Medicare Supplement Coverage complete

Blue Cross of Texas 
Medicare Supplement Insurance Coverage

Blue Cross and Blue Shield of Texas offers underwritten Medicare Supplement insurance plans A, D, and F by law, some prospects will qualify for these plans on a guaranteed issue basis. Plans are available to Texas residents age 65 and over, who are enrolled in Medicare Part A & Part B or under age 65 Texas residents who are enrolled in Medicare Part A and are within 6 months, of enrolling in Part B. 

Your client's choice of a Medicare Supplement insurance company should be based on price, reputation and service. No matter which policy your client chooses, they are sure to agree that it simply makes sense to choose Blue Cross and Blue Shield of Texas. 

PRODUCT BENEFIT HIGHLIGHTS 

FOR PLANS D AND F 
� Part A Hospital Deductible Coverage 
� Hospital Co-payment Coverage 
� Skilled Nursing Facility Coverage 
� Coverage for Physician Fees and Other Medical Expenses 
� Coverage for Foreign Travel Emergencies 
Individual Insurance Plan Highlights: 

Plan D: Coverage for at-Home Recovery After a Hospital Stay 
Plan F: Coverage for Part B Deductible and Excess Charges Above Medicare-Approved Amounts 

PRODUCT FEATURES 

� No Claim Forms in Most Cases 
� Membership Card Recognition Guaranteed Nationwide 
� No Waiting Period for Pre-Existing Health Conditions 
� Coverage for All Medicare-Approved Services 
� Protection to Keep Pace with Medicare Cost Increases 
� Freedom to Choose Licensed Physicians and Hospitals 
� Five Billing Options � E-Z Blue Payment Option for Monthly Pre-Authorized, Automatic Withdrawals or Pay by Check Every Month, Three Months, 6 months or once a year. 

ELIGIBILITY 

Our products are under written. However, Medicare Supplement insurance Plans A, D and F are issued on a guarantee issue basis f r all Texas residents age 65 and over who have Medicare Part A and are within six months of eligibility for Medic; ire Part B or had one of the following events occur within the last 63 days. You must provide material support: long evidence that one of these events has occurred. 

� Were enrolled in employer/retiree group health coverage and canceled because they either could no longer be covered under the terms of the plan or the company cancelled the company plan in its entirety. 
� Were enrolled in a Medicare+Choice (including Medicare HMO) plan., a Medicare Select plan or a PACE program and were disenrolled because they moved out of the service area. 
� Were enrolled in a Medicare+Choice (including Medicare HMO) plan or PACE program and were disenrolled because their plan withdrew from their service area. 
� Were enrolled in a Medicare+Choice (including Medicare HMO) plan for the first time since they became Medicare Eligible and were disenrolled or decided to disenroll within one year of initial enrollment. 
� They had a Blue Cross and Blue Shield of Texas Medicare Supplement Insurance plan and then cancelled it to enroll in a Medicare+Choice (including Medicare HMO) plan. A Medicare Select plan or a PACE program within the last 12 months, and than disenrolled from their new plan within one year of initial enrollment. 
� Were enrolled in a Medicare Supplement Insurance plan and their previous carrier ended their coverage through no fault of their own. 

If your client does not meet the qualifications listed 
above, their application will be subject to underwriting. 
They must complete Part Two (Health History/Medical 
Questions) on the application. 
Applicants at or exceeding the following weights (based on height and gender) cannot be offered coverage:

EFFECTIVE DATE

When your client is 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 your client is 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 their 65th birthday. 
We can not assign effective dates more than 90 days after your client has signed the application unless your client is guaranteed t' issue. 
� The Effective Date ill be printed on the member's ID card. 

REPLACING OTHER POLICIES 

In the case that your client is replacing a current Medicare Supplement insurance policy with us or another carrier please be sure that both you and the applicant read, sign and date a replacement form. This form is required and must be submitted with the application. 
Always advise your client to continue paying the premiums on his or her current coverage until Blue Cross and Blue Shield of Texas issues the new Medicare Supplement insurance policy and he or she has accepted the new coverage. 

BILLING OPTIONS 

Blue Cross and Blue Shield of Texas gives your client added flexibility and choice when it comes to paying premiums for your Medicare Supplement insurance. They can choose to be billed every month, every three months, every s x months or once a year. Simply indicate on the application which option they prefer. 

PREMIUMS 

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

PREMIUM PAYMENTS 

Do not accept cash with an application. When your client receives his or her Medicare Supplement Insurance policy, an initial premium notice will be enclosed. To activate coverage, your client 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 your client signs up for this automatic payment method, he or she authorizes Blue Cross and Blue Shield of Texas to automatically withdraw future premiums from a checking or savings account on a monthly basis. 
If your client prefers to pay premiums by check or money order on an on-going basis, he or she will receive premium notices according to the premium mode they have chosen at their 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 
� Have the applicant initial and date all corrections Please review all applications to verify that they are complete and legible. 
If you or your client falsifies or fails to include all material information (e.g. age and medical history) required on this application, their policy may be rescinded by the Blue Cross and Blue Shield of Texas. Rescission means voiding their policy back to its effective date. If their 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 FORFIPS 

The following form(s) must be used when submitting 
a case: 
� Application for Blue Cross and Blue Shield of Texas Medicare Supplement Insurance Plan (30004.0704 TX) 
� Notice of Replacement (30029.0704 TX) if replacing a current Medicare Supplement Insurance Policy 
Please review any and all applications to verify that they are complete and legible. Any changes to the application must be initialled by the applicant before submission. 

WHERE TO SUBMIT 

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

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 the clients current Medicare Supplement insurance premium payment status and will take effect as of the next billing due date. 
A client wishing to change coverage must submit a new application, indicating which insurance plan he or she is choosing. Any change from a previous block of business will have to be underwritten. Changes within an old block of business are not underwritten from the Medicare Supplement insurance plan.