Humana Medicare Supplement Important Update

Posted from a Humana MS communication on 4/16//21:

New Proof of Guaranteed Issue Requirement for Med Supp Submissions for Replacement of Coverage

Beginning the weekend of 4/17/2021, Med Supp applications submitted as GI due to Replacement of Coverage will need to include proof of prior coverage showing loss of Medicare Advantage/MAPD or Group/Employer Coverage. Based on this new requirement, applications submitted as GI for replacing prior coverage will pend. Other qualifying GI right scenarios, OEP, and UW submissions will continue to follow existing processes.

This change is specific to applications submitted as GI when an applicant answers yes to the “are you replacing MA or employer coverage” questions during the application process*.

During the enrollment process, if the enrollment team determines that the application was submitted as GI for replacement of coverage and no verification of prior coverage was included with the application, a communication will be sent to the Agent and Member.

Examples of forms of verification of prior coverage include: Disenrollment Letter, Plan Exit Letter, Denied Claim, or Letter from Employer stating coverage is ending.

No additional Humana form for prior coverage has been created to go along with the verification outside of the standard enrollment forms. A form of the verification above will be all that will be needed in addition to the standard enrollment forms.

When submitting applications when loss of prior coverage is the GI right, proof of loss of coverage can be submitted as follows:

  • Paper Applications
    • Verification of prior coverage should be submitted along with the application using standard submission methods of Fax, Doc, Transmitter or Mail
  • Electronic Submissions via Fast App
    • Verification of prior coverage should be submitted immediately following electronic app submission to prevent agent/member outreach via:
      • Fax – (502) 508-9003
      • Email – [email protected]
      • Note, if proof of loss of coverage is being submitted via email, proof of loss of coverage and the applicants name should be in the subject line. Fax submissions should include applicants name, agent name and SAN on coversheet

*Applications submitted with special Guaranteed Issue rights i.e. Birthday or Annual rules (CA, OR, MO, and WA) or State Regulations offering expanded GI rights (CT, MA, NY, and VT) are excluded from this process change.