Medicare Supplement Insurance Coverage

EFFECTIVE DATE 

When you are 65 or older: Requested effective dates will be honored if the application is received by us on or before the requested date. If the requested effective date is prior to the date we receive the application, the effective date will be made the receipt date. When no effective date is requested, the effective date issued will be the first of the month after the application is received by our office. In no case will an effective date be issued for any date prior to us receiving an application.
When you are turning 65: The effective date of the policy will be the first day of the 65th birth month (the date Medicare is effective) as long as the application is received on or before your 65th birthday. 

We can not assign effective dates more than 90 days after you have signed the application unless you are guaranteed issue. 

The effective date will be printed on your ID card. 

REPLACING OTHER POLICIES In the case you are replacing a current Medicare Supplement insurance policy with us or another carrier, please be sure that you read, sign and date a replacement form. This form is required and must be submitted with the application.

Always be advised that you need to continue paying the premiums on your current medicare supplement insurance coverage until Blue Cross Blue Shield of Texas issues the new policy and you have accepted the new coverage. 

BILLING OPTIONS Blue Cross Blue Shield of Texas gives you added flexibility and choice when it comes to paying premiums for your Medicare supplement insurance. You can choose to be billed every month, every three months, every six months, or once a year. Simply indicate on the application which option you prefer.

PREMIUMS 
Premiums are based on area, age and plan of coverage. Area is defined by the zip code where you live in.
Medicare Supplement insurance plans are guaranteed renewable. Premiums can only be raised if Blue Cross Blue Shield of Texas raises premiums for all insured under the policy form or there is a rate change for everyone in your class of coverage. Premiums change at ages 67, 70, 75, 80 and 85. They may also change if you change your primary place of residence or class of coverage. You will be notified of premium changes at least 30 days in advance. 

PREMIUM PAYMENTS do not send cash with an application. You receive your Medicare Supplement Insurance policy, an initial premium notice will be enclosed. To activate coverage, you must send a check or money order to cover the full amount billed.

An Authorization Form for the E-Z Blue Payment Option will also be enclosed with the policy at delivery. If you sign up for this automatic payment method, you authorize Blue Cross Blue Shield of Texas to automatically withdraw future premiums from a checking or savings account on a monthly basis.

If you prefer to pay premiums by check or money order on an on-going basis, you will receive premium notices according to the premium mode you have chosen at your residential address (or billing address, if different). 

COMPLETING THE APPLICATION 

The application must be filled out completely and accurately, and all information must be legible. If not, processing of the application may be delayed or a new application may be required for consideration.

When completing the application, please:

• Do not use ditto or dash marks to answer questions
• Use one color ink, preferably black
• Do not use correction fluid to make corrections
• Initial and date all corrections. Please review your application to verify that it is complete and legible.

If you falsify or fail to include all material information e.g. age and medical history) required on this application, your policy may be rescinded by the Blue Cross Blue Shield of Texas. Rescission means voiding your policy back to its effective date. If your policy is rescinded, any premiums paid (less any benefits paid) will be refunded.

SUBMISSION PROCEDURES 

For pre-submission questions or general sales and marketing information please call 800-366-4236. REQUIRED FOR FIPS 

The following form(s) must be used when submitting
a case:

• Application for Blue Cross Blue Shield of Texas Medicare Supplement Plan (30004.0704 TX)
• Notice of Replacement (30029.0704 TX) if replacing a current Medicare Supplement Policy
  Please review your application to verify that it is complete and legible. Any changes to the application must be initialed by you before submission.

WHERE TO SUBMIT 

All applications and supporting paperwork should be submitted to:
Blue Cross Blue Shield of Texas
Direct Markets -Medicare Supplement P.O.Box 806162
Chicago, IL 60680-4L'3
Policies will be sent to you when approved. 

COVERAGE CHANGES 

An example of a Medicare supplement insurance coverage change would be switching from Plan A to Plan D or from Plan D to Plan F. When the change is approved, the effective date will be determined by your current premium payment status and will take effect as of the next billing due date.

If you wish to change coverage you must submit a new application, indicating which insurance plan you are choosing. Any change from a previous block of business will have to be underwritten. Changes within an old block of business are not underwritten. 

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