- Thread starter
- #21
germanwine1
Super Genius
- 112
I did think Medicare Parts A and B was considered creditable coverage. Please don't tell me it's not.
Pre-Existing Condition Clause
- Thread starter germanwine1
- Start date
- 1,199
It's number 2. on Fl. replacement form that says IF REPLACING waiting periods are waived ....
2. State law provides that your replacement policy or
certificate may not contain new pre-existing
conditions, waiting periods, elimination periods, or
probationary periods. The insurer will waive any time
periods applicable to pre-existing conditions, waiting
periods, elimination periods, or probationary periods
in the new policy (or coverage) for similar benefits to
the extent such time was spent (depleted) under the
original policy.
- 1,199
Sure i guess medicare would be considered creditable coverage for waiver of waiting periods purposes if someone was dropping medicare all together and replacing it with a non medicare health plan
but why does that matter here? going from medicare only and ADDING a med supp is not REPLACING anything therefore any of the provisions giving credit for time spent under previous coverage that is being REPLACED does not apply.duhhhh
t
I understand, and never said that was the issue.
I realize this may be above your pay grade, but waiving p-x or not has nothing to do with replacement. Unless required without qualification by statute, carriers may waive p-x subject to verification of prior creditable coverage.
I have been looking for a definition of creditable coverage for years to no avail. Carriers get to decide what is and isn't creditable, and whether they will waive p-x or not.
You probably got lost along the way, but this thread is not about D&R it is about p-x
- 1,199
insurance laws that force carriers to waive pre ex med supps has everything to do with REPLACEMENT of some type of health coverage i.e RGHP,indvidual,union.Is a cancer policy creditable coverage ? -No, Is Is a limited benefit of hospital indemnity policy creditable coverage ?- probably not.In my 23 years of selling med supps I have never had an issue with prior EGHP,major medical,union etc. coverage that was being replaced not being creditable coverage.
This is why it's critical to use GI on med supp applications even if consumer can pass underwriting.
from Medicare Supplement Consumer Guide that we agents have to give to every med supp prospect:
Creditable coverage
If you have a
pre
‑
existing condition
, you buy a Medigap policy during
your
Medigap
Open Enrollment Period
,
and you’re replacing certain
kinds of health coverage that count as “creditable coverage,” it’s possible
to avoid or shorten waiting periods for pre
‑
existing conditions. Prior
creditable coverage is generally any other health coverage you recently had
before applying for a Medigap policy. If you have had at least 6 months of
continuous prior creditable coverage, the Medigap insurance company can’t
make you wait before it covers your pre
‑
existing conditions.
There are many types of health care coverage that may count as creditable
coverage for Medigap policies, but they'll only count if you didn’t have a
break in coverage for more than 63 days.
Your Medigap insurance company can tell you if your previous coverage will
count as creditable coverage for this purpose.
----------
creditable coverage - yes.
help satify the wating period for pre ex on new med supp policy-no
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Thanks Jen, but it does not define creditable coverage. Neither does google's verbiage.
"Generally" leaves some wiggle room.
The new carrier has the right to decide what is and isn't creditable.
Some carriers never considered Mega (remember them?) creditable coverage, others accepted it without question.
Same for other group limited benefit plans.
STM was not considered creditable in OH but it was in GA by statute. I had to fight a couple of decisions for clients here in the "old" days (pre-2014). After showing the statute to the carrier they agreed to waive pre-ex.
Medicare and Medicaid are specifically mentioned as creditable. Your link does not mention CHAMPUS or TRICARE but most carriers accepted them as such.
I won't bother to address the D&R comment by google. But I am still open to anyone that provides a definition of creditable coverage.
Interesting that COBRA is listed in the laundry list of examples of creditable coverage, but Medicare does not recognize COBRA as such. If you left a group plan, went on COBRA for 10 months and then wanted to enroll in Medicare Part B you would be considered a late entrant, have to enroll during the GEP and pay a penalty.
And here's a link for that.
People with Medicare Beware: COBRA Is Not Coverage as a “Current” Employee*||*CMA
Screw it. Might as well address D&R and get it over with.
School is back in session.
D&R and continuity of coverage go hand in hand in the group market. At least they did before Obama changed everything.
Continuity of coverage was commonly (and mistakenly) referred to as "no loss, no gain". If an employer group plan was replace mid calendar year, it was understood (and mandated in most if not all jurisdictions) that there would be no loss of coverage. Plan participants under the old plan would be given deductible & OOP credit for claims under the prior plan.
While this mainly applied to mid-year changes, many plans also had deductible carry over credit. So the new carrier had to apply partially satisfied deductibles from the prior carrier to the new plan.
D&R and continuity only applied for group to group not individual to group.
In the Medicare world, changing from prior coverage (of any kind) can involve either a gain or a loss of coverage so D&R and continuity does not apply.
"Generally" leaves some wiggle room.
The new carrier has the right to decide what is and isn't creditable.
Some carriers never considered Mega (remember them?) creditable coverage, others accepted it without question.
Same for other group limited benefit plans.
STM was not considered creditable in OH but it was in GA by statute. I had to fight a couple of decisions for clients here in the "old" days (pre-2014). After showing the statute to the carrier they agreed to waive pre-ex.
Medicare and Medicaid are specifically mentioned as creditable. Your link does not mention CHAMPUS or TRICARE but most carriers accepted them as such.
I won't bother to address the D&R comment by google. But I am still open to anyone that provides a definition of creditable coverage.
Interesting that COBRA is listed in the laundry list of examples of creditable coverage, but Medicare does not recognize COBRA as such. If you left a group plan, went on COBRA for 10 months and then wanted to enroll in Medicare Part B you would be considered a late entrant, have to enroll during the GEP and pay a penalty.
And here's a link for that.
People with Medicare Beware: COBRA Is Not Coverage as a “Current” Employee*||*CMA
Screw it. Might as well address D&R and get it over with.
School is back in session.
D&R and continuity of coverage go hand in hand in the group market. At least they did before Obama changed everything.
Continuity of coverage was commonly (and mistakenly) referred to as "no loss, no gain". If an employer group plan was replace mid calendar year, it was understood (and mandated in most if not all jurisdictions) that there would be no loss of coverage. Plan participants under the old plan would be given deductible & OOP credit for claims under the prior plan.
While this mainly applied to mid-year changes, many plans also had deductible carry over credit. So the new carrier had to apply partially satisfied deductibles from the prior carrier to the new plan.
D&R and continuity only applied for group to group not individual to group.
In the Medicare world, changing from prior coverage (of any kind) can involve either a gain or a loss of coverage so D&R and continuity does not apply.
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- 1,199
pick a topic and stay with it.I thought we were discussing prior coverage only as it effects pr ex of med supp waiting period. everbody knows having cobra doesn't preclude a consumer from being subject to the part b late enrollment penalty past the 8 months
The point he's trying to make is that pre ex can be eliminated with proof of creditable coverage
HOWEVER, creditable coverage is a moving target, determined by the state of issue and carrier.
So why this should be a "simple" question, its really not.
(And Bob, I think the DOL is THE definition. As wishy washy as it is. Thats what used in court cases)
