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Small Accounts - Senior Markets
| How far ahead will Anthem accept a Medicare Supplement application?|
Anthem will accept Medicare Supplement or Medicare Select applications six (6) months in advance, if policyholders are within their 6-month open enrollment window. Applications are valid only for 90 days if policyholders are not within their open enrollment period.
| I have an 80-year-old client in one of the old, traditional (non-standardized) Medicare Supplement plans. Premiums are getting too expensive for this client to remain in the program. What options are available?|
Typically, the traditional Medicare Supplement policies remain the best coverage available for those already enrolled because of the excellent benefits. True, premiums are expensive for these traditional policies because they are closed to new entrants, and because individuals in the closed pool are aging. However, clients who are outside their open enrollment window must answer health questions and qualify medically if they wish to move into one of the federally standardized Medicare supplemental products.
| What are the amounts covered for prescription drugs in the Medicare Extended Plus plan?|
Medicare Extended Plus, one of our traditional Medicare Supplement plans no longer offered for sale, has a $0 deductible for prescription drugs and a 60% coinsurance amount when the customer uses a participating network pharmacy. There is no annual maximum limit on prescription drug benefits with this particular plan.
| Do your plans include any at-home recovery benefits, such as private duty nursing? |
Most of our plans do not cover private duty nursing. However, Medicare Extended Plus, a traditional Medicare Supplement plan no longer offered for sale, does include coverage for private duty nursing, after the $100 calendar year deductible has been met. This particular benefit covers 80% of the allowable charges for covered services with a $1,500 calendar year maximum. Our standardized Medicare Supplement plans I and J cover up to $40 a visit for home care certified as medically necessary by a physician, or for personal care when Medicare has approved a home treatment plan for recovery from injury or illness. There are some limitations and restrictions to this benefit. For example, the patient must receive treatment within 8 weeks of the last Medicare visit. Also, visits are limited to 7 per week and up to $1,600 per year.
| Which Medicare Supplement program is a disabled person under age 65 eligible for? |
A person who is under age 65 and eligible for Medicare due to disability can receive our guaranteed issue Medicare Supplement Plan F.
| Does Anthem pay commission on Medicare Supplement Guaranteed Issue (GI) policies, for both over age 65½ and under age 65? |
Anthem pays 4% commission on Guaranteed Issue Medicare Supplement policies in years 1-6. However, we do not pay commission on disabled Medicare Supplement policies (when the enrollee is eligible for Medicare prior to turning age 65 due to disability).
| What's the difference between an ECP and an EOB?|
Both forms serve essentially the same purpose - to inform the customer about what benefits have or have not been provided for a claim. The forms look different because they serve different lines of business. The ECP, or Explanation of Claims Processed, goes to customers enrolled in our individual business Personal Health Care and Medicare Supplement programs. The EOB, or Explanation of Benefits, goes to customers enrolled in some of our group programs. Both ECPs and EOBs explain how Anthem has processed a claim. In addition, our individual business Medicare Supplement customers receive an EOMB, or Explanation of Medicare Benefits, from the federal Medicare program. This form explains what Medicare has processed and allowed on a claim.
| My client sent in a bank draft form with a voided check but still received a bill for the premium. What happened?|
The timing of when we receive a completed bank draft form has a direct bearing on how soon we are able to start the actual bank draft process for the customer. The 15th of the month is the cut-off date to remember. If we receive the bank draft form by the 15th of the month, our Finance Department can usually set up an automatic draft for the following month, and the customer will not receive a bill in the mail. However, if we receive the bank draft form after the 15th of the month, we will bill the customer for the following month's premium. Some customers may receive a bill and disregard it, thinking that it was generated before the bank draft request took place. Then, if the policy cancels due to nonpayment, the person is understandably upset. To avoid this scenario, please be aware of the 15th of the month cut-off date for automatic bank drafts and explain to customers the circumstances under which they may receive a bill.
| What are the addresses for the various departments?|
Send Medicare supplemental applications and claims to:
Anthem Blue Cross and Blue Shield Medicare Supplement
P.O. Box 13087
Roanoke, VA 24031
Send payments to:
Anthem Blue Cross and Blue Shield Finance Department
P.O. Box 11900
Roanoke, VA 24022-9962
Send membership inquiries to:
Anthem Blue Cross and Blue Shield Customer Service Department
P.O. Box 13047
Roanoke, VA 24030-9987
| Who should I contact about dental claims?|
All dental claims, except for treatment of impacted teeth, are handled by Health Management Systems, Inc. If the client has a policy with a dental rider, call 1-800-551-3346. If the client has our stand-alone dental product, call 1-800-453-3622.
| Can I sign change requests for the policyholder, or call in changes by phone?|
No. All written change requests must be signed by the policyholder or applicant. In addition, we cannot take a change of address from a broker by telephone. While we prefer to have all change requests in writing, we will accept a change of address by phone from the policyholder. Medicare supplemental (over-65) customers can reach a Customer Service Representative at 1-800-451-0361.
| I have a client on an individual plan who will turn 65 soon. Will Anthem contact the broker 60 days before the client turns 65, or do you wait until the actual birthday?|
Anthem's Personal Health Care (under-65 individual) line of business has a successful Medicare Supplement Birthday Program that generates sales leads six months in advance for existing customers who are turning age 65. This is the time when Medicare-eligible individuals start shopping for Medicare Supplement coverage.
These customers receive a letter with their writing agent's name and phone number, along with a broker application kit and other promotional information.
Our Broker Sales and Retention Unit also calls the writing agents and reminds them to follow-up with these customers. This is typically done six months in advance, so that the broker has four months to follow through with the application.
If we don't receive the application back within 60 days of the person's 65th birthday, we assume that the agent does not want to write a Medicare Supplement plan. Then, we automatically turn these leads over to our Direct Sales Unit for follow-up, unless we receive clear indication that the broker is actively pursuing the lead.
Remember, no underwriting is required if the customer enrolls in a Medicare Supplement plan within six months of turning 65, or within 6 months of their Medicare Part B effective date if they are 65 or older. The waiting period for pre-existing conditions is also waived during this time frame.