng e a t a ny time .

1. We d o no t a c c e p t a ny a p p lic a nt o n Me d ic a id . 2. No p o lic y will b e issue d to a n a p p lic a nt who is no t c o ve re d und e r b o th Me d ic a re Pa rt A

a nd Pa rt B. 3. Ap p lic a nts sho uld b e a wa re tha t missta te me nts o f me d ic a l info rma tio n a nd / o r to b a c c o

use c o uld re sult in d e nia l o f a c la im o r re sc issio n o f the p o lic y. With the e xc e p tio n o f O p e n Enro llm e nt a nd G ua ra nte e d Issue , a ll p o lic ie s a re c o nte sta b le fo r 2 ye a rs, inc lud ing re p la c e me nt p o lic ie s. 4. We will no t a c c e p t a n a p p lic a tio n mo re tha n nine ty (90) d a ys p rio r to the re q ue ste d e ffe c tive d a te , e xc e p t fo r O p e n Enro llme nt a p p lic a tio ns. O p e n Enro llm e nt a p p lic a tio ns ma y b e se nt in a ny time d uring the 6 mo nths b e fo re the a p p lic a nt' s 65th b irthd a y. 5. We d o no t b a c kd a te p o lic ie s. Ap p lic a tio ns sho uld b e sub m itte d a t le a st 5 d a ys b e fo re the re q ue ste d e ffe c tive d a te . 6. We will a c c e p t a p p lic a tio ns b y ma il, fa x, o r E-a p p lic a tio n, sub mitte d thro ug h yo ur se c ure lo g in a t ne we ra life .c o m . 7. Re q ue sts to c ha ng e p o lic y e ffe c tive d a te s must b e sub mitte d in writing b y the a p p lic a nt. 8. Eve ry a pplic a tio n will re quire a te le pho ne inte rvie w with the a pplic a nt. Ple a se m a ke sure we ha ve the c o rre c t p ho ne num b e r. We will no t a llo w a PO A to c o m p le te the inte rvie w. 9. Ap p lic a tio ns a re c o nsid e re d to b e still in und e rwriting until a p o lic y ha s b e e n issue d to the p o lic yho ld e r. If a c o nd itio n sho uld a rise a fte r the a p p lic a tio n is ta ke n b ut b e fo re the p o lic y is issue d , the a p p lic a nt sho uld no tify the c o mp a ny fo r furthe r c o nsid e ra tio n. 10. The a p p lic a nt ha s a 30 d a y fre e lo o k p e rio d . The p o lic y must b e ma ile d b a c k to us with a writte n re q ue st to c a nc e l if the y c ho o se no t to a c c e p t it. 11. The a p p lic a nt must re sid e in the Unite s Sta te s to g e t a p o lic y. 12. Fa xe d o r ma ile d a p p lic a tio ns must b e c o mp le te a nd must b e le g ib le to a vo id a ny d e la ys. Pre m ium info rm a tio n 1. Ple a se ma ke sure a ll b a nking info rma tio n is fille d o ut c o rre c tly o n the a uto ma tic b a nk d e d uc tio n fo rm. 2. All E-a p p lic a tio ns must b e se t up fo r a uto m a tic b a nk d e d uc tio n. 3. Ap p lic a nts ma y re q ue st a mo nthly b a nk d ra ft d a te o the r tha n the ir p a id to d a te e xc e p t the 29th, 30th a nd 31st. The re q ue ste d d ra ft d a te m ust b e w ithin 15 d a ys o f the p a id -to d a te o f the p o lic y to a vo id unne c e ssa ry la p se s in c o ve ra g e . 4. The c o m pa ny will dra ft the initia l pre m ium plus the a pplic a tio n fe e upo n a ppro va l o n a ll a pplic a tio ns. Ple a se info rm yo ur a pplic a nt o f this b e fo re yo u sub m it the a pplic a tio n. 5. The re is a $2.o o a d m inistra tio n fe e fo r a ny m o nthly d ire c t b ill p re m ium s. 6. We will no t a c c e pt a n a g e nt's c he c k o r a ny third pa rty c he c ks fo r the pre m ium .

Spe c ia l Fo rm s Sp e c ia l fo rms a re re q uire d b y m a ny sta te s. The se fo rm s a re ne c e ssa ry fo r b o th the a g e nt a nd the Ho me O ffic e to c o mp ly with sp e c ific sta te re g ula tio ns. The se fo rms must b e sub mitte d with the a p p lic a tio ns. Fo llo wing is a list o f fo rms a nd the sta te s in whic h e a c h is re q uire d :

Re p la c e me nt Fo rm (If re p la c ing a Me d Sup p o r MA p la n) - All Sta te s Autho riza tio n to O b ta in o r Re le a se Me d ic a l Info rma tio n - All Sta te s Po lic y C he c klist - Illino is

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To b a c c o Usa g e If the a p p lic a nt ha s use d a ny fo rm o f to b a c c o in the la st 5 ye a rs the y will b e g ive n to b a c c o use r ra te s.

The fo llo wing list o f illne sse s a nd c o nditio ns a re de c lina b le (a ny "ye s" a nswe rs to he a lth

q ue stio ns m a y re sult in a de c line d a pplic a tio n):

1. Ap p lic a nts who must use a wa lke r, whe e lc ha ir o r mo to rize d sc o o te r fo r a mb ula tio n. C a ne usa g e m ig ht b e a c c e p ta b le d e p e nd ing o n c irc umsta nc e s

2. Ind ivid ua ls who a re c o nfine d to a skille d nursing fa c ility o r ho sp ita l. 3. Ap p lic a nts who ha ve b e e n c o nfine d in a ho sp ita l two (2) o r mo re time s within the la st 2

ye a rs (unle ss the c o nfine me nts a re fo r the sa me o r re la te d c o nd itio ns.) 4. Ind ivid ua ls who ha ve b e e n a d vise d to ha ve a ny typ e o f surg e ry within the la st 2 ye a rs

tha t ha s no t b e e n p e rfo rme d , inc lud ing a p e nd ing b io p sy. Fo r e xa mp le , kne e surg e ry, hip re p la c e me nt, c a ta ra c t surg e ry, p ro sta te b io p sy, e tc . 5. Pla c e m e nt o f a p a c e ma ke r within the la st 12 mo nths. 6. Jo int re p la c e me nt wa s d o ne within the la st 12 mo nths o r ha s b e e n d isc usse d with d o c to r in p a st 24 mo nths b ut no t ye t d o ne . If the a pplic a nt ha s a histo ry o f a nd/ o r tre a tm e nt within the la st five (5) ye a rs fo r: 7. Ind ivid ua ls re q uiring d ia lysis o r d ia g no se d with re na l fa ilure , kid ne y d ise a se o r ha s ha d o r ne e d s a n o rg a n tra nsp la nt. 8. Pla c e me nt o f a d e fib rilla to r. 9. Any fo rm o f c a nc e r (e xc e p t b a sa l c e ll a nd sq ua mo us c e ll skin c a nc e r), le uke mia o r m a lig na nt m e la no m a . 10. Alzhe ime r' s d ise a se , se nile d e me ntia , Pa rkinso n' s d ise a se , sp ina l ste no sis, a ny o rg a nic b ra in d iso rd e r o r ne uro lo g ic a l d iso rd e r, inc lud ing , b ut no t limite d to tre a tm e nt fo r se izure s. 11. Any Am p uta tio ns. 12. He a rt a nd va sc ula r c o nd itio ns inc lud ing , b ut no t lim ite d to , he a rt a tta c k, stro ke , TIA (se rie s o f mini-stro ke s), c o ro na ry a rte ry b yp a ss, a ng io p la sty, c o ro na ry insuffic ie nc y (unsta b le a ng ina ), c o ng e stive he a rt fa ilure , c o ro na ry a the ro sc le ro sis, mitra l va lve d iso rd e r, a tria l fib rilla tio n, c a rd io myo p a thy, ste nts, he a rt p a lp ita tio ns, a o rtic va lve d iso rd e r, o c c lusio n a nd ste no sis o f the c a ro tid a rte ry, p e rip he ra l va sc ula r d ise a se , a ne urysm (a ny typ e inc lud ing a b d o mina l). 13. If a he a rt c a th wa s d o ne in the p a st five ye a rs we will re q uire a c o p y o f the re sults b e fo re we c a n m a ke a n und e rwriting d e c isio n (a t the a p p lic a nt' s e xp e nse if the re is a fe e ). 14. C hro nic re sp ira to ry d ise a se s, inc lud ing , b ut no t lim ite d to , e m p hyse m a , a sthm a , C O PD (C hro nic O b struc tive Pulm o na ry Dise a se ), RAD (Re a c tive Airwa y Dise a se ), p ulmo na ry fib ro sis o r a ny re sp ira to ry a b no rma lity re q uiring ne b ulize rs o r a ny use o f o xyg e n o r o the r re sp ira to ry the ra p y. Any use o f to b a c c o within the la st five (5) ye a rs in c o mb ina tio n with o ng o ing re sp ira to ry d ise a se is a n a uto ma tic d e c line . C -p a p ma c hine fo r sle e p a p ne a is o k a s lo ng a s b o ttle d o xyg e n o r c o nc e ntra to r is no t use d with it. Se a so na l a sthma / a lle rg ie s ma y b e a c c e p ta b le d e p e nd ing o n c irc umsta nc e s. 15. Any o ng o ing inje c tio n the ra p y. 16. Insulin use (Bye tta a nd Vic to za a re a c c e p ta b le me d ic a tio ns). 17. Pe rm a ne nt o sto my b a g (c o lo sto my o r ile o sto m y). 18. Lup us. 19. C irrho sis o f the live r.

Fo r E- a pplic a tio n Instruc tio ns ple a se c lic k the link o n the we b site title d "Me d Supp E- a pplic a tio n Instruc tio ns." Ple a se re a d a ll instruc tio ns b e fo re sub m itting yo ur first Me dic a re Supple m e nt E- a pplic a tio n.

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G ua ra nte e d Issue fo r Elig ib le Pe rso ns The fo llo wing a re the mo st c o mmo n g uid e line s fo r d e te rmining a p p lic a nts who q ua lify a s g ua ra nte e d issue in a c c o rd a nc e with sta te a nd fe d e ra l re g ula tio ns. C e rta in re g ula tio ns ma y va ry b y sta te . The se g uid e line s a re no t a ll-inc lusive . G ua ra nte e d Issue p la ns a re p la ns A, B, C , F, inc lud ing Hig h De d uc tib le F, if the se p la ns a re o ffe re d in yo ur sta te . An e lig ib le p e rso n is a n ind ivid ua l d e sc rib e d in a ny o f the fo llo wing :

1. The ind ivid ua l is e nro lle d und e r a n e m p lo ye e we lfa re b e ne fit p la n tha t p ro vid e s he a lth b e ne fits tha t sup p le me nt Me d ic a re , a nd the p la n te rm ina te s, o r the p la n c e a se s to p ro vid e a ll sup p le me nta l b e ne fits. Do c ume nta tio n with the te rmina tio n d a te o f the g ro up c o ve ra g e fo r the a p p lic a nt is re q uire d .

2. The ind ivid ua l is e nro lle d und e r a n e m p lo ye e we lfa re b e ne fit p la n tha t is p rim a ry to Me d ic a re a nd the p la n te rm ina te s o r the p la n c e a se s to p ro vid e a ll he a lth b e ne fits b e c a use the ind ivid ua l le a ve s the p la n. Do c um e nta tio n with the te rm ina tio n d a te o f the g ro up c o ve ra g e fo r the a p p lic a nt is re q uire d .

3. The ind ivid ua l is e nro lle d in a Me d ic a re Ad va nta g e Pla n und e r Pa rt C (MA) a nd the c e rtific a tio n o f the o rg a niza tio n o r p la n ha s b e e n te rmina te d . Do c ume nta tio n is re q uire d .

4. The MA p la n ha s d isc o ntinue d p ro vid ing the p la n in the a re a in whic h the ind ivid ua l re sid e s. Do c ume nta tio n is re q uire d .

5. The ind ivid ua l m o ve s o ut o f the a re a se rvic e d b y the MA p la n. Do c um e nta tio n is re q uire d .

6. The ind ivid ua l ha d a Me d ic a re Sup p le me nt p o lic y, te rm ina te s tha t c o ve ra g e a nd e nro lls fo r the first time in a MA p la n, a nd d e c id e s to d ise nro ll fro m the p la n within the first 12 mo nths. Dise nro llme nt must b e ve rifie d .

7. An ind ivid ua l, up o n first b e c o ming e nro lle d in Me d ic a re Pa rt B a t a g e 65, e nro lls in a MA p la n, a nd d e c id e s to d ise nro ll fro m the p la n no la te r tha n 12 mo nths a fte r the e ffe c tive d a te o f e nro llme nt. (In this c a se , the a p p lic a nt is e lig ib le fo r ANY p la n we o ffe r in yo ur sta te .) Dise nro llme nt must b e ve rifie d . If a n a p p lic a nt fulfills a ny o f the a b o ve g ua ra nte e d issue re q uire me nts, a nd the y ha ve a p p lie d fo r a Pla n A, B, C , F, o r Hig h De d uc tib le F, the p o lic y will b e g ua ra nte e d issue . The Ho me o ffic e will no t c o nd uc t a te le p ho ne inte rvie w fo r a p p lic a nts who q ua lify fo r a g ua ra nte e d issue d p o lic y.

If a n a p p lic a nt fulfills a ny o f the a b o ve g ua ra nte e d issue re q uire m e nts, a nd the y ha ve a p p lie d fo r a Pla n A, B, C , F, o r Hig h De d uc tib le F, the p o lic y will b e g ua ra nte e d issue . The ho me o ffic e will no t c o nd uc t a te le p ho ne inte rvie w fo r a p p lic a nts who q ua lify fo r a g ua ra nte e d issue d p o lic y.

De c line s a nd Appe a ls Any a p p lic a nt wishing to kno w the re a so n fo r the ir d e c line d a p p lic a tio n ma y re q ue st the info rma tio n b y se nd ing in a writte n re q ue st to o ur Und e rwriting De p a rtme nt. The y ma y a lso se nd in a writte n re q ue st to a p p e a l o ur d e c isio n a lo ng with a ny sup p o rting me d ic a l re c o rd s.

The se g uide line s a re no t a ll inc lusive . The re m a y b e c o nditio ns tha t a re no t liste d in this g uide tha t a re de c lina b le . Ple a se c o nta c t o ur Unde rwriting de pa rtm e nt if yo u ha ve a dditio na l q ue stio ns o r spe c ific he a lth sc e na rio s to g o o ve r.

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