Anthem Producer Online News – May 5, 2022
Beginning May 14, 2022, proof of loss of group coverage must be provided for individuals moving from Employer Group medical coverage to a new Med Supp plan. This requirement is found in the Med Supp Guaranteed Issue Guidelines, Situation #2.
Guarantee Issue Situation #2 is described as “having Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare and that plan is ending.” Please review this GI Situation in the guidelines as the member may have additional rights under state law. The Med Supp Guaranteed Issue Guidelines are included with the Med Supp application for your convenience.
Beginning May 14, 2022, when submitting electronic Med Supp enrollment applications for GI Situation #2, you will receive a system prompt, indicating “Loss of Creditable Group Coverage” is required and must be included with the enrollment application submission. If you are submitting a paper application, you or your client must submit the documentation directly to the plan.
Acceptable documentation includes a loss of group coverage letter also known as a “Certificate of Coverage,” or letter from the former plan noting the dates the coverage started and ended. The “Certificate of Coverage” serves as proof of coverage. It is always possible to obtain a replacement copy from the employer or union.
- If required proof is not submitted with the application, the application cannot be processed until loss of group coverage proof is received.
- If the loss of group coverage proof is not received within seven calendar days, the application will be closed, and a letter will be mailed to the applicant letting them know the application will be re-opened for processing when it is received by the plan.
The application can be re-opened up to 180 days from the signature date on the application.