medicare supplement insurance applies to medicare...
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Aetna Proprietary Information 01/14 1
Medicare Supplement Insurance Applies to Medicare Supplement Policies underwritten by Aetna Life Insurance Company
Aetna Proprietary Information 01/14 2
The information included applies to Aetna Medicare Supplement insurance coverage underwritten by
Aetna Life Insurance Company (ALIC). Benefits and costs may vary depending upon the insurance
plan. Health insurance plans contain exclusions and limitations and are subject to eligibility
requirements. Neither Aetna Life Insurance Company nor any of its agents or Medicare Supplement
insurance policies are connected with or endorsed by the U.S. or state government, Social Security
or federal Medicare program.
Medicare Supplement Insurance policies underwritten by Aetna Life Insurance Company are available
on a Direct to Consumer basis as well as for sale by Internal Aetna Agents, Telesales and Select
National Distributors.
While this material is believed to be accurate as of the print date, it is subject to change.
Aetna Proprietary Information 01/14 3
Field Underwriting Guide Table of Contents
Introduction 4
Eligibility requirements 5
State-by-state eligibility grid 5
Definition of rating types 6
State-specific requirements for those under age 65 7
Effective dates 9
Open Enrollment 9
Guaranteed Issue rights 10
Application process delays 12
Payment and billing options 13
Contact Information 15
Agent responsibilities and checklist 16
Premium rate changes 18
Request for plan option change 18
Policy cancellation 19
Notification of member’s death to Aetna 19
Medical underwriting: Overview 19
Declinable conditions and medications 20
Other criteria for automatic declination 20
Previously declined applications 21
Medical underwriting process 21
Missing information 21
Medical records 22
Processing and pending timelines 22
Drug List Information 23
Aetna Proprietary Information 01/14 4
Introduction
This guide is designed to help you submit applications for the Aetna Medicare Supplement Plans
underwritten by Aetna Life Insurance Company (ALIC). It provides information to help you and
your clients to complete the application accurately to expedite the processing time in the
Underwriting department.
You should review the application for completeness and accuracy and make sure any necessary
documents are attached before you submit it.
The Medical Underwriting section of this guide summarizes common health conditions encountered in
the underwriting process. The medical underwriting risk criteria will help you anticipate the
underwriting outcome for policies not issued on a guaranteed-issue basis. The Underwriting
department will make the final decision.
This guide is intended as a brief overview only and is not intended to be the source for
underwriting decisions. Aetna reserves the right to request additional information or
decline coverage.
The final decision will be based on enrollment requirements, Medicare eligibility, health history and
medical underwriting risk criteria.
This guide and medical underwriting risk criteria are subject to revision and may change
at any time without notice.
Aetna Proprietary Information 01/14 5
Eligibility Requirements
To qualify for enrollment:
1. Applicants must be enrolled in Medicare Part A (Hospital Insurance) & Medicare Part B
(Medical Insurance) at the time of application.
2. Applicants must be age 65 or older (in some states, those under age 65 with a disability
and/or end-stage renal disease plans may be eligible).*
3. Applicants must live in the state in which Aetna Individual Medicare Supplement Plan
insurance policies are offered.
*Disabled individuals under age 65 may be eligible in the following states for the plans
specified:
State-by-State Plan Availability Grid
The charts below reflect Plan availability for Medicare Supplement Insurance Plans underwritten by
Aetna Life Insurance Company. Effective dates for recently approved states are shown below.
NOTE: The following information is provided for producers only and is not for distribution to Medicare
beneficiaries. This material provides a brief overview and is for informational purposes only. It
contains only a partial, general description of Aetna Individual Medicare Supplement Plan (Plan)
benefits, and rating, eligibility and state requirements. Please review Plan documents for a full
description of Plan eligibility, rating and state requirements and benefits. To view Plan documents, go
to AetnaMedicare.com. This document should not be used as or considered legal advice.
State Aetna Medicare
Supplement Plans
available to Medicare
beneficiaries age 65
and over
Rating Type
Alabama Plans A,B,F,G & N Attained Age
Arizona Plans A,B,F,G & N Issue Age
California Plans A,B,F,G & N Attained Age
Colorado Plans A,B,F,G & N Attained Age
Florida Plans A,B,F,G & N Issue Age
Georgia Plans A,B,F,G & N Issue Age
Illinois Plans A,B,F,G & N Attained Age
Indiana Plans A,B,F,G & N Attained Age
Iowa Plans A,B,F,G & N Attained Age
Kansas Plans A,B,F,G & N Attained Age
Kentucky Plans A,B,F,G & N Attained Age
Louisiana Plans A,B,F,G & N Attained Age
Maryland Plans A,B,F,G &,N Attained Age
Michigan Plans A,B,C,F,G & N Attained Age
Nebraska Plans A,B,F,G &,N Attained Age
Nevada Plans A,B,F,G & N Attained Age
New Jersey Plans A,B,C,F,G & N Attained Age
New York Plans A,B & F Community Rated
Aetna Proprietary Information 01/14 6
North Carolina Plans A,B,F,G & N Attained Age
Ohio Plans A,B,F,G & N Attained Age
Oklahoma Plans A,B,F,G & N Attained Age
Oregon Plans A,B,F,G & N Attained Age
Pennsylvania Plans A,B,F,G & N Attained Age
Rhode Island Plans A,B,F,G & N Attained Age
South Carolina Plans A,B,F,G & N Attained Age
Tennessee Plans A,B,F,G & N Attained Age
Texas Plans A,B,C,F,G & N Attained Age
Virginia Plans A,B, F, G & N Attained Age
West Virginia Plans A,B,F,G & N Attained Age
Wisconsin Base Plan with riders Attained Age
During the 6 month Open Enrollment Period (period of time when individual is first both enrolled in
Medicare and age 65 or older), all Plans offered are available on a Guaranteed Issue basis.
During the Guaranteed Issue Periods (loss of an Employer Plan, Loss of MA Plan or Medicare
Supplement Plan etc.) , Plans A, B, C (where available) and F are available on a Guaranteed Issue
basis.
All plans are guaranteed issue during the Medicare Advantage trial Periods.
State of WI does not allow standardized Plans mentioned above, the Base Plan with riders are Guaranteed Issue during the OE/GI events. If an individual applies for a rider after the policy is in effect and outside of GI, medical underwriting is required.
Definition of rating types:
▪ Community rated: For each Medicare Supplement Plan, the same monthly premium is
charged to all individuals in each Plan regardless of age. Premiums may increase due to
inflation and other factors, but not due to age.
▪ Issue-age rated: The premium is based on the age of the individual when the Medicare
supplement policy is purchased (issued). Premiums may increase due to inflation and other
factors, but not due to age.
▪ Attained-age rated: The premium is based on the current age of the individual (age
attained), so the premium increases as the individual gets older. Premiums may increase due
to age. There may also be increases for inflation and other factors.
Aetna Proprietary Information 01/14 7
STATE-SPECIFIC UNDER AGE 65 REQUIREMENTS
The following chart provides a brief overview of State rules that require Aetna to offer at least one
kind of Aetna Individual Medicare Supplement Plan policy to Medicare beneficiaries who are under
age 65. The chart describes the Aetna Individual Medicare Supplement Plans that each State
requires that Aetna offer, and the period(s) during which under age 65 Medicare beneficiaries are
eligible to enroll in these Plans.
Applicants who are under age 65 Medicare beneficiaries are eligible to enroll in the Aetna Individual
Medicare Supplement policy as shown in this chart. In all States that require coverage of Medicare
beneficiaries who are under age 65, beneficiaries are eligible to enroll in the policy during their 6-
month Open Enrollment (OE) period. Under aged 65 Medicare beneficiaries are only eligible to enroll
in the Plan during a Guaranteed Issue (GI) event if required under State law, as indicated in the
chart.
State
Aetna Medicare
Supplement Plans
available to Medicare
beneficiaries under age
65
State specific requirements –
when required to offer plan to Medicare
Beneficiaries under age 65
Alabama None No requirement
Arizona None No requirement
California Plans A, B, F & N -
No plans offered to under
age 65 Medicare
beneficiaries with End
Stage Renal Disease
During 6 month OE period and GI events
applicable to Medicare beneficiaries age 65
or over
Colorado Plans A, B, F, G & N
-----------------------
Plans A, B & F
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Florida Plans A, B, F, G & N
-----------------------
Plans A, B & F
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Georgia Plans A, B, F, G & N
-----------------------
Plans A, B & F
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Illinois Plans A, B, F, G & N
-----------------------------
----
Plans A, B, F & G
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Indiana None No requirement
Iowa None No requirement
Kentucky Plans A, B, F, G & N Always medically underwritten
Louisiana Plans A, B, F, G & N
-----------------------
Plans A, B & F
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Kansas Plans A, B, F, G & N
------------------------
Plans A, B & F
During 6 month OE period
---------------------------------------
GI events applicable to Medicare
Aetna Proprietary Information 01/14 8
beneficiaries age 65 or over
Maryland Plan A only
------------------------------------------
Plan A only
During 6 month OE period,
including loss of coverage under the
Maryland Health Insurance Plan
(MHIP) For other GI events required by the
State
Michigan Plans A & C During 6 month OE period; enrolled
in Medicare due to disability
Nebraska None No requirement
Nevada None No requirement
New Jersey Plan C only
----------------------------------------
Plan C only
During 6 month OE period – Limited
to individuals age 50-64
------------------------------------------
For other GI events required by the
State – Limited To individuals
age 50-64
New York Plans A, B & F Eligible to enroll in same plans
available to age 65 and over Medicare
beneficiaries at any time. This means
that there are no restrictions on when
an under age 65 Medicare beneficiary
can enroll in Aetna Individual
Medicare Supplement Plans.
North
Carolina
Plans A & F
-------------
Plans A & F
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Ohio None No requirement
Oregon Plans A, B, F, G & N
----------------------------------
Plans A, B & F
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Oklahoma Plan A only
------------------------------------------
Plan A only
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Pennsylvania Plans A, B, F, G & N
----------------------------------
Plans A, B & F
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Rhode Island None No requirement
South
Carolina
None No requirement
Tennessee Plans A, B, F, G & N
----------------------------------
Plans A, B & F
During 6 month OE period
------------------------------------------
For other GI events required by the
Aetna Proprietary Information 01/14 9
State
Texas Plan A only
--------------------------------------------
Plan A only
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Virginia None No requirement
West Virginia None No requirement
Wisconsin Basic Plan plus riders
--------------------------------------------
Basic Plan plus riders
During 6 month OE period
------------------------------------------
For other GI events required by the
State
Effective dates
The requested effective date must be included on the enrollment application. Applicants may choose
an effective date ranging from the 1st-28th of the month. Effective date must be on or after
application signature date. Paper applications that have the first of the month hardcoded, can be
revised by crossing off the “first”, substituting it with the correct effective date, initialed by the
applicant.
Effective dates must coordinate with the expiration date of the existing policy if the policy is being
replaced. All existing policies should remain in force until the replacement application is approved
and issued by the underwriter.
Applications will be accepted 6 months* prior to the effective date for individuals applying during an
Open Enrollment period. Applications will be accepted 90 days in advance of the requested effective
date for individuals applying during a guaranteed Issue event and for underwritten applications.
*In New York and Wisconsin, applicants can apply for coverage no sooner than 3
months prior to turning 65 and in West Virginia no more than 30 days prior to
enrollment in Medicare Part B.
Open Enrollment
Open Enrollment lasts six months and begins on the first day of the first month in which an
individual is both age 65 or older and is enrolled in Medicare Part B.
During Open Enrollment, carriers cannot discriminate in pricing by health status, claims experience,
receipt of healthcare, or medical conditions. They must accept all eligible applicants; there is no
medical underwriting.
All plans that Aetna offers in a state must be available to any individual in that state who applies
during his/her Open Enrollment (OE) Period.
Some states require coverage on a Guaranteed Issue basis during the Open Enrollment period for
individuals under age 65 entitled to Medicare due to disability. This can be found in the “STATE-
SPECIFIC UNDER AGE 65 REQUIREMENTS” chart included below.
Individuals who enroll during the six-month Open Enrollment period may be subject to Pre-existing
Condition Limitations.
Aetna Proprietary Information 01/14 10
Effective 7/1/13, Pre-existing Condition Limitations no longer apply to Aetna Medicare Supplement
Plans.
Guaranteed Issue requirements for eligible persons
For a specified time, an individual who has lost other health coverage and submits evidence of the
date of termination or disenrollment from the prior coverage may be eligible for a Medicare
Supplement policy on a guaranteed issue basis. During this time, carriers cannot discriminate in
pricing, by health status, claims experience, receipt of health care, or medical conditions. They must
accept all eligible applicants and carriers can not medically underwrite.
The applicant must submit evidence of the date of termination or disenrollment from the prior
coverage with the enrollment application, or can send it to Aetna at:
PO Box 14399
Lexington, KY 40512-9701 Fax 1-877-380-2777 (Do not fax premium checks)
Events that require Guaranteed Issue* of a Medicare Supplement
Plan:
1) Loss of an employer plan** that provides benefits that supplement the applicant’s
Medicare benefits because the plan terminates or ceases to provide the supplemental
benefits (involuntary loss of coverage).
2) Loss of a Medicare Advantage (MA) or a Program of All-Inclusive Care for the Elderly
(PACE), due to the following:
Certification of the plan was terminated
Plan was discontinued in the applicant’s area
Applicant no longer eligible for the plan because he or she moved out of area, or the
plan is terminated for all residents in the area
Plan/organization materially misrepresented plan provisions when marketing it
3) Enrolled in a Medicare risk contract health care prepayment plan, cost contract or
Medicare Select plan, or similar organization due to the following:
o Certification of the plan was terminated
o Plan was discontinued in the applicant’s area
o Applicant no longer eligible for the plan because he or she moved out of area, or the
plan is terminated for all residents in the area
Plan/organization materially misrepresented plan provisions when marketing it
4) Loss of a Medicare Supplement policy because of:
o Bankruptcy/insolvency of organization
o Other involuntary termination or enrollment in the plan
o Issuer substantially violated a material provision of the policy
o Issuer or agent materially misrepresented the policy provisions when marketing the
policy
Aetna Proprietary Information 01/14 11
5) Applicant was enrolled under a Medicare Supplement Policy and terminated it. The
applicant then enrolled as a first-time member under a Medicare Advantage, PACE
program or Medicare Select policy and terminated the plan during the first 12 months of
enrollment.
6) When first enrolled in Medicare Part A at 65, the applicant also enrolled in a Medicare
Advantage or PACE program, and disenrolled from that plan within 12 months of the
effective date.
To be eligible for Guaranteed Issue, individuals must apply no later than 63 calendar days after
current coverage ends. If the person loses employer-sponsored coverage, the application should be
made 63 days from date the coverage ends, or the date the individual receives notice of termination
or claim denial.
*New York State is Guaranteed Issue all the time for all plans. The application does not include a
section for health questions.
Involuntary loss of an Employer Plan that supplements Medicare results in a Guaranteed Issue event
in all States. The following States require Guaranteed Issue for loss
of an Employer Plan that is primary to Medicare because the individual leaves the plan (voluntary):
CO, IL, IN, KS, LA, NV, NJ, OH, PA, TX, WI.
Although all plans must be guaranteed issue during the 6 month Open Enrollment period,
Plans G and N are not required as GI for the normal guaranteed issue events. The following chart
outlines the requirements for ALIC Medicare Supplement insurance.
State Plan G Plan N AZ, CO, GA, IL, MD, MI, NV, NC, PA, SC, TX, VA
Guaranteed issue for GI
events mentioned above and
Open Enrollment
Medically underwritten
outside of 6 month Open
Enrollment Period
AL, FL, IN, IA, KS, KY, LA, NE, NJ, OH, OK, OR, RI, TN, WV
Medically underwritten
outside of 6 month Open
Enrollment Period
Medically underwritten
outside of 6 month Open
Enrollment Period
CA Guaranteed issue for GI
events mentioned above and
Open Enrollment
Guaranteed issue for GI
events mentioned above and
Open Enrollment
NY N/A N/A
WI N/A N/A
The exception to the chart above is that Guaranteed Issue applies for #5 and #6 listed
above (trial period for Medicare Advantage):
Plans G and N were not filed and will not be offered in New York. For the State of WI, the Base Plan with riders are Guaranteed Issue during the OE/GI events.
If an individual applies for a rider after the policy is in effective and outside of GI, medical underwriting is required.
Examples of documentation required for proof of Guaranteed Issue:
Aetna Proprietary Information 01/14 12
Loss of group coverage – copy of disenrollment (creditable coverage) letter. Letter should
include the applicant’s name, address and date of termination.
Medicare Advantage (MA) Plans – Disenrollment / notification, including MA plan leaving their
service area, letter from MA plan indicated date of disenrollment, applicants name and
address.
Applicant leaving Medicare Advantage (MA) area – letter from the MA plan indicating the
disenrollment is due to move from the area or a copy of documentation indicating applicant’s
prior address.
Loss of a Medicare Supplement Plan – Proof of the Company’s insolvency, misrepresentation
etc.
Applications that are submitted outside on an Open Enrollment or Guaranteed issue period must be
medically underwritten*. The Individual must complete the Health Questions section of the
enrollment application.
The “smoker rate” applies to any individuals who applies outside of the Open Enrollment/Guaranteed
issued period and indicates that they smoke or have used tobacco during the time period indicated
on the application.
The “smoker rate” applies in Florida for any individual who indicates that they smoked or have used
tobacco during the time period indicated on the application. This is not limited to underwritten
applications like other states.
Application process delays/declinations Our intent is to make the application process as smooth as possible for you and your clients.
We cannot process an application until we have all the necessary information from the applicant and
agent.
Here are the most frequent omissions or errors that cause delay in underwriting/processing:
1. Failure to provide the Medicare Claim Number (HICN)
2. Failure to provide Medicare Parts A and B effective dates
3. Failure to submit correspondence to validate eligibility for Open Enrollment or Guaranteed
Issue
4. Incomplete address information
5. Missing or incomplete answers to health questionnaire
6. Missing date of birth or age for the applicant
7. Missing Social Security Number for the applicant
8. Application not signed and/or dated
Aetna Proprietary Information 01/14 13
9. Changes made to answers without accompanying explanation or initials
10. “White out” or “Liquid Paper” used without initials
11. Broker information incomplete or agent number missing. (Agent SS# will be blacked out on
the copy of the application that is sent with the policy).
12. Application completed in pencil
13. Submission of an outdated or expired application form
14. Multiple omitted items in the application
15. Signature date is postdated or more than 30 days old
16. The applicant did not know he/she applied for coverage.
17. The applicant is unwilling to complete a phone interview when applying outside of an Open
Enrollment or Guaranteed Issue Period.
18. The Health Questions section of the application is completed for individuals who are applying
during an Open Enrollment or Guaranteed Issue event.
19. If discovered that the Agent who signed the application did not speak with the applicant.
20. Applications submitted with check from third party payer that has no family
(spouse/partner/child) or business relationship (business owner, employer/retiree of the
business)
Important notes when completing applications:
- Billing Address: If the applicant wants to provide a billing address that is different than the
residence address, they should be instructed to call Aetna after receiving the policy at 1-888-
624-6290 or submit the request in writing to PO Box 1188, Brentwood, TN 37024.
- Notice or Policy Lapse: Whether or not the State enrollment application includes the section
to assign someone as a third party designee in the event a policy may lapse, the applicant
should be told that after they receive their policy, they should call 1-888-624-6290 for the
appropriate form required for this designation.
Payment and billing options
Individuals can choose to be billed monthly, quarterly, semi-annually or annually. The initial
premium payment is required with the enrollment application. The exception is New York where the
premium is not required with the application.
The initial premium payment for California is limited to the first month’s premium. Do not submit
more than one month’s premium with California applications.
In addition to the various premium modes available, there are three billing methods available:
Aetna Proprietary Information 01/14 14
EFT (Electronic Funds Transfer) payment option: The Electronic Fund Transfer (EFT)
payment option allows for premium payment to be drafted from the member’s checking or
savings account.
o Applicants can apply for EFT as part of the Med Supp enrollment application.
If an applicant would like to apply for EFT payments at a later date, they can complete the
EFT payment option form included in the enrollment packet or on aetnamedicare.com
o Go to: http://www.aetnamedicare.com/plan_choices/supplement_state_select.jsp
o Then select your state, click on the “Enrollment” tab, then “Apply” and then choose the
link to the form under the Electronic Funds Transfer (EFT) and Credit Card Option Program
Credit card (MasterCard or Visa) payment option: The Credit Card payment option
allows for premium payment to be drafted from the member’s Visa or
o MasterCard account.
The credit card payment Option form is included in the enrollment packet or on
aetnamedicare.com
Go to: http://www.aetnamedicare.com/plan_choices/supplement_state_select.jsp
Then select your state, click on the “Enrollment” tab, then “Apply” and then choose the link to
the form under the Electronic Funds Transfer (EFT) and Credit Card Option Program
Important information regarding the credit card premium payment option:
Submit the completed Medicare Supplement application documents WITHOUT the credit card
form to:
Aetna Life Insurance Company, P.O. Box 14399, Lexington, KY 40512-9701
Advise the applicant to call Policyholder Services at 888-624-6290 two business days after
submitting the application to get the necessary information needed to complete the credit
card authorization form. Policyholder Services will provide them with their pending Policy
Identification Number and the actual premium amount.
Ask the applicant to send the completed credit card form (and not the application documents)
to:
Aetna Life Insurance Company
P.O. Box 14389
Lexington, KY 40512-4389
Use one form for each applicant. (Husband and wife CANNOT be listed on the same
form.)
Only VISA and MasterCard credit cards will be accepted.
Credit card form must include the wet signature of the Cardholder and Signature
Date.
Aetna Proprietary Information 01/14 15
If the credit card holder is NOT the applicant/proposed Insured, then the Cardholder’s
relationship to the applicant MUST be included on the form to ensure payment is
applied to the appropriate application.
All credit card transactions will appear as “Aetna Ind. Medicare Supp” with the
phone number “888-624-6290” on the bank transaction.
Credit card transactions can have a Bill Day from the 1st to the 28th of the month.
Credit card details provided should be active (i.e.: Credit Card expiration date should
be in the future).
Applicant should NOT use a credit card which expires within 30 calendar days after the
date of the application.
Credit card information WILL NOT be accepted (and will be destroyed) if sent
through phone, fax, or email.
Direct Billing: Individuals are sent an invoice for premium payment due and pay, using a
check or money order.
The premium for all plans will be $2 higher per month for policyholders who choose the
monthly direct billing option. The $2 additional premium does not apply to policies when
premiums are paid on a quarterly, semi-annual or annual basis or if paid monthly through
the Aetna Electronic Funds Transfer (EFT) or Credit Card Payment option program.
With the exception of California, the rates shown in the Outlines of Coverage are the EFT rates. The
$2 must be added to individuals who pay on a monthly direct billed based, the rates shown in the
California Outline of Coverage are the monthly direct billed rates. The rate for California is
discounted by $2 for individuals who pay other than monthly direct billed.
Draft Dates.
Initial premium for EFT will be drafted on the date the policy is issued
Initial premium for Credit Card will be drafted on the date the policy is issued
Initial premium submitted via check will be processed when received
A 31-day grace period is allowed for payment of premiums. The policy will be cancelled at the end of
the 31-day grace period if the premium has not been paid during this time.
CONTACT INFORMATION
Aetna Customer Service 1-888-624-6290
TTY/TDD 711 Monday- Friday 8:00-8:00 CST
Submit applications, including initial premium payment to:
Aetna Life Insurance Company PO Box 14399
Lexington, KY 40512-9701
(See instructions above for credit cards)
Aetna Proprietary Information 01/14 16
Correspondence Aetna Life Insurance Company
PO Box 1188 Brentwood, TN 37024
Claims
Aetna Life Insurance Company PO Box 5008
Brentwood, TN 37024
Overnight Delivery for Applications Aetna Life Insurance Company
101 Yorkshire Blvd. Lexington, KY 40509
Renewal Premium Payments
(do not send initial premium to this address)
Aetna Life Insurance Company PO Box 742085
Atlanta, GA 30374-2085
Agents questions on commissions status, etc. 888-624-6290. Agents can view application status and commission statements at:
www.aetnaseniorproducts.com
Agent responsibilities and checklist
Before submitting application, review it for the following information:
Applicant’s personal information. Is it complete and correct?
Medicare Parts A and B information
Guaranteed-Issue questions answered
Proof of prior creditable coverage (termination notice, HIPAA certification, etc.)
Plan selection information
Statement of health questions (if applicable)
Release authorization
Agent information
Application includes a street address, not a PO Box
If mailing address is not the same as the applicant’s, make sure a contact name is included
with the billing address
Aetna Proprietary Information 01/14 17
First month’s premium is attached – Attach check made payable to: Aetna Life Insurance
Company, OR a completed application along with the Aetna Electronic Funds Transfer (EFT)
or Credit card Payment Application. Note: New York applicants are not required to pay the
first month’s premium with the application. Do not take more than one month’s premium for
California, even if request quarterly, semi-annual or annual billing.
Include completed/signed Notice of Replacement Form for any application that is for a
replacement of a Medicare Supplement or Medicare Advantage Plan.
Complete / sign checklist for Illinois** and Kentucky sales. EFT or Credit card
payment option forms are completed if premiums requested via credit card or EFT.
o **IL Checklist is not required for Applications taken from a Call Center
Mail application to:
Aetna Life Insurance Company Overnight Delivery
PO Box 14399 Aetna Life Insurance Company
Lexington, KY 40512-9701 101 Yorkshire Blvd.
Lexington, KY 40509
You can fax the information, but only if the applicant is enrolling in the Aetna Electronic Funds
Transfer (EFT) at the time of the application.* The form can be found on
http://www.aetnamedicare.com/plan_choices/supplement_state_select.jsp, and in the enrollment
kit. The program permits premium payment by automatic deduction from the applicant’s checking or
savings account. Fax to: 1-855-291-0553
*If an applicant has given you a check for the initial premium, please DO NOT submit the
application via fax. It will not be processed. Instead, mail the application and the check
to the address above for application submissions.
PLEASE NOTE: Applications received without premium payment will not be processed until
the initial premium is received. To avoid delays in application processing and closure of
the application due to non-payment of initial premium, please make sure that the
applicant is aware that premium must be submitted. To avoid delays, it is suggested that
the applicant enroll in the EFT program at the same time the application for Medicare
Supplement Insurance is submitted.
Enrollment forms for the credit card payment option (Visa or MasterCard) may be submitted by mail
only. The form can be found at:
http://www.aetnamedicare.com/plan_choices/supplement_state_select.jsp
Credit Card premium payment application forms must be mailed to:
PO Box 14389
Lexington, KY 40512-4399
To check the status of an application or for member services, call:
1-888-624-6290; TTY/TDD 711, or go online at:
www.aetnaseniorproducts.com
Aetna Proprietary Information 01/14 18
Premium rate changes existing business Increases/changes to Aetna’s Individual
Medicare Supplement Plans occur annually on the individual’s policy anniversary date. All individuals
are notified by letter in advance of any premium rate increase in accordance with the state-specific
notification requirements.
Premium rate changes new business
State specific premium rate changes are applied to new applications based on the application
signature date.
Example: Rate increase implemented effective 1/1/14:
- If application is signed before 12/01/13 for a 1/1/14 effective date, the 2013
rate will apply
- If the application is signed on or after 12/01/13 for a 1/1/14 effective date, the
2014 rate will apply
Request for policy exchanges (upgrades, downgrades, pre-to post-MIPPA)*
Following applies to Individual Medicare Supplement plans underwritten by Aetna Life Insurance
Company.
Any request to exchange a current policy to another Aetna Medicare Supplement policy
requires that the member complete a new enrollment application. Medical underwriting is
required for upgrades and pre to post-MIPPA plan exchanges.
The premium rate applicable to the new policy will be at the member's current
age. The exception is Florida where the premium will be the current premium
but at the age the policyholder was first enrolled in an ALIC Individual
Medicare Supplement Plan.
*If the member is still within the 6 month Open Enrollment or applicable Guaranteed
Issue period, medical underwriting is not required, however a new enrollment
application is required. Medical underwriting is required for Plans G and N outside of
the Open enrollment as indicated in the Medical Underwriting Guidelines. The Plan
Option change may be approved or denied based on the risk criteria stated in the
Medical Underwriting Guidelines.
The States of California and Oregon require that beginning each year on an individual’s
birthday and lasting for 30 days thereafter, an individual enrolled in a Medicare supplement
policy may cancel the their current Medicare supplement policy and enroll in another Medicare
supplement policy of the same or lesser value. This includes replacing a pre-MIPPA plan by a
post-MIPPA plan considered the same or of lesser value. The individual may apply within the
30 day period prior to and 30 days following his/her birthday and elect an effective
date up to 90 days past his/her birthday. Applications will not be accepted if signed prior to
the applicant’s birthday. This applies to internal as well as external replacements.
Within the free-look period – Policy exchanges are permitted on a Medicare Supplement
policy effective as of the original issue date of the policy. This requires a new application.
Underwriting needs to review the new application and entire case file. Any necessary
underwriting requirements are ordered for approval or declination of an upgrade. These
requests are handled by the New Business department.
Aetna Proprietary Information 01/14 19
After the free-look period – Policy exchanges are permitted on a Medicare Supplement policy
as described above. A new application must be taken and fully underwritten if applicable as
described above. The change will be effective the next premium due date after Underwriting
approval. Underwriting needs to review the new application and entire case file. Any
necessary underwriting requirements are ordered for approval or declination of an upgrade.
Any premium shortage may be requested as a delivery requirement. The policy must be
maintained on its anniversary date billing cycle
The new/reissued policy reflecting the benefit change, a copy of the signed application
requesting the increase and an acknowledgement letter are sent to the policyholder, with a
carbon copy to the writing agent of record
If the request is declined, coverage will remain as originally approved, with a letter sent
explaining this (letter is mailed from the Underwriting Department).
Policy cancellation
30-day “free look” period
The policyholder may request cancellation for a full refund within the 30-day “free look” period.
Notification of policyholder’s death A death certificate is required to cancel a policy when a policyholder has died. Aetna must receive
proof of the death (obituary or copy of the death certificate) in order to send a premium refund.
Medical underwriting: Overview
Medical underwriting is the process of reviewing and comparing the medical history of an applicant
against established underwriting risk criteria in order to determine the appropriate level of risk.
The medical underwriting process is designed to identify the potential medical risk and cost for the
conditions listed on the application. These costs are predicted based on existing and anticipated
future:
Hospitalizations
Surgeries
Medical office visits
Outpatient therapies
Laboratory tests
Prescription medications
Radiological and diagnostic tests
Durable medical equipment and supplies
Medical underwriting
When an applicant does not have Guaranteed Issue rights and is not applying during Open
Enrollment, the application will be medically underwritten. Medical underwriting staff will review all
the information submitted on the application, including medical records when necessary.
Aetna Proprietary Information 01/14 20
Applications are underwritten up until the time the policy is issued and the first premium paid. If a
declinable health condition emerges between the time the application is taken and the time of policy
issuance, the application will be declinable.
Telephone interviews are required on all underwritten business.
Power of Attorney will not be accepted on any underwritten application.
Any “yes” answer in the Health Questions section of the application will automatically disqualify the
applicant. This does not apply to the question regarding smoking.
Once the medical underwriting process is completed, applicants will be enrolled in the plan they
selected, or will be declined coverage based on significant medical risk factors.
Declinable conditions and medications
Many health conditions present an extreme risk because of the high cost of treatment and
medications. When such conditions or medications are listed on the application and the applicant is
not in the Open Enrollment or Guaranteed Issue period, Aetna reserves the right to decline coverage
without further review of medical records.
Applicants answering “yes” to the health questions on the enrollment application will typically be
turned down for enrollment in the Aetna Individual Medicare Supplement Plan. Applications are not
declined solely based on smoking status, however smoking premium rate adjustment of 1.10 will be
made in all states (excluding NY).
Conditions and medications in this category include, but are not limited to the
conditions/medications included on pages 19 and 22.
Additional Underwriting information
Common reasons for decline:
Any type of further evaluation, diagnostic testing or surgery that has not been performed.
Any condition listed under the Health Questions section of the enrollment application
Macular Degeneration (wet) requiring injections within the past 12 months.
Atrial Fibrillation currently being treated with medication.
Diabetes with hear or artery blockage at any time.
History of prostate cancer with a detectable PSA reading.
Aneurysms that have not been surgically removed.
Osteoporosis with fracture 9any type)
Lung or respiratory disorders; use of oxygen or a nebulizer within the past 24 months
including hospital/in home use).
Lung or respiratory disorder with tobacco use.
Other criteria for denial of coverage
Other risk conditions and situations that may result in denial:
Applicant has not obtained coverage under Medicare Part A and/or Part B
Applicant answered “Yes” to “Are you currently hospitalized, residing in a nursing home,
enrolled in a hospice program, or expecting to enter a hospital or nursing home within the
next 6 months”
Aetna Proprietary Information 01/14 21
Applicant answered “Yes” to the health questions included on the enrollment application
Applicant awaiting surgery, recommended to have surgery, or is a surgical candidate
Documented signs and symptoms requiring treatment, but no definitive diagnosis provided
Applicant is recommended to have further diagnostic testing
Applicant has been referred to a specialist for a consultation not yet completed
Applicant has been recommended to have a prosthesis replaced or modified
Multiple suicide attempts documented, or single suicide attempt within the past 10 years
Applicant has been taking medications listed on declinable conditions and medications list
Previously declined applications
An applicant who has previously been declined coverage can submit a new application. The
underwriter will review the new application along with the reason for the previous denial to ensure:
No conditions previously disclosed have been omitted from the new application.
If the previous denial was for a condition that will always result in a decline, the same result
will occur.
If the previous denial was for a condition that is now resolved or reduced in risk, the
underwriting process will be followed.
Medical underwriting process
If an applicant meets all eligibility criteria for enrollment in the Aetna Individual Medicare
Supplement Plan, Aetna will accept and enroll the applicant in the plan under the following
circumstances:
The applicant is eligible for Guaranteed Issue or is applying during an Open Enrollment
period.
The application is complete and the underwriting review process determines the applicant is
eligible based on medical history.
Missing information
When information on the health history is incomplete or unclear, the underwriter will make a follow-
up call or send a letter to the applicant for clarification. Some examples include:
Health statement questions answered “No,” but medications or provider information is listed
in the “Details” section
Unclear or unanswered questions regarding treatments or medications listed on the
application
Dates or services not provided
End dates of treatment not provided
Aetna Proprietary Information 01/14 22
Medical records
At times, medical records may be requested as part of the risk selection process. It is up to the
underwriter to make the final determination whether medical records are required by using:
Health history provided on the application
Underwriting guidelines
Assessment of overall risk based on sound medical underwriting judgment
Processing and pending timelines
The goal of the underwriting team is to process applications in a timely manner.
To achieve this goal, the team has established time lines around functions and responsibilities:
Underwriters will complete initial review of application with decision to accept, decline or pend for
further information within 6-8 business days assuming applications were received in good order
with no missing information or billing details.
Applications with missing information will be pended for 10 business days.
We will again follow-up with applicants and pend application.
Closed and Incomplete letters will be sent on day 60.
If medical records are requested, the application is pended up to 20 business days. When Aetna
receives the medical records, the underwriting process will be completed within 6-8 business
days.
Applications will be closed out within 60 days of receipt if additional information
required to process the application is not received.
Aetna Proprietary Information 01/14 23
Drug list information
Drug list information is provided to assist agents in completing Medicare Supplement insurance
applications.
Simple and concise list of the most commonly prescribed medications for declinable conditions.
Applicants may be unaware of a condition listed on the application, but prescribed medication
may indicate the condition exists and are not eligible for coverage with the company. Medications
include oral drugs, inhalers, injections, and infusions.
New drugs for these conditions are regularly introduced and may not be included but may be
unacceptable. Any questions concerning questionable medications should be directed to the
Underwriting Department
Because of the nature of some medications, individuals taking them will be declined, regardless
of the severity of the condition.
Some medications can be given for multiple conditions; medications are unacceptable when they
are prescribed for any of the conditions listed next to the drug. When applicant is prescribed a
medication that has multiple uses, the condition for which it is prescribed must be furnished.
Medications listed alone, are unacceptable for any condition.
The following drug list information has been arranged alphabetically by medication. This should be
helpful in finding the medication prescribed.
lower case: generic name
Upper Case: brand name
Aetna Proprietary Information 01/14 24
Drug list information –
*specific conditions
Akineton: treatment of Parkinson’s Disease
Amantadine: treatment of Parkinson’s
Disease
Artane: treatment of Parkinson’s Disease
atenolol + blood thinner: treatment of atrial
fibrillation, arrhythmia, irregular heartbeat
baclofen: treatment of Multiple Sclerosis
Calan + blood thinner: treatment of atrial
fibrillation, arrhythmia, irregular heartbeat
Carbidopa: treatment of Parkinson’s disease
Cardioquin + blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
carvedilol: treatment of cardiomyopathy,
heart disorder
clopidogrel: treatment of Peripheral Vascular
Disease
Coreg: treatment of cardiomyopathy, heart
disorder
Coumadin: treatment of atrial fibrillation,
arrhythmia, irregular heartbeat
Covera + blood thinner: treatment of atrial
fibrillation, arrhythmia, irregular heartbeat
Digitek: treatment of atrial fibrillation,
arrhythmia, irregular heartbeat
Digoxin: treatment of atrial fibrillation,
arrhythmia, irregular heartbeat
Dopar: treatment of Parkinson’s Disease
Efudex: treatment of cancer
Furosemide (40mg): treatment for
congestive heart failure, heart disorder
Hydromorphone: treatment of chronic pain
Inderal + blood thinner: treatment of atrial
fibrillation, arrhythmia, irregular heartbeat
InnoPran +blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
Isoptin + blood thinner: treatment of atrial
fibrillation, arrhythmia, irregular heartbeat
Lanoxicaps: treatment of atrial fibrillation,
arrhythmia, irregular heartbeat
Lanoxin: treatment of atrial fibrillation,
arrhythmia, irregular heartbeat
Laradopa: treatment of Parkinson’s Disease
Lasix (40 mg): treatment for congestive
heart failure
Levodopa: treatment for Parkinson’s Disease
Lioresal: treatment for multiple sclerosis
Lodosyn: treatment of Parkinson’s Disease
Lopresor + blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
Metoprolol + blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
Mirpex: treatment of Parkinson’s Disease
Plavix: treatment of peripheral vascular
disease
Pramipexole: treatment of Parkinson’s
Disease
Propranolol+blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
Quinidex + blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
Quinidine + blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
Quinora + blood thinner: treatment of atrial
fibrillation, arrhythmia, irregular heartbeat
Aetna Proprietary Information 01/14 25
Requip: treatment of Parkinson’s Disease
Ropinirole: treatment of Parkinson’s Disease
Sinemet: treatment of Parkinson’s Disease
Symmetrel: treatment of Parkinson’s Disease
Tenormin +blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
Toprol + blood thinner: treatment of atrial
fibrillation, arrhythmia, irregular heartbeat
Trihexyphenidyl: treatment of Parkinson’s
Disease
Verapamil + blood thinner: treatment of
atrial fibrillation, arrhythmia, irregular
heartbeat
Verelan + blood thinner: treatment of atrial
fibrillation, arrhythmia, irregular heartbeat
Warfarin: treatment of atrial fibrillation,
arrhythmia, irregular heartbeat
Aetna Proprietary Information 01/14 26
Drug List
abatacept
Abilify
acamprosate
Actigall
Actimmune
adalimumab
Adriamycin
Adrucil
Agrylin
*Akineton for: Parkinson’s
Disease
alefacept
alemtuzumab
Alferon
Alkeran
*amantadine for:
Parkinson’s Disease
ambenonium
Amevive
amiodarone
anagrelide
anakinra
Anandron
anastrazole
Antabuse
Aranesp
Arava
Aredia
Aricept
Arimidex
aripiprazole
*Artane for: Parkinson’s
Disease
*atenolol + blood thinner
for: atrial fibrillation,
arrhythmia, irregular
heartbeat
auranofin
Aurolate
Avinza
Avonex
azathioprine
AZT (azidothymidine)
Azilect
*baclofen for: Multiple
Sclerosis
benztropine
Betapace
Betaseron
bethanechol
Bexxar
bicalutamide
Blenoxane
bleomycin
bromocriptine
bumetanide
Bumex
busulfan
Busulfex
*Calan + blood thinner
for: atrial fibrillation,
arrhythmia, irregular
heartbeat
calcium acetate
Campath
Campral
capectabine
*carbidopa for:
Parkinson’s disease
*Cardioquin + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
*carvedilol for:
Cardiomyopathy
Casodex
CeeNu
Cellcept
Cerespan
Cerubidine
chlorambucil
chlorpromazine
cilostazol
cisplatin
*clopidogrel for: Peripheral
Vascular Disease
clozapine
Clozaril
Cogentin
Cognex
Comtan
Aetna Proprietary Information 01/14 27
Cordarone
*Coreg for: Cardiomyopathy
Heart Disorder
Cosmegen
*Coumadin for: atrial
fibrillation, arrhythmia,
irregular heartbeat
*Covera + blood thinner
for: atrial fibrillation,
arrhythmia, irregular
heartbeat
cyclophosphamide
cyclosporine
cytarabine
Cytosar
Cytoxan
dactinomycin
Dantrium
dantrolene
darbepoetin alfa
daunorubicin
Demadex
Demerol
didanosine
dideoxyinosine
Didronel
*Digitek for: atrial
fibrillation, arrhythmia,
irregular heartbeat
*digoxin for: atrial
fibrillation, arrhythmia,
irregular heartbeat
Dilaudid
Disipal
disulfam
docetaxel
dofetilide
Dolophine
donepezil
*Dopar for: Parkinson’s
Disease
doxorubicin
dronedarone
Droxia
Duragesic
Duvoid
edrophonium
*Efudex for: Cancer
Eldepryl
Eligard
Eloxatin
Emcyt
Enbrel
Endocet
Enlon
entacapone
epoetin alfa
Epogen
ergoloid mesylates
erythropoietin
Eskalith
etanercept
etidronate
etoposide
Eulexin
Exelon
Exvoxac
Faslodex
Femara
fentanyl
filgrastim
flecainide
floxuridine
fluorouracil
fluphenazine
flutamide
Forteo
foscarnet sodium
FUDR
fulvestrant
*Furosemide (40 mg) for:
Congestive Heart Failure,
Heart Disorder
galantamine
gamma interferon
gefitinib
gemtuzumab
Gengraf
Geodon
Gleevex
gold sodium thiomalate
goserelin
Aetna Proprietary Information 01/14 28
Haldol
Haloperidol
Hizentra
Humira
Hydergine
Hydrea
*Hydromorphone for:
chronic pain
hydroxyurea
imatinib
Imuran
*Inderal + blood thinner
for: atrial fibrillation,
arrhythmia, irregular
heartbeat
infliximab
*InnoPran + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
interferon alpha 2a
interferon alpha 2b
interferon beta
Intron A
Invega
Iressa
*Isoptin for: atrial
fibrillation, arrhythmia,
irregular heartbeat
Kadian
Kemadrin
Kineret
*Lanoxicaps for: atrial
fibrillation, arrhythmia,
irregular heartbeat
*Lanoxin for: atrial
fibrillation, arrhythmia,
irregular heartbeat
*Laradopa for: Parkinson’s
Disease
*Lasix (40 mg): for:
Congestive Heart Failure,
Heart Disorder
leflunomide
lenalidomide
letrozole
Leukeran
leuprolide
*levodopa for: Parkinson’s
Disease
*Lioresal for: Multiple
Sclerosis
Lithane
lithium
Lithobid
*Lodosyn for: Parkinson’s
Disease
lomustine
*Lopressor + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
loxapine
Loxitane
Lupron
Lysodren
Matulane
mechlorethamine
Megace
megestrol
Mellaril
melphalan
memantine
Mepergan
meperidine
mercaptopurine (6MP)
mesoridazine
Mestinon
methadone
Methadose
methotrexate
*metoprolol + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
Mexate
*Mirapex for: Parkinson’s
Disease
Mithracin
mitomycin
mitotane
Moban
molindone
morphine
MS Contin
Multaq
Mustargen
Aetna Proprietary Information 01/14 29
Mutamycin
mycophenolate mofetil
Myleran
Mylotarg
Myochrysine
Myotonachol
Mytelase
Namenda
Nardil
Navane
Nebupent
Neoral
neostigmine
Neulasta
Neupogen
Nilandron
nilutamide
olanzapine
Oncovin
Opana
Orencia
oxaliplatin
oxycodone
Oxycontin
Pacerone
paclitaxel
paliperidone
pamidronate
papaverine
Parlodel
Pavabid
pegfilgrastim
Peg-Intron
Pentam
pentamidine
pentoxifylline
Pentoxil
Percocet
perphenazine
phenelzine
Phoslo
Platinol
*Plavix for: Peripheral
Vascular Disease
Pletal
plicamycin
*pramipexole for:
Parkinson’s Disease
Pradaxa
Prednisone
procarbazine
Procrit
procyclidine
Prograf
Prolixin
propafenone
*propranolol + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
Prostigmin
Purinethol (6MP)
pyridostigmine
quetiapine
*Quinidex + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
*quinidine + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
*Quinora + blood thinner
for: atrial fibrillation,
arrhythmia, irregular
heartbeat
rasagiline
Razadyne
Rebetol
Rebif
Remicade
Reminyl
*Requip for: Parkinson’s
Disease
Retrovir
Revlimid
Rhythmol
ribarvirin
Ridaura
Rilutek
riluzole
Risperdal
risperidone
Aetna Proprietary Information 01/14 30
rivastigmine
Roferon-A
*ropinirole for: Parkinson’s
Disease
Roxanol
Roxicet
Roxicodone
Sandimmune
selegiline
Serentil
Seroquel
*Sinemet for: Parkinson’s
Disease
sotalol
Stelazine
Symbyax
*Symmetrel for:
Parkinson’s Disease
Tabloid
tacrine
tacrolimus
Tambocor
Taxol
Taxotere
*Tenormin + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
Tensilon
teriparatide
Teslac
testolactone
tetrabenazine
thioguanine
Thioplex
thioridazine
thiotepa
thiothixene
Thorazine
Ticlid
ticlopidine
Tikosyn
*Toprol + blood thinner
for: atrial fibrillation,
arrhythmia, irregular
heartbeat
torsemide
tositumomab
Trelstar LA
Trental
trifluoperazine
*trihexyphenidyl for:
Parkinson’s Disease
Trilafon
triptorelin pamoate
Tylox
Urecholine
Urso
ursodiol
Velban
VePesid
*verapamil + blood
thinner for: atrial
fibrillation, arrhythmia,
irregular heartbeat
*Verelan + blood thinner
for: atrial fibrillation,
arrhythmia, irregular
heartbeat
Viadur
Videx
vinblastine
vincristine
*warfarin for: atrial
fibrillation, arrhythmia,
irregular heartbeat
Xeloda
Xenazine
Zelapar
zidovudine, AZT
ziprasidone
Zoladex
zoledronic acid
Zometa
Zyprexa
Aetna Proprietary Information 01/14 31
The above list is not all-inclusive. Many of these medications have generic forms and new
medications are introduced frequently.