Current through August 31, 2023
01.
Application Forms.
Application forms include the following questions designed to elicit
information as to whether, as of the date of the application, the applicant
currently has another Medicare supplement, Medicare Advantage, Medicaid
coverage, or another health insurance policy or certificate in force or whether
a Medicare supplement policy or certificate is intended to replace any other
accident and sickness policy or certificate presently in force. A supplementary
application or other form to be signed by the applicant and agent containing
such questions and statements may be used. (3-31-22)
02.
Statements. (3-31-22)
a. You do not need more than one (1) Medicare
supplement policy. (3-31-22)
b. If
you purchase this policy, you may want to evaluate your existing health
coverage and decide if you need multiple coverages. (3-31-22)
c. You may be eligible for benefits under
Medicaid and not need a Medicare supplement policy. (3-31-22)
d. If, after purchasing this policy, you
become eligible for Medicaid, the benefits and premiums under your Medicare
supplement policy can be suspended, if requested, during your entitlement to
benefits under Medicaid for twenty-four (24) months. You need to request this
suspension within ninety (90) days of becoming eligible for Medicaid. If you
are no longer entitled to Medicaid, your suspended Medicare supplement policy
(or, if that is no longer available, a substantially equivalent policy) will be
reinstituted if requested within ninety (90) days of losing Medicaid
eligibility. If the Medicare supplement policy provided coverage for outpatient
prescription drugs and you enrolled in Medicare Part D while your policy was
suspended, the reinstituted policy will not have outpatient prescription drug
coverage, but will otherwise be substantially equivalent to your coverage
before the date of the suspension. (3-31-22)
e. If you are eligible for and have enrolled
in a Medicare supplement policy 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 policy can be suspended, if requested,
while you are covered under the employer or union-based group health plan. If
you suspend your Medicare supplement policy under these circumstances, and
later lose your employer or union-based group health plan, your suspended
Medicare supplement policy (or, if that is no longer available, a substantially
equivalent policy) will be reinstituted if requested within ninety (90) days of
losing your employer or union-based health plan. If the Medicare supplement
policy provided coverage for outpatient prescription drugs and you enrolled in
Medicare Part D while your policy was suspended, the reinstituted policy will
not have outpatient prescription drug coverage, but will otherwise be
substantially equivalent to your coverage before the date of the suspension.
(3-31-22)
f. Counseling services
are available through the Senior Health Insurance Benefit Advisors program
(SHIBA), to provide advice concerning your purchase of Medicare supplement
insurance and concerning medical assistance through the state Medicaid program,
including benefits as a Qualified Medicare Beneficiary (QMB) and a Specified
Low-Income Medicare Beneficiary (SLMB). (3-31-22)
03.
Agents. Agents will list any
other health insurance policies they have sold to the applicant. (3-31-22)
a. List policies sold which are still in
force. (3-31-22)
b. List policies
sold in the past five (5) years which are no longer in force.
(3-31-22)
04.
Direct Response Issuer. In the case of a direct response issuer, a
copy of the application or supplemental form, signed by the applicant, and
acknowledged by the insurer, is returned to the applicant by the insurer upon
delivery of the policy. (3-31-22)
05.
Notice Regarding Replacement of
Medicare Supplement Coverage. Upon determining that a sale will involve
replacement of Medicare supplement coverage, any issuer, other than a direct
response issuer, or its agent, furnishes the applicant, prior to issuance or
delivery of the Medicare supplement policy or certificate, a notice regarding
replacement of Medicare supplement coverage. One (1) copy of the notice signed
by the applicant and the agent, except where the coverage is sold without an
agent, is provided to the applicant and an additional signed copy is retained
by the issuer. A direct response issuer delivers to the applicant at the time
of the issuance of the policy the notice regarding replacement of Medicare
supplement coverage. (3-31-22)
06.
SHIBA and Consumer Assistance Link. The notice prescribed in
Subsection 071.05 for an issuer is provided
in the NAIC Model Regulation as incorporated by reference in Section
002 of this rule, which includes
NAIC Appendixes A, B, and C and all other outlines of coverage and specific
plan designs which can be accessed on the Idaho Department of Insurance
website. To obtain a copy of the NAIC Model Regulation, contact SHIBA at the
Idaho Department of Insurance. (3-31-22)
