Medicare Supplement

You Choose Your Own Doctors And The Plan That’s Best For You

Make Your Choice From Seven Medicare Insurance Plans

With all plans (A, B, C, D, G, F, & N), you have unlimited lifetime benefits and your coverage keeps up with the changing deductibles and coinsurance amounts whenever Medicare changes – it’s automatic. Your Outline of Coverage will describe each additional benefit in the plan you select.

FULL SERVICE: To get personal help call the help-line 1-800-MEDIGAP or 1-800-633-4427

Self-Service: APPLY FOR A MEDICARE SUPPLEMENT ONLINE | Apply For A Medicare Advantage Online | Apply for a Prescription Drug Plan Online

By Choosing Medicare Supplemental Insurance, You Make The Choice

Prompt, Personal, Professional Service Provided by our favorite Medigap Company IAC.

IAC has a personal touch and your claims are paid fast! Ask us about our “under 5 day” claim service. We’re only a toll-free phone call away, and we don’t use computerized answering systems, just friendly people willing to help you.

How to Apply for a Medicare Supplemental Plan?

Apply for a Medicare supplement plan by calling the toll-free help-line 1-800-MEDIGAP or 1-800-633-4427

FULL SERVICE: To get personal help call the help-line 1-800-MEDIGAP or 1-800-633-4427

Self-Service: APPLY FOR A MEDICARE SUPPLEMENT ONLINE | Apply For A Medicare Advantage Online | Apply for a Prescription Drug Plan Online

WHat to expect during the process

Medicare Supplement Telephone Interviews

The underwriting department may call you to verify personal and health information on
underwritten cases. Please advise your client that they may receive a call during the underwriting process.
Your applicant should be ready to answer any personal and health information related to their application.
Applications requiring a telephone interview may be declined if we are unable to complete an interview.
In Wisconsin, telephone interviews will be conducted with applicants age 75 and over on underwritten
cases.

Medicare Supplement Guaranteed Issue Rules

Guaranteed Issue Rules The situations listed below are based upon scenarios found in the Guide to Health Insurance. Note: Not all plans offered are available guaranteed issue. Guaranteed Issue Situation Client has the right to buy. . . Client is in the original Medicare Plan and has an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays. That coverage is ending. Note: In this situation, state laws may vary. Medigap Plan A, B, C, F, K or L that is sold in client’s state by any insurance company. Plan selection is subject to availability. If client has COBRA coverage, client can either buy a Medigap policy/certificate right away or wait until the COBRA coverage ends. Plan selection is subject to availability. Client is in the original Medicare Plan and has a Medicare SELECT policy/certificate. Client moves out of the Medicare SELECT plan’s service area. Client can keep the Medigap policy/certificate or he/she may want to switch to another Medigap policy/certificate. Medigap Plan A, B, C, F, K or L that is sold by any insurance company in client’s state or the state he/she is moving to. Plan selection is subject to availability. Client’s Medigap insurance company goes bankrupt and the client loses coverage, or client’s Medigap policy/certificate coverage otherwise ends through no fault of client. Medigap Plan A, B, C, F, K or L that is sold in client’s state by any insurance company. Plan selection is subject to availability. Group Health Plan Proof of Termination Proof of Involuntary Termination If applying for Medicare supplement, Underwriting cannot issue coverage as Guaranteed Issue without proof that an individual’s employer coverage is no longer offered. The following is required: • Complete the Medicare and Insurance Information section on the Medicare supplement application; and • Provide a copy of the termination letter, showing date of and reason for termination, from the employer or group carrier Proof of Voluntary Termination Under the state specific voluntary terminations scenarios, the following proof of termination is required along with completing the Medicare and Insurance Information section on the Medicare supplement application: • Certificate of Group Health Plan Coverage • In CA, IA, NM, OK, VA and WV, provide proof of change in benefits from employer or group carrier. Guaranteed Issue Rights for Voluntary Termination of Group Health Plan State Qualifies for Guaranteed Issue… AK, CO, ID, IN, IL, LA, MT, NV, NJ, OH, TX, PA, If the employer sponsored plan is primary to Medicare. AR, KS, MO, SD No conditions – always qualifies. 6 For purposes of determining GI eligibility due to a Voluntary Termination of an employer sponsored group welfare plan, a reduction in benefits will be defined as any increase in the insured’s deductible amount or their coinsurance requirements (flat dollar co-pays or coinsurance %). A premium increase without an increase in the deductible or coinsurance requirement will not qualify for GI eligibility. This definition will be used to satisfy IA, NM, OK, VA and WV requirements. Proof of coverage termination is required. Additional State Specific Guaranteed Issue Rights Minnesota Basic Plan and any combination of these riders: Part A Deductible, Part B Deductible, and Part B Excess for all guaranteed issue situations. Wisconsin All plans and riders available for all guaranteed issue situations. Oregon All plans available for all guaranteed issue situations. Guaranteed Issue Rights for Loss of Medicaid Qualification State Guaranteed Issue Situation Client has the right to buy… CA Client is enrolled in Medicare Part B, and as a result of an increase in income or assets, is no longer eligible for MediCal benefits, or is only eligible for Medi-Cal benefits with a share cost and certify at the time of application that they have not met the share cost. Open enrollment beginning with notice of termination and ending six months after the termination date. 65 years or older any Medigap plan offered by any issuer. Under Age 65 Plans A, F & M. Not available for individuals with end stage renal disease. KS Client loses eligibility for health benefits under Medicaid. Guaranteed Issue beginning with notice of termination and ending 63 days after the termination date. any Medigap plan offered by any issuer. MT Client is enrolled in Medicaid and is involuntarily terminated. Guaranteed Issue beginning with notice of termination and ending 63 days after the termination date. any Medigap plan offered by any issuer. OR Client is enrolled in an employee welfare benefit plan or a state Medicaid plan that provides health benefits that supplement the benefits under Medicare, and the plan terminates or the plan ceases to provide all such supplemental health benefits. Guaranteed Issue beginning with notice of termination and ending 63 days after the termination date. Medigap Plan A, B, C, D, F (including F with a high deductible), G, K, L, M, or N offered by any issuer. TN Client, age 65 and older covered under Medicare Part B, enrolled in Medicaid (TennCare) and the enrollment involuntarily ceases, is in a Guaranteed Issue beginning with notice of termination and ending 63 days after the termination date. Client, under age 65, losing Medicaid (TennCare) coverage have a six month Open Enrollment period beginning on the Medigap Plan A, B, C, F (including F with a high deductible), K or L offered by any issuer. Any Medigap plan offered by any issuer. CA If the employer sponsored plan’s benefits are reduced, with Part B coinsurance no longer being covered. IA If the employer sponsored plan’s benefits are reduced, but does not include a defined threshold NM, OK, VA, WV If the employer sponsored plan’s benefits are reduced substantially. 7 date of involuntary loss of coverage. TX Client loses eligibility for health benefits under Medicaid. Guaranteed Issue beginning with notice of termination and ending 63 days after the termination date. Medigap Plan A, B, C, F (including F with a high deductible), K or L offered by any issuer; except that for persons under 65 years of age, it is a policy which has a benefit package classified as Plan A. UT Client is enrolled in Medicaid and is involuntarily terminated. Guaranteed Issue beginning with notice of termination and ending 63 days after the termination date. Medigap Plan A, B, C, F (including F with a high deductible), K or L offered by any issuer. WI Client is eligible for benefits under Medicare Parts A and B and is covered under the medical assistance program and subsequently loses eligibility in the medical assistance program. Guaranteed Issue beginning with notice of termination and ending 63 days after the termination date. Wisconsin’s Basic Medicare supplement policy or certificate.

Medicare Advantage

MEDICARE ADVANTAGE (MA) Medicare Advantage (MA) Annual Election Period General Election Periods for Medicare Advantage (MA) Timeframe Allows for… Annual Election Period (AEP) Oct. 15th – Dec. 7th each year • Enrollment selection for a MA plan • Dis-enroll from a current MA plan • Enrollment selection for Medicare Part D Medicare Advantage Disenrollment Period (MADP) Jan. 1st – Feb. 14th each year • MA enrollees to dis-enroll from any MA plan and return to Original Medicare The MADP does not provide an opportunity to: • Switch from original Medicare to a Medicare Advantage Plan • Switch from one Medicare Advantage Plan to another • Switch from one Medicare Prescription Drug Plan to another • Join, switch or drop a Medicare Medical Savings Account Plan There are many types of election periods other than the ones listed above. If there is a question as to whether or not the MA client can dis-enroll, please refer the client to the local SHIP office for direction. Medicare Advantage (MA) Proof of Dis-enrollment If applying for a Medicare supplement, Underwriting cannot issue coverage without proof of disenrollment. If a member dis-enrolls from Medicare, the MA plan must notify the member of his/her Medicare supplement guaranteed issue rights. Dis-enroll during AEP and MADP  Complete the Medicare and Insurance Information section on the Medicare supplement application; and  Send ONE of the following with the application a. A copy of the applicant’s MA plan’s termination notice b. Image of insurance ID card (only allowed if MA plan is being terminated) If an individual is dis-enrolling outside AEP/MADP  Complete the Medicare and Insurance Information section on the Medicare supplement application; and  Send a copy of the applicant’s MA plan’s disenrollment notice with the application. For any questions regarding MA disenrollment eligibility, contact your State Health Insurance Assistance Program (SHIP) office or call 1-800-MEDICARE, as each situation presents its own unique set of circumstances. The SHIP office will help the client dis-enroll and return to Medicare.

Open Enrollment
To be eligible for open enrollment, an applicant must be at least 64 ½ years of age (in most states) and be within six
months of his/her enrollment in Medicare Part B.
Applicants covered under Medicare Part B prior to age 65 are eligible for a six-month open enrollment period upon
reaching age 65.
Additional Open Enrollment Periods for Residents of the Following State:
California – Annual Open Enrollment lasting 60 days, beginning 30 days before and ending 30 days after the
individual’s birthday, during which time a person may replace any Medicare supplement policy with a policy of equal
or lesser benefits. Coverage will not be made effective prior to the individual’s birthday. Please include documentation
verifying the Plan information and paid to date of the current coverage. If replacing a pre-standardized Plan, a copy of
the current policy or policy schedule is required.
Missouri – Individuals that terminate a Medicare supplement policy within 30 days of the annual policy
anniversary date may obtain the same plan on a guaranteed issue basis for a period of 63 days after the
termination of their existing policy, from any issuer that offers that plan. This would include Medicare
supplement and select plans. Please include documentation verifying the Plan information, paid-to-date and the
policy anniversary of the current coverage. For policies with an effective date of 6/1/2010 or after, individuals
with existing plans E, H, I and J can convert to one of the following plans: A, B, C, F, K or L.
Oregon – Annual Open Enrollment lasting 60 days, beginning 30 days before and ending 30 days after the
individual’s birthday, during which time a person may replace any standardized Medicare supplement policy
with a policy of equal or lesser benefits. Coverage will not be made effective prior to the individual’s
birthday. Please include documentation verifying the Plan information and paid to date of the current
coverage.

Medicare Supplement Plans for individuals on Disability Under 65

States with Under Age 65 Requirements

• California All plans available. Open enrollment if applied for within six months of Part B enrollment.
  Not available for individuals with end stage renal disease.
• Colorado All plans available. Open enrollment if applied for within six months of Part B enrollment.
• Delaware All plans available. Open enrollment if applied for within six months of Part B enrollment.
• Illinois All plans available. Open enrollment if applied for within six months of Part B enrollment.
• Kansas All plans available. Open enrollment if applied for within six months of Part B enrollment.
• Kentucky All plans available. No open enrollment. All applications are underwritten.
• Louisiana All plans available. Open enrollment if applied for within six months of Part B enrollment
• Maryland Plan A is available. Open enrollment if applied for within six months of Part B enrollment.
• Minnesota All plans and riders available. Open enrollment if applied for within six months of Part B
  enrollment.
• Mississippi All plans available. Open enrollment if applied for within six months of Part B enrollment.
  3
• Missouri All plans available. Open enrollment if applied for within six months of Part B enrollment.
• Montana All plans available. Open enrollment if applied for within six months of Part B enrollment
• New Jersey Plan C available to people ages 50-64. Open enrollment if applied for within six months of
  Part B enrollment
• North Carolina Plans A & F available. Open enrollment if applied for within six months of Part B enrollment.
• Oklahoma Plan A is available. Open enrollment if applied for within six months of Part B enrollment.
• Oregon All plans available. Open enrollment if applied for within six months of Part B enrollment.
• Pennsylvania All plans available. Open enrollment if applied for within six months of Part B enrollment.
• South Dakota All plans available. Open enrollment if applied for within six months of Part B enrollment.
• Tennessee All plans available. Open enrollment if applied for within six months of Part B enrollment for
  persons no longer having access to alternative forms of health insurance coverage due to
  termination or action unrelated to the individuals status, conduct or failure to pay premium or
  persons being involuntarily dis-enrolled from Title XIX (Medicaid) or Title XXI (State
  Children’s Health Insurance Program) of Social Security Act.
  Alternative forms of health insurance in the statement above include accident and sickness
  policies, employer sponsored group health coverage or Medicare Advantage plans.
• Texas Plan A is available. Open enrollment if applied for within six months of Part B enrollment.
• Wisconsin Base policy and riders are available. Open enrollment if within six months of Part B enrollment.

Selective Issue
Applicants over the age of 65, or under age 65 in the states listed above, and at least six months beyond
enrollment in Medicare Part B will be selectively underwritten. All health questions must be answered. The
answers to the health questions on the application will determine the eligibility for coverage. If any health
questions are answered “Yes,” including “Not Sure” in California, the applicant is not eligible for coverage.
Applicants will be accepted or declined. Elimination endorsements will not be used.
In addition to the health questions, the applicant’s height and weight will be taken into consideration when
determining eligibility for coverage. Coverage will be declined for those applicants who are outside the
established height and weight guidelines. In the state of California premium rate-ups do not apply.
Health information, including answers to health questions on applications and claims information, is confidential and
is protected by state and federal privacy laws. Accordingly, Individual Assurance Company does not disclose health
information to any non-affiliated insurance company.
Application Dates
• OPEN ENROLLMENT – Up to six months prior to the month the applicant turns age 65
• UNDERWRITTEN – Up to 60 days prior to the requested coverage effective date
• GROUP HEALTH – Individuals whose employer group health plan coverage is ending can apply up to three
months prior to the requested effective date of coverage.
• West Virginia – Applications may be taken up to 30 days prior to the effective date of their Medicare eligibility
due to age.
• Wisconsin – Applications may be taken up to three months prior to an applicant’s Medicare eligibility date.

Medicare Supplement Plans that offer Discounts

Household Discount This policy contains a 7% household discount available to applicants residing with at least one, but no more than three other adults. States differ in requirement and availability. See the chart below for details regarding discount availability by state. Refer to the premium calculation sheet included in the application packet for assistance with calculating the discount. State Description All states not indicated below. HHD Rule 1: • Individuals who, for the last consecutive twelve (12) months, have resided with at least one, but no more than three adults; or • Individuals who live with another adult to whom they are married, or with whom they are in a civil union partnership. IL, ND, NJ, OH, OK HHD Rule 2: • Individuals who, for the last consecutive twelve (12) months, have resided with at least one, but no more than three adults; or • Individuals who live with another adult to whom they are married, or with whom they are in a civil union partnership, AND • Who has an existing Medicare supplement policy with IAC. ID, MN HHD not available Types of Medicare Policy Ratings • COMMUNITY RATED – The same monthly premium is charged to everyone who has the Medicare policy, regardless of age. Premiums are the same no matter how old the applicant is. Premiums may go up because of inflation and other factors, but not based on age.