New! Med Supp application now includes document upload for guaranteed issue rights
Guaranteed issue cases often require extra follow‑up, manual documentation, and delays that can impact you and your clients. Based on your feedback, we’ve enhanced our Medicare Supplement online application, which helped:
- Streamline the application process
- Reduce follow‑up requests and delays
- Ensure timely review of guaranteed issue eligibility
We will continue to strive for turnaround times of 2–5 days for underwritten application, subject to peak volume seasonality.
What qualifies as guaranteed issue supporting documentation
You may upload the following documentation for guaranteed issue eligibility. Please make sure documents are clear and legible, preferably on carrier letterhead (if applicable), to expedite processing. All documents will be reviewed to confirm guaranteed issue eligibility.
- Proof of prior coverage termination or non‑renewal notice
- Employer or plan sponsor letter confirming loss of medical coverage
- Medicare Advantage or PACE plan disenrollment confirmation notice
- Letter from prior Medigap insurer documenting bankruptcy or coverage termination
- CMS or carrier correspondence supporting trial right timelines
- Power of Attorney (POA) paperwork
- Current insurance, Medicare Advantage, Medicare Supplement, or state issued ID cards
- Proof insurance is paid to date, such as a bank statement
- Valid proof of address, such as a utility bill
- Certificate of insurance, policy summary, or schedule pages
Timing for submitting guaranteed issue rights application
Clients must generally apply within 63 days of their prior coverage ending to preserve guaranteed issue rights. If client knows they will be applying in advance of their loss of coverage, they can apply up to 60 days in advance of the expected loss of coverage date.
Guaranteed issue rights details and benefits
When guaranteed issue rights apply, clients receive important protections, including:
- No medical underwriting
- No pre‑existing condition waiting periods
- No health‑based rate increases
Guaranteed issue rights generally apply when a client experiences a qualifying coverage event, including:
- Employer or union group health plan ends
- Retiree coverage ends or the individual leaves the group plan
- Medigap Anniversary Rule
- Loss of Medicare Advantage or PACE coverage – Plan stops operating, leaves the service area, or terminates coverage
- Medicare Advantage trial right (first time at age 65) – Client joined a Medicare Advantage plan when first eligible and switches back to Original Medicare within 12 months
- Medigap coverage ends involuntarily – Carrier bankruptcy or documented fraud causes coverage termination
- Returning to Medigap trial right from Medicare Advantage – Client dropped Medigap policy to join a Medicare Advantage plan for the first time, was on the Medicare Advantage plan less than 12 months and wants to repurchase the same Medigap plan.
If you have questions about eligible situations or documentation, your Blue KC team is here to help. Thank you for continuing to partner with us to make Medicare coverage transitions as smooth as possible for your clients and our members.
