Gerberlife.com

Medicare Supplement
Table of Contents
Contacts . Page 1
• Addresses for Mailing and Delivery Receipts• Online Forms• Important Phone Numbers Introduction . Page 2
Policy Issue Guidelines . Page 3
• Open Enrollment• States with Under Age 65 Requirements• Selective Issue• Application Dates• Coverage Effective Dates• Replacements• Reinstatements• Medicare Select to Medicare Supplement Conversion Privilege• Telephone Interviews• Pharmaceutical Information• Policy Delivery Receipt• Guarantee Issue Rules − Guaranteed Issue Rights for Voluntary Termination of Group Health Plan− Additional State Specific Rights− Guaranteed Issue Rights for Loss of Medicaid Qualification Medicare Advantage (MA) . Page 9
• Medicare Advantage (MA) Annual Election Period• Medicare Advantage (MA) Proof of Disenrollment• Guarantee Issue Rights Premium . Page 11
• Calculating Premium• Types of Medicare Policy Ratings• Height and Weight Chart• Completing the Premium on the Method of Payment Form• Collection of Premium• Business Checks• Premium Receipt and Notice of Information Practices• Shortages• Refunds• General Administrative Rule – 12 Month Rate Application . Page 15
• Application Sections − Section A – Plan Information Section− Section B – Applicant Information− Section C – Medicare Information − Section D – Previous or Existing Coverage Information− Section E – Please answer all of the following questions− Section F – Health Information− Section G – Medication Information− Section H – Agreement and Authorization− Section J – To be Completed by Producer Health Questions . Page 17
• Uninsurable Health Conditions• Partial List of Medications Associated with Uninsurable Health Conditions Mailing Applications to Prospects . Page 20
• The Facts• The Process Required Forms . Page 23
• Application• Producer Information Page• Method of Payment Form• Premium Receipt and Notice of Information Practices• Replacement Form• Select Disclosure Agreement• Agent or Witness Certification for Non-English Speaking and/or Reading Applicants State Special Forms . Page 24
• Arkansas – Documentation of Solicitation of Medicare Related Products form• California – California Agent / Applicant Meeting Form – Guarantee Issue and Open Enrollment Notice for California • Colorado – Commission Disclosure Form• Florida– Florida Certification Form• Illinois – Medicare Supplement Checklist• Iowa – Important Notice Before You Buy Health Insurance• Kentucky – Medicare Supplement Comparison Statement• Louisiana – Your Rights Regarding the Release and Use of Genetic Information• Maryland – Eligible Persons for Guarantee Issue and Open Enrollment• Minnesota – Agent Information Form• Montana – Privacy Notice• Nebraska – Senior Health Counseling Notice• Ohio – Solicitation and Sale Disclosure• New Mexico – New Mexico Confidential Abuse Information• Pennsylvania – Guarantee Issue and Open Enrollment Notice• South Carolina – Duplication of Insurance Form• Texas – Definition of Eligible Person for Guaranteed Issue Notice• Wisconsin – Disclosure of Other Health Insurance Sold to Applicant by Agent CONTACTS
Addresses for Mailing New Business and Delivery Receipts
When mailing or shipping your new business applications, be sure to use the preaddressed envelopes.
Administrative Office Mailing Information
Mailing Address
Overnight/Express Address
Gerber Life Insurance Company Gerber Life Insurance CompanyP.O. Box 2271 Records/Mailing Processing Center Omaha, NE 68103-2271 9330 State Highway 133 Blair, NE 68008-6179 FAX Number for New Business - Automated Bank Account Withdrawal Applications
1-866-422-9139
Online Forms, General and State Specific
• Enter user name and password and click "log in".
USER NAME: medsupp
PASSWORD: medsupp
Important Phone Numbers
Phone Number
Compensation Support Center Customer Call Center, Service Customer Call Center, Claims INTRODUCTION
This guide provides information about the evaluation process used in the underwriting and issuing of
Medicare supplement insurance policies. Our goal is to process each application as quickly and efficiently
as possible while assuring proper evaluation of each risk. To ensure we accomplish this goal, the producer
or applicant will be contacted directly by underwriting if there are any problems with an application.
POLICY ISSUE GUIDELINES
All applicants must be covered under Medicare Part A & B in Michigan, Texas and Washington; in all other
states, only Part A is required. Policy issue is state specific. The applicant's state of residence controls the
application, forms, premium and policy issue. If an applicant has more than one residence, the state where
taxes are filed should be considered as the state of residence. Please refer to your introductory materials for
required forms specific to your state.
Open Enrollment
To be eligible for open enrollment, an applicant must be at least 64 ½ years of age (in most states) and be within six months of his/her enrollment in Medicare Part B.
Applicants covered under Medicare Part B prior to age 65 are eligible for a six-month open enrollment period upon reaching age 65.
Additional Open Enrollment periods for Residents of the following state:
California – Annual Open Enrollment lasting 60 days, beginning 30 days before and ending 30 days after
the individual's birthday, during which time a person may replace any Medicare supplement policy with
a policy of equal or lesser benefits. Coverage will not be made effective prior to the individual's birthday.
Please include documentation verifying the Plan information and paid to date of the current coverage. If
replacing a pre-standardized Plan, a copy of the current policy or policy schedule is required.
Missouri – Individuals that terminate a Medicare supplement policy within 30 days of the annual policy
anniversary date may obtain the same plan on a guarantee issue basis for a period of 63 days after the
termination of their existing policy, from any issuer that offers that plan. This would include Medicare
supplement and select plans. Please include documentation verifying the Plan information, paid-to-date
and the policy anniversary of the current coverage. For policies with an effective date of 6/1/2010 or after,
individuals with existing plans E, H, I and J can convert to one of the following plans: A, B, C, F, K or L.
Oregon – Annual Open Enrollment lasting 60 days, beginning 30 days before and ending 30 days after
the individual's birthday, during which time a person may replace any standardized Medicare supple-
ment policy with a policy of equal or lesser benefits. Coverage will not be made effective prior to the
individual's birthday. Please include documentation verifying the Plan information and paid to date of the
current coverage.
Washington – Individuals who currently have a standardized Medicare supplement plan may replace the
plan as indicated below on an Open Enrollment basis.
• Persons with a Plan A may only move to another Plan A.
• Persons with a Plan B, C, D, E, F, G, M or N may move to any other Plan B, C, D, F (including high deductible), G, M or N (Whether higher or lower in benefits compared to current plan.) • Persons with a "Standardized" Plan H, I or J may move to another less comprehensive Plan B, C, D, F, G, M or N.
• Please include documentation verifying the Plan information and paid-to-date of the current coverage.
Note: Plans E, H, I and J will no longer be available for new business as of June 1, 2010.
States with Under Age 65 Requirements
California
Plans A & F available. Open enrollment if applied for within six months of Part B enrollment. Not available for individuals with end stage renal disease.
Colorado
All plans available. Open enrollment if applied for within six months of Part B enrollment.
Delaware
All plans are available. Open enrollment if within six months of Part B enrollment.
All plans are available. Open enrollment if applied for within six months of Part B enrollment.
All plans available. Open enrollment if applied for within six months of Part B enrollment.
Illinois
All plans available. Open enrollment if applied for within six months of Part B enrollment.
All plans available. Open enrollment if applied for within six months of Part B enrollment.
Kentucky
All plans are available. No open enrollment. All applications are underwritten.
Louisiana
All plans available. Open enrollment if applied for within six months of Part B enrollment.
Maryland
Plan A available. Open enrollment if applied for within six months of Part B enrollment.
Minnesota
All plans and riders available. Open enrollment if applied for within six months of Part B enrollment.
Mississippi
All plans available. Open enrollment if applied for within six months of Part B enrollment.
Missouri
All plans available. Open enrollment if applied for within six months of Part B enrollment.
New Hampshire All plans available. Open enrollment if applied for within six months of Part B
enrollment.
New Jersey Plan C available to people ages 50-64. Open enrollment if applied for within six
months of Part B enrollment.
North Carolina
Plans A & F available. Open enrollment if applied for within six months of Part B enrollment.
Oklahoma
Plan A is available. Open enrollment if applied for within six months of Part B enrollment.
All plans available. Open enrollment if applied for within six months of Part B enrollment.
Pennsylvania All plans available. Open enrollment if applied for within six months of Part B
enrollment.
South Dakota All plans available. Open enrollment if applied for within six months of Part B
enrollment.
Tennessee
All plans available. Open enrollment if applied for within six months of Part B enrollment for persons no longer having access to alternative forms of health insurance coverage due to termination or action unrelated to the individuals status, conduct or failure to pay premium or persons being involuntarily disenrolled from Title XIX (Medicaid) or Title XXI (State Children's Health Insurance Program) of Social Security Act. Alternative forms of health insurance, in the statement above, include accident and sickness policies, employer sponsored group health coverage or Medicare Advantage plans. Plan A is available. Open enrollment if applied for within six months of Part B enrollment.
Wisconsin
Base policy and riders are available. Open enrollment if within six months of Part B Applicants over the age of 65, or under age 65 in the states listed above, and at least six months beyond enrollment in Medicare Part B will be selectively underwritten. All health questions must be answered. The answers to the health questions on the application will determine the eligibility for coverage. If any health questions are answered "Yes," including "Not Sure" in California, the applicant is not eligible for coverage. Applicants will be accepted or declined. Elimination endorsements will not be used.
In addition to the health questions, the applicant's height and weight will be taken into consideration when determining eligibility for coverage. Coverage will be declined for those applicants who are outside the es-tablished height and weight guidelines.
Health information, including answers to health questions on applications and claims information, is con-fidential and is protected by state and federal privacy laws. Accordingly, Gerber Life Insurance Company does not disclose health information to any non-affiliated insurance company. • Open Enrollment – Up to six months prior to the month the applicant turns age 65• Underwritten Cases – Up to 60 days prior to the requested coverage effective date• West Virginia – Applications may be taken up to 30 days prior to the month the applicant turns age 65.
• Wisconsin – Applications may be taken up to three months prior to an applicant's Medicare eligibility date.
Coverage Effective Dates
Coverage will be made effective as indicated below: 1. Between age 64 ½ and 65 – The first of the month the individual turns age 65.
2. All Others – Application date or date of termination of other coverage, whichever is later.
A "replacement" takes place when an applicant terminates an existing Medicare supplement/Select policy and replaces it with a new Medicare supplement policy. Gerber Life requires a fully completed application when applying for a replacement policy (both internal and external replacements). A policyowner wanting to apply for a nontobacco plan must complete a new application and qualify for coverage.
If an applicant has had a Medicare supplement policy issued by Gerber Life within the last 60 days, any new applications will be considered to be a replacement application. If more than 60 days has elapsed since prior coverage was in force, then applications will follow normal underwriting rules.
All replacements involving a Medicare supplement, Medicare Select or Medicare Advantage plan must include a completed Replacement Notice. One copy is to be left with the applicant; one copy should accompany the application. The replacement cannot be applied for on the exact same coverage and exact same company.
The replacement Medicare supplement policy cannot be issued in addition to any other existing Medicare supplement, Select or Medicare Advantage plan.
When a Medicare supplement policy has lapsed and it is within 90 days of the last paid to date, coverage may be reinstated, based upon meeting the underwriting requirements.
When a Medicare supplement policy has lapsed and it is more than 90 days beyond the last paid to date, the coverage cannot be reinstated. The client may, however, apply for new coverage. All underwriting requirements must be met before a new policy can be issued.
Medicare Select to Medicare Supplement Conversion Privilege
Policy owners covered under a Medicare Select plan with Gerber Life Insurance Company may decide they no longer wish to participate in our hospital network. Coverage may be converted to one of our Medi-care supplement plans not containing network restrictions. We will make available any Medicare supple-ment policy offered in their state that provides equal or lesser benefits. A new application must be com-pleted; however, evidence of insurability will not be required if the Medicare Select policy has been inforce for at least six months at the time of conversion.
Random telephone interviews with applicants will be conducted on underwritten cases. Please be sure to advise your clients that we may be calling to verify the information on their application. In Wisconsin, telephone interviews will be conducted with applicants age 75 and over on underwritten cases.
Gerber has implemented a process to support the collection of pharmaceutical information for underwritten Medicare supplement applications. The "Authorization to Disclose Personal Information (HIPAA)" is included in the Agreement and Authorization section of the application. Prescription infor-mation noted on the application will be compared to the additional pharmaceutical information received. This additional information will not be solely used to decline coverage.
Policy Delivery Receipt
Delivery receipts are required on all policies issued in Louisiana, South Dakota and West Virginia. Two copies of the delivery receipt will be included in the policy package. One copy is to be left with the client. The second copy must be returned to Gerber in the postage-paid envelope which is also included in the policy pack-age. In Kentucky and Nebraska the policy is allowed to be mailed directly to the insured. If this option is elected, the delivery receipt does not need to be included in the policy package; If the policy is not mailed directly to the insured a delivery receipt will need to be included in the policy package.
Guarantee Issue Rights
The situations listed below are based upon scenarios found in the Guide to Health Insurance. Note: All plans we offer are not available guarantee issue.
Guarantee Issue Situation
Client has the right to buy. .
Client is in the original Medicare Plan and has an Medigap Plan A, B, C, F, K or L that is sold in cli-employer group health plan (including retiree or ent's state by any insurance company.
COBRA coverage) or union coverage that pays af-ter Medicare pays. That coverage is ending.
If client has COBRA coverage, client can either buy a Medigap policy/certificate right away or wait Note: In this situation, state laws may vary.
until the COBRA coverage ends.
Client is in the original Medicare Plan and has a Medicare SELECT policy/certificate. Client moves out of the Medicare SELECT plan's service area.
Medigap Plan A, B, C, F, K or L that is sold by any insurance company in client's state or the state he/ Client can keep the Medigap policy/certificate or she is moving to.
he/she may want to switch to another Medigap policy/certificate.
Client's Medigap insurance company goes bankrupt and the client loses coverage, or client's Medigap Medigap Plan A, B, C, F, K or L that is sold in cli- policy/certificate coverage otherwise ends through ent's state by any insurance company.
no fault of client.
Group Health Plan Proof of Termination
Proof of Involuntary Termination: If applying for Medicare supplement, Underwriting cannot issue
coverage as Guarantee Issue without proof that an individual's employer coverage is no longer offered. The following is required:• Complete the Other Health Insurance section on the Medicare supplement application; and• Provide a copy of the termination letter, showing date of and reason for termination, from the employer or group carrier Proof of Voluntary Termination: Under the state specific voluntary terminations scenarios, the following proof of termincation is required along with completing the Other Health Insurance section on the Medicare supplement application:
• Certificate of Group Health Plan Coverage.
• In IA, NM, OK, VA and WV, provide proof of change in benefits from employer or group carrier.
Guaranteed Issue Rights for Voluntary Termination of Group Health Plan
Qualifies for Guaranteed Issue.
CO, ID, IL, IN, MT, NJ, if the employer sponsored plan is primary to Medicare.
OH, PA, TXAR, FL, KS, LA, MO, No conditions - always qualifies.
if the employer sponsored plan's benefits are reduced, with Part B coinsurance no longer being covered.
if the employer sponsored plan's benefits are reduced, but does not include a defined if the employer sponsored plan's benefits are reduced substantially.
if the annualized premium for the employer sponsored plan would be greater than 125% of the Basic Annual Premium for the applicant's age, gender and tobacco, then the applicant would qualify for GI eligibility.
For purposes of determining GI eligibility due to a Voluntary Termination of an employer sponsored group welfare plan, a reduction in benefits will be defined as any increase in the insured's deductible amount or their coinsurance requirements (flat dollar co-pays or coinsurance %). A premium increase without an increase in the deductible or coinsurance requirement will not qualify for GI eligibility. This definition will be used to satisfy IA, NM, OK, VA and WV requirements. Proof of coverage termination is required.
Additional State Specific Guarantee Issue Rights
Minnesota
Basic Plan and any combination of these riders: Part A Deductible, Part B Deductible, and Part B Excess for all Guarantee Issue situations.
Wisconsin
All plans and riders available for all Guarantee Issue situations.
Guarantee Issue Rights for Loss of Medicaid Qualification
State Open Enrollment Situation
Client has the right to buy. .
Client is enrolled in Medicare Part B, and as a 65 years or older
result of an increase in income or assets, is no longer any Medigap plan offered by any issuer.
eligible for Medi-Cal benefits, or is only eligible Under Age 65
for Medi-Cal benefits with a share cost and certify Plans A and F. Not available for at the time of application that they have not met individuals with end stage renal disease.
the share of cost. Open enrollment beginning with notice of termination and ending six months after the termination date.
State Guarantee Issue Situation
Client has the right to buy. .
Client loses eligibility for health benefits under any Medigap plan offered by any issuer.
Medicaid. Guaranteed Issue beginning with notice of termination and ending 63 days after the termina-tion date.
Client is enrolled in an employee welfare benefit Medigap Plan A, B, C, F (including F plan or a state Medicaid plan that provides health with a high deductible), K or L offered by benefits that supplement the benefits under Medi- care, and the plan terminates or the plan ceases to provide all such supplemental health benefits. Guar-anteed Issue beginning with notice of termination and ending 63 days after the termination date.
Client, age 65 and older covered under Medicare Part
Medigap Plan A, B, C, F (including F with B, enrolled in Medicaid (TennCare) and the enrollment a high deductible), K or L offered by any involuntarily ceases, is in a Guaranteed Issue beginning issuer.
with notice of termination and ending 63 days after the
termination date.
Client, under age 65, losing Medicaid (TennCare) cover- any Medigap plan offered by any issuer.
age have a 6 month Open Enrollment period beginning on the date of involuntary loss of coverage.
Client loses eligibility for health benefits under Medigap Plan A, B, C, F (including F Medicaid. Guaranteed Issue beginning with notice with a high deductible), K or L offered by of termination and ending 63 days after the termina- any issuer; except that for persons under tion date.
65 years of age, it is a policy which has a benefit package classified as Plan A.
Client is enrolled in Medicaid and is involuntarily Medigap Plan A, B, C, F (including F terminated. Guaranteed Issue beginning with notice with a high deductible), K or L offered by of termination and ending 63 days after the termina- Client is eligible for benefits under Medicare Parts Wisconsin's Basic Medicare supplement A and B and is covered under the medical assistance policy or certificate, along with any of- program and subsequently loses eligibility in the fered rider.
medical assistance program. Guaranteed Issue begin-ning with notice of termination and ending 63 days after the termination date.
MEDICARE ADVANTAGE (MA)
Medicare Advantage (MA) Annual Election Period
General Election Periods
for Medicare Advantage
• Enrollment selection for a MA plan Oct. 15th – Dec. 7th Annual Election Period (AEP) • Disenroll from a current MA plan • Enrollment selection for Medicare Part D• MA enrollees to disenroll from any MA plan and return to Original Medicare The MADP does not provide an oppourtunity to: • Switch from original Medicare to a Medicare Medicare Advantage Disenroll- Jan. 1st – Feb. 14th • Switch from one Medicare Advantage Plan to ment Period (MADP) • Switch from one Medicare Prescription Drug • Join, switch or drop a Medicare Medical Sav- ings Account Plan There are many types of election periods other than the ones listed above. If there is a question as to whether or not the MA client can disenroll, please refer the client to the local SHIP office for direction.
Medicare Advantage (MA) Proof of Disenrollment
If applying for a Medicare supplement, Underwriting cannot issue coverage without proof of disenrollment. If a member disenrolls from Medicare, the MA plan must notify the member of his/her Medicare supplement guaran-tee issue rights.
Disenroll during AEP and MADP
Complete the MA section on the Medicare supplement application; and
ONE of the following with the application
a. A copy of the applicant's MA plan's termination noticeb. Image of insurance ID card (only allowed if MA plan is being terminated) If an individual is disenrolling outside AEP/MADP
1. Complete the MA section on the Medicare supplement application; and2. Send a copy of the applicant's MA plan's disenrollment notice with the application.
For any questions regarding MA disenrollment eligibility, contact your State Health Insurance Assistance Program (SHIP) office or call 1-800-MEDICARE, as each situation presents its own unique set of circum-stances. The SHIP office will help the client disenroll and return to Medicare.
Guarantee Issue Rights
The situations listed below are based upon scenarios found in the Guide to Health Insurance.
Note: All plans we offer are not available guarantee issue.
Guarantee Issue Situation
Client has the right to…
Client's MA plan is leaving the Medicare program, buy a Medigap Plan A, B, C, F, K or L that is sold stops giving care in his/her area, or client moves out in the client's state by any insurance carrier. Client of the plan's service area.
must switch to original Medicare Plan.
Client joined an MA plan when first eligible for Medicare Part A at age 65 and within the first year buy any Medigap plan that is sold in your state by of joining, decided to switch back to original Medi- any insurance company.
obtain client's Medigap policy/certificate back if that Client dropped his/her Medigap policy/certificate to carrier still sells it. If his/her former Medigap policy/join an MA Plan for the first time, have been in the certificate is not available, the client can buy a Me-plan less than a year and want to switch back.
digap Plan A, B, C, F, K or L that is sold in his/her state by any insurance company.
Client leaves an MA plan because the company has buy Medigap plan A, B, C, F, K or L that is sold in not followed the rules or has misled the client.
the client's state by any insurance company.
Client's group health plan ended and the client joined a MA Plan for the first time, has been in the buy any Medigap plan and riders plan less than a year, and wants to switch back to
Original Medicare. (Wisconsin only)
If you believe another situation exists, please contact the client's local SHIP office.
Utilize Outline of Coverage
• Determine ZIP code where the client resides and find the correct rate page for that ZIP code• Determine Plan• Determine if non-tobacco or tobacco• Find Age/Gender - Verify that the age and date of birth are the exact age as of the application date• This will be your base monthly premium Tobacco rates do not apply during Open Enrollment or Guarantee Issue situations in the fol-
lowing states:
Utilizing the Calculate Your Premium Form
• Enter the base premium on line #1 and proceed with the instructions that follow.
Types of Medicare Policy Ratings
• Community Rated - The same monthly premium is charged to everyone who has the Medicare
policy, regardless of age. Premiums are the same no matter how old the applicant is. Premiums may go up because of inflation and other factors, but not based on age.
• Issue-age Rated – The premium is based on the age the applicant is when the Medicare policy is
bought. Premiums are lower for applicants who buy at a younger age, and won't change as they get older. Premiums may go up because of inflation and other factors, but not because of applicant's age.
• Attained-age Rated – The premium is based on the applicant's current age so the premium goes up
as the applicant gets older. Premiums are low for younger buyers, but go up as they get older. In addition to change in age, premiums may also go up because of inflation and other factors.
Note: If a premium is paid by a business account, refer to the "Business Checks" section of this guide to deter-
mine if acceptable.
Rate Type Available by State
Tobacco /
Attained, Issue,
Tobacco Rates
Non-Tobacco
Gender Rates
or Community
During Open
Policy Fee
Height and Weight Chart
To determine whether you may purchase coverage, locate your height, then weight in the chart below. If your weight is in the Decline column, we're sorry, you're not eligible for coverage at this time. There will be a one-time application fee of $25.00 ($6.00 in Mississippi) that will be collected with each
applicant's initial payment. For a husband and wife written on the same application, $50 in fees must be
collected. This will not affect the renewal premiums. The application fee does not apply in Arkansas, Min-
nesota, Washington, or West Virginia.
Completing the Method of Payment Form
Premiums are calculated based upon the applicants exact age at the time of application, not
their age as of the requested coverage effective date.
Initial Premium
• The amount determined from the Calculate Your Premium Form will be the amount you enter on the Initial Premium Amount box.
• Mark the appropriate mode for the initial payment.
Ongoing Premium Payments
• Determine how the client wants to be billed going forward (renewal) and select the appropriate
mode on the Ongoing Premium Payments section.
• Monthly billing is not allowed.
Collection of Premium
At least one month's premium must be submitted with the application. If a mode other than monthly is selected, then the full modal premium must be submitted with the application. • Money orders, cashier's checks and counter checks are only acceptable if obtained by the applicant. Third party payors cannot obtain a money order or cashier's check on behalf of the applicant.
• In California, only one month's premium can be submitted with the application.
NOTE: Gerber does not accept post-dated checks or payments from Third Parties, including any Founda-
tions as premium for Medicare supplement/Select.
Business checks are only acceptable if they are submitted for the business owner or the owner's spouse. If
submitted for the business owner or spouse, complete the information located on the Payor Information
section (Part II) of the Method of Payment Form.
Premium Receipt and Notice of Information Practices
Leave the Premium Receipt and the Notice of Information Practices with the applicant. The Premium
Receipt must be completed when provided to applicant if premium is collected.
NOTE: Do not mail a copy of the receipt with the application.
Gerber will communicate with the producer by telephone, e-mail or FAX in the event of a premium shortage. The application will be held in pending until the balance of the premium is received. Producers may commu-nicate with Underwriting by calling 1-800-646-1999 or by FAX at 1-402-997-1871.
Gerber will make all refunds to the applicant in the event of rejection, incomplete submission, overpay-ment, cancellations, etc. Our General Administrative Rule – 12 Month Rate
Our current administrative practice is not to adjust rates for 12 months from the effective date of cover-age.
APPLICATION
Properly completed applications should be finalized within 5-7 days of receipt at Gerber's administrative
office. The ideal turnaround time provided to the producer is 11-14 days, including mail time.
The application must be completed in it's entirety. Please be sure to review your applications for the following information before submitting.
Administrative Information
• Agent Writing Number
• Enter your agent writing number or Social Security number.
Note: You do NOT need to complete the FAV Key field.
Section A — Plan Information Section
• Entire Section must be completed.
• This section should indicate the plan or policy form selected, requested effective date and the policy
delivery option.
Section B — Applicant Information
• Please complete the applicant's residence address in full. If premium notices are to be mailed to an
address other than the applicant's residence address, please complete the mailing address in full.
• Age and Date of Birth are the exact age as of the application date.
• Height/Weight —These are required on underwritten cases.
• Answer the tobacco question, this includes any tobacco, nicotine or e-cigarette use. (Refer to the
Calculating Premium section of this Guide for a list of states where Tobacco rates do not apply during open enrollment or guaranteed issue situations).
Section C — Medicare Information
• Medicare Claim number, also referred to as the Health Insurance Claim (HIC) number, is vital for
electronic claims payment.
• Please indicate if the applicant is covered under Parts A and B of Medicare.
Section D — Previous or Existing Coverage Information
• Verify if the applicant is covered through his/her state Medicaid program. If Medicaid is paying
for benefits beyond the applicant's Part B premium or the Medicare supplement premium for this policy, then the applicant is not eligible for coverage.
• If the applicant is replacing another Medicare supplement policy, complete question 2 and include the replacement notice.
• If the applicant is leaving a Medicare Advantage plan, complete question 3 and include the replacement notice.
• If the applicant has had any other health insurance coverage in the past 63 days, including coverage through a union plan, employer group health plan, or other non-Medicare supplement coverage, complete question 4. Section E — Please answer all of the following questions
• If the applicant is applying during a guaranteed issue period, be sure to include proof of eligibility.
• If either Applicant A or B answered "YES" to question 5 OR BOTH questions 6 and 7 in Section E,
they can skip to Section H — Agreement and Authorization.
Section F — Health Information
• If the applicant is applying during an open enrollment or a guaranteed issue period, do not answer
the health questions.
• If applicant is not considered to be in open enrollment or a guaranteed issue situation, all health questions must be answered.
NOTE: In order to be considered eligible for coverage, all health questions must be answered "No."
For questions on how to answer a particular health question, see the Health Questions
section of this Guide for clarification.
Section G — Medication Information
• If the applicant is applying during an open enrollment or a guaranteed issue period, do not answer
the medication information section.
• If applicant is not considered to be in open enrollment or a guaranteed issue situation, all medication information must be listed as indicated.
Section H — Agreement and Authorization
• Applicant acknowledges receiving the Guide to Health Insurance and Outline of Coverage. It is
required to leave these two documents with the client at the time the application is completed.
• Applicant agrees to the Authorization to Disclose Personal Information.
• Signatures and dates: required by applicant(s).
• If someone other than the applicant is signing the application (i.e., Power of Attorney), please include copies of the papers appointing that person as the legal representative.
Section J — To be Completed by Producer
• The producer(s) must certify that they have:
• provided the applicant with a copy of the replacement notice if applicable,• accurately recorded in the application the information supplied by the applicant,• and have interviewed the proposed applicant.
NOTE: Applications will only be accepted with an answer of "No" if the producer has submitted
the sales process for review and received written prior approval.
• Signatures and dates: required by producer(s).
• The producer must be appointed in the state where the application is signed.
• If an application is taken on a Kansas resident, the producer must be appointed in Kansas and in the state where the application is signed.
NOTE: Applicant's signature must match name of applicant on the application. In rare cases
where applicant cannot sign his/her name, a mark ("X") is acceptable. For their own protection, producers are advised against acting as sole witness.
HEALTH QUESTIONS
Unless an application is completed during open enrollment or a guarantee issue period, all health questions,
including the question regarding prescription medications, must be answered. Our general underwriting
philosophy is to deny Medicare supplement coverage if any of the health questions are answered "Yes," including "Not Sure" in
California. For a list of uninsurable conditions and the related medications associated with these conditions,
please refer to the next two sections in this guide.
There may, however, be situations where an applicant has been receiving medical treatment or taking prescription medication for a long-standing and controlled health condition. Those conditions are listed in health questions 12 and 14.
A condition is considered to be controlled if there have been no changes in treatment or medications for at least two years. If this situation exists and you would like consideration to be given to the application, an-swer the appropriate question "Yes," and attach an explanation stating how long the condition has existed and how it is being controlled. Be sure to include the names and dosages of all prescription medications.
If you have questions about the interpretation of health questions 12 on the application, please see the information below.
People with diabetes (insulin dependent or treated with oral medications) who also have one or more of the complicating conditions listed in question 12 on the application, are not eligible for coverage. For pur-poses of this question, hypertension (high blood pressure) is considered a heart condition. Some additional questions to ask your client to determine if he/she does have a complication include: Does he/she have eye/vision problems? Does he/she have numbness or tingling in the toes or feet? Does he/she have problems with circulation? Pain in the legs? Consideration for coverage may be given to those persons with well-controlled cases of hypertension and diabetes. A case is considered to be well controlled if the person is taking no more than two oral medica-tions for diabetes and no more than two medications for hypertension. A combination of insulin and one oral medication would be the same as two oral medications if the diabetes were well controlled. In general, to verify stability, there should be no changes in the dosages or medications for at least two years. Individ-ual consideration will be given where deemed appropriate. We consider hypertension to be stable if recent average blood pressure readings are 150/85 or lower.
Uninsurable Health Conditions
Applications should not be submitted if applicant has the following conditions: End-Stage Renal Disease (ESRD) Alzheimer's Disease Kidney disease requiring dialysis Chronic kidney disease Any cardio-pulmonary disorder requiring oxygen Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) Chronic hepatitis Lupus - Systemic Chronic Obstructive Pulmonary Disease (COPD) Multiple Sclerosis Other chronic pulmonary disorders to include: Myasthenia Gravis Chronic bronchitis Organ transplant Chronic obstructive lung disease (COLD) Osteoporosis with fracture Parkinson's Disease Chronic interstitial lung disease Chronic pulmonary fibrosis Other cognitive disorders to include: Mild cognitive impairment (MCI) Organic brain disorder Diabetes (MN and WI only) Emphysema In addition to the above conditions, the following will also lead to a decline: • Implantable cardiac defibrillator• Use of supplemental oxygen• Use of a nebulizer• Asthma requiring continuous use of three or more medications including inhalers• Taking any medication that must be administered in a physician's office• Advised to have surgery, medical tests, further diagnostic evaluation, treatment or therapy• If applicant's height/weight is in the decline column on the chart Partial List of Medications Associated with Uninsurable Health Conditions
This list is not all-inclusive. An application should not be submitted if a client is taking any of the following medications:
*Insulin (MN and WI only) AIDS, Cancer, Hepatitis Parkinson's Disease Parkinson's Disease Parkinson's Disease Parkinson's Disease Lasix / Furosemide Multiple Sclerosis Parkinson's Disease Parkinson's Disease Pulmonary Hypertension Multiple Sclerosis Multiple Sclerosis Parkinson's Disease Parkinson's Disease Multiple Sclerosis Parkinson's Disease Parkinson's Disease Multiple Sclerosis Alzheimer's Disease Cancer, Severe Arthritis, Rheumatoid Arthritis Parkinson's Disease Alzheimer's Disease Parkinson's Disease Rheumatoid Arthritis Parkinson's Disease Kidney Failure, AIDS Multiple Sclerosis Parkinson's Disease Parkinson's Disease Prednisone (>10 mg/day) Rheumatoid Arthritis, COPD Rheumatoid Arthritis Kidney Failure, AIDS Rheumatoid Arthritis Melanoma, Leukemia, Pulmonary Hypertension Parkinson's Disease *Coverage not available for individuals with diabetes in MN and WI.
Partial List of Medications Associated with Uninsurable Health Conditions (continued)
Multiple Sclerosis Amyotrophic Lateral Sclerosis Multiple Sclerosis Parkinson's Disease Parkinson's Disease Parkinson's Disease Parkinson's Disease Parkinson's Disease Hypercalcemia in Cancer MAILING APPLICATIONS TO PROSPECTS
Mailing a completed application adds a few steps to the normal sales process. Below is a description of the neces- sary steps.
The Facts
When Face-to-face Interviews Aren't Possible
Face-to-face interviews are always preferable, however, there will be times when you cannot meet with prospects in person. When necessary, and with the prospect's consent, you may conduct the interview over the phone and mail the completed application to the prospect.* This option is to be used only with people who have responded to lead-generation material or with whom you have ongoing client relationships. It is not appropriate for cold calling as national and corporate do-not- call rules and other compliance requirements apply. The Sales Process
The method for selling Medicare supplements doesn't change: Call a lead, review coverage, ask for the sale, complete and sign the application, submit the business, deliver the policy. The difference is that parts of the sales process may be conducted via the telephone instead of face-to-face. Consequently, there are a few more steps, outlined on the next two pages, to complete the sale. Improve Time Service
Submitting complete and accurate information ensures quick time service. Other factors are: • You must be licensed to sell in the state where the prospect is at the time of solicitation; that is the state where he/she is located when you ask the questions on the application • If an application is taken on a Kansas resident, the producer must be appointed in Kansas and in the state where the application is signed • The producer who solicits the business must sign the corresponding application • You cannot sign blank applications • It is not acceptable to mail blank applications, brochures and outlines as prospecting material Spot Check for Customer Satisfaction
To ensure that customers who complete Medicare supplement applications over the phone perceive this process as positive and that it's followed correctly, Gerber will call a portion of these applicants to: • Verify the content and accuracy of the information submitted • Determine their overall satisfaction level • Confirm that producers followed this process *Applies only to Gerber Medicare supplement products and does not change the current underwriting requirements for other Gerber Life Insurance Company products.
The Process
Please complete the following steps when you conduct the Medicare supplement sales interview over the phone and mail the completed application to the prospect: Call the prospect who responded to a lead.

When you receive a lead, telephone the person to discuss the benefits, rates and answer questions.
Attempt to schedule a face-to-face appointment to review details, ask for the sale and apply for coverage.
If the prospect prefers to continue the sales process on the phone, continue to Step 2.
Note: You must be licensed to sell in the state where the prospect is at the time of solicitation; that is the
state where he/she is located when asked the questions on the application.
Communicate the process.

If the prospect wants coverage and prefers to apply for a policy over the phone instead of in
person, explain the process before proceeding to Step 3:
1. Producer asks the prospect the questions on the application and required forms.
2. Producer mails the completed application and forms to the prospect for review and his/her signature.
3. Prospect carefully reviews the application and forms for completeness and accuracy and signs them.
4. Prospect returns the application, forms and premium in the provided postage-paid envelope.
5. Producer verifies all the required forms are completed and signed.
6. Producer submits the application through your usual channel.
7. When issued, the producer delivers the policy according to current policy delivery guidelines.
Complete the required forms over the telephone.

Ask the prospect all the questions on the application, replacement notice and state special forms
(if needed) and print the answers. Consider repeating his/her responses for accuracy.
Note: Privacy requirements prohibit discussing eligibility for other products over the telephone.
Mail forms to the prospect.
Place the following in an envelope and mail to the prospect:• Cover letter (attach your business card): - Indicating which forms to sign and what to return to you - Asking the prospect to verify all information including his/her Medicare card number, to make necessary corrections and initial changes - Inviting the prospect to contact you with any questions • Application and forms (replacement notice and state special forms, if needed) with signature areas and premium highlighted • Outline of Coverage, Guide to Health Insurance for People with Medicare • Postage-paid addressed envelope Note: Plan availability and premium rates are based on when the application is signed. The producer
must communicate changes in plan availability or premium to the prospect before submitting the forms
to Gerber.
Prospect reviews and signs forms.
Once the prospect receives the application and forms, he/she:• Verifies the responses and initials any corrections • Signs the application and forms as highlighted • Returns the application and forms to the producer in the provided envelope Verify and sign forms.
When you receive the envelope from the prospect, you: • Check that you have the first premium payment and the completed and signed application and forms • Verify that the prospect initialed any changes • Sign the required items • Send the Premium Receipt to the applicant Note: The producer who solicited the business must sign the application.
Submit for processing.
Submit the business (application and forms) in the usual manner.
Deliver the policy according to current policy delivery guidelines.
Questions?
Call Sales Support, 1-877-617-5592.
Only current Medicare supplement applications may be used in applying for coverage. A copy of the com-pleted application will be made by Gerber and attached to the policy to make it part of the contract.
The agent is responsible for submitting completed applications to Gerber's administrative office.
Producer Information Page
Producers must include their name and Agent Writing Number or Social Security number. A maximum of two producers are allowed and they should indicate the commission percentage shares, which must total 100%. Commission Code is required only if the producer is not appointed or licensed or is changing bro-kerage firms.
Method of Payment Form
Complete this required form regarding payment options and submit with all applications.
Premium and Notice of Information Practices
Receipt must be completed and provided to applicant as receipt for premium collected. Notice must be provided to applicant.
The replacement form must be signed and submitted with the application when replacing any Medicare supplement or Medicare Advantage application. A signed replacement notice must be left with the appli-cant; a second signed replacement notice must be submitted with the application.
In Wisconsin, the replacement form must also be completed when replacing any other health insurance.
Select Disclosure Agreement
The Select Disclosure Agreement form must be signed and submitted with the application when a Select
plan is chosen (Select plan not available in all states).
Agent or Witness Certification for Non-English Speaking and/or Reading Applicants
If the applicant does not speak English, this form is to be completed by the agent if agent is translating or a witness if a witness is translating. A copy must be submitted with the application and a copy left with the applicant.
STATE SPECIAL FORMS
Forms specifically mandated by states to accompany point of sale material.
Arkansas
Documentation of Solicitation of Medicare Related Products form – Form must be completed and
retained in agent's file for the applicant.
California
California Agent / Applicant Meeting Form – To be completed and signed by the Gerber Life
Insurance Company representative and given to applicant when a meeting to discuss Medicare supple-
ment insurance is scheduled.
Guarantee Issue and Open Enrollment Notice for California – This form includes the requirements
for individuals who are eligible for Guarantee Issue. This form must be read and signed by the Applicant
and Agent. A copy must be submitted with all applications and a copy left with the Applicant.
Colorado
Commission Disclosure Form – This form is to be completed by the Agent, then signed by the Agent
and Applicant. Leave a copy with the Applicant and retain a copy in the agent's file for the applicant.
Florida
Florida Certification Form – This form is to be completed by the Agent, then signed by the Agent and
Applicant. A copy must be submitted with the application and a copy left with the Applicant.
Illinois
Medicare Supplement Checklist – The Checklist must be completed and submitted with the applica-
tion and a copy left with the applicant.
Iowa
Important Notice before You Buy Health Insurance – To be left with the Applicant.
Kentucky
Medicare Supplement Comparison Statement – Form should be completed when replacing a Medi-
care supplement or Medicare Advantage plan and submitted with the application.
Louisiana
Your Rights Regarding the Release and Use of Genetic Information – This form is to be left with
the Applicant.
Maryland
Eligible Persons for Guarantee Issue and Open Enrollment – To be left with the Applicant.
Minnesota
Agent Information Form – This form is be completed and signed by the Agent and left with the applicant.
Montana
Privacy Notice – This form is to be left with the Applicant.
Nebraska
Senior Health Counseling Notice – This form is to be left with the Applicant.
New Mexico
New Mexico Confidential Abuse Information – Optional form, submit copy if completed.
Ohio
Solicitation and Sale Disclosure – This form is to be left with the Applicant.
Pennsylvania
Guarantee Issue and Open Enrollment Notice – To be left with the Applicant.
South Carolina
Duplication of Insurance – Form should be completed and submitted with the application when du-
plicating Medicare supplement insurance with other health insurance.
Texas
Definition of Eligible Person for Guaranteed Issue Notice – This notice must be provided to the
client.
Wisconsin
Disclosure of Other Health Insurance Sold to Applicant by Agent – To be completed and signed
by the Agent, then submitted with the application.

Source: https://www.gerberlife.com/gl/view/group_benefits/medsupp/documents/T03_238_0114.pdf