WIXLIB

cannot be reinstated. The client may, however, apply for new coverage. All underwriting requirements must be metbefore a new policy can be issued.Telephone InterviewsRandom telephone interviews with applicants will be conducted on underwritten cases. Please be sure to advise yourclients that we may call to verify the information on their application.Pharmaceutical InformationWe have implemented a process to support the collection of pharmaceutical information for underwritten MedicareSupplement applications. In order to obtain the pharmaceutical information as requested, the “Health InformationAuthorization” (Series 8555) form included in the application packet needs to be completed and signed by theapplicant. Prescription information noted on the application will be compared to the additional pharmaceuticalinformation received.Policy Delivery ReceiptDelivery receipts are required on all policies issued in Kentucky, Louisiana, Nebraska, South Dakota, and WestVirginia. For policies delivered by the agent, two copies of the delivery receipt will be included in the policy package.One copy is to be left with the client. The second copy must be signed and dated by the client and returned toAmerico Financial Life and Annuity Insurance Company in the postage-paid envelope included in the policy package.For policies mailed directly to the client, a certified mail receipt is considered proof of delivery.Guarantee Issue RulesThe rules listed below are federal requirements and can also be found in the Guide to Health Insurance for Peoplewith Medicare. Plans A, B, C, or F are offered (subject to state availability) on a guarantee issue basis.Voluntarily leaving an employer group health plan does not always result in the applicant’s eligibility for guaranteedissue. In this situation, state laws may vary.Guarantee Issue SituationClient is in the original Medicare Plan and has anemployer group health plan (including retiree orCOBRA coverage) or union coverage that pays afterMedicare pays. That coverage is ending.Note: In this situation, state laws may vary.Client is in the original Medicare Plan and has aMedicare SELECT policy. Client moves out of theMedicare SELECT plan’s service area.Client has the right to buy. . .Medicare Supplement Plan A, B, C, F, K or L that is soldin client’s state by any insurance company.If client has COBRA coverage, client can either buy aMedicare Supplement policy right away or wait until theCOBRA coverage ends.Medicare Supplement Plan A, B, C, F, K or L that is soldby any insurance company in client’s state or the stateClient can keep your Medicare Supplement policy or he/ he/she is moving to.she may want to switch to another Medicare Supplementpolicy.Client’s Medicare Supplement insurance companygoes bankrupt and the client loses coverage, or client’sMedicare Supplement Plan A, B, C, F, K or L that is soldMedicare Supplement policy coverage otherwise endsin client’s state by any insurance company.through no fault of client.7

Group Health Plan Proof of TerminationProof of Involuntary Termination: Underwriting cannot issue Medicare Supplement coverage as Guarantee Issue(GI) without proof that an individual’s employer coverage is no longer offered. The following is required: Complete the Medicare 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 groupcarrier.Proof of Voluntary Termination: See chart below for a list of the states that allow voluntary termination from anemployer group plan and the condition under which an applicant qualifies.StateCondition and proof requiredCO, KS, ID, IL, IN,MT, NJ, OH, PA, TXQualifies for Guarantee Issue, if the employer sponsored plan is primary to Medicare.We would require a letter from the employer or insurance company, reflecting this isan employer sponsored plan, date of termination and must include that the employersponsored plan is primary to Medicare as acceptable proof.Qualifies for Guaranteed Issue, always - No conditions. We would require a Certificate ofGroup Health Plan Coverage as acceptable proof.Qualifies for Guaranteed Issue if the employer sponsored plan’s benefits are reduced,with Part B co-insurance no longer being covered. We would require a letter from theemployer or insurance company, reflecting this is an employer sponsored plan and thereduction in benefits as acceptable proof.Qualifies for Guaranteed Issue, if the employer sponsored plan’s benefits are reducedsubstantially. We would require a letter from the employer or insurance company,reflecting this is an employer sponsored plan and the reduction in benefits as acceptableproof.FL, SDIA*NM, OK, VA, WV**For purposes of determining GI eligibility due to a voluntary termination of an employer sponsored group healthplan, a reduction in benefits will be defined as any increase in the client’s deductible amount or their co-insurancerequirements (flat dollar co-pays or co-insurance %). A premium increase without an increase in the deductible orco-insurance requirement will not qualify for GI eligibility. Proof of the coverage reduction is required.Guarantee Issue Rights for Loss of Medicaid QualificationStateGuarantee Issue SituationClient has the right to buy .KSClient loses eligibility for health benefits under Medicaid.Guaranteed Issue beginning with notice of terminationand ending 63 days after the termination date.Client is enrolled under Medicaid and the enrollmentinvoluntarily ceases and the individual is eligible for andenrolled in Medicare Part B. Guaranteed Issue beginningwith notice of termination and ending 63 days after thetermination date.Client loses eligibility for health benefits under Medicaid.Guaranteed Issue beginning with notice of terminationand ending 63 days after the termination date.any Medicare Supplement plan offered byany issuer.TNTXUTClient is enrolled in Medicaid and is involuntarilyterminated. Guaranteed Issue beginning with notice oftermination and ending 63 days after the termination date.Medicare Supplement Plan A, B, C, F(including F with a high deductible), K, orL offered by any issuer.Medicare Supplement Plan A, B, C, F(including F with a high deductible), K,or L offered by an issuer; except that forpersons under 65 years of age, it is a policywhich has a benefit package classified asPlan A.Medicare Supplement Plan A, B, C, F(including F with a high deductible), K, or8L offered by any issuer.

MEDICARE ADVANTAGE (MA)Medicare Advantage (MA) Annual Election PeriodGeneral Election Periods forMedicare Advantage (MA)TimeframeAllows for Enrollment selection for a MA planAnnual Election Period (AEP)Oct. 15th – Dec. 7th of every yearDisenroll from a current MA planEnrollment selection for MedicarePart DMA enrollees to disenroll from anyMA plan and return to OriginalMedicare.The MADP does not provide anopportunity to:Medicare Advantage DisenrollmentPeriod (MADP)Jan. 1st – Feb 14th of every yearSwitch from original Medicare to aMedicare Advantage Plan.Switch from one MedicareAdvantage Plan to another.Switch from one MedicarePrescription Drug plan to another.Join, switch or drop a Medicaremedical Savings Account plan.There are many types of election periods other than the ones listed above. For any questions regardingMA disenrollment eligibility, contact your State Health Insurance Assistance Program (SHIP) office or call1-800-MEDICARE, as each situation presents its own unique set of circumstances. The SHIP office will help theclient disenroll and return to Medicare.Medicare Advantage (MA) Proof of DisenrollmentUnderwriting cannot issue Medicare Supplement coverage without proof of Medicare Advantage disenrollment. If amember disenrolls from Medicare Advantage, the MA plan must notify the member of his/her Medicare Supplementguarantee issue rights.Disenrolling from a Medicare Advantage PlanComplete the MA section on the Medicare Supplement application.For Guaranteed Issue applications: proof must be submitted.For Underwritten or Open Enrollment applications: once the application has been approved, the agent will becontacted via the agent portal and advised to begin the disenrollment process from the MA plan. The MA plandisenrollment form that was provided to the applicant must be submitted to New Business, which will verify thedisenrollment date against the effective date of the Americo policy: Effective date cannot overlap the MA coverage date. Policies will not be mailed until confirmation of disenrollment from the MA plan is received.9

Guarantee Issue RightsThe rules listed below are federal requirements and can also be found in the Guide to Health Insurance for Peoplewith Medicare. We offer plans A, B, C, or F (state variations apply) on a guarantee issue basis.Guarantee Issue SituationClient has the right to Client’s MA plan is leaving the Medicare program,stops giving care in his/her area, or client moves out ofthe plan’s service area.Client joined an MA plan when first eligible forMedicare Part A at age 65 and within the first year ofjoining, decided to switch back to Original Medicare.Client dropped his/her Medicare Supplement policyto join an MA Plan for the first time, have been in theplan less than a year and want to switch back.buy a Medicare Supplement Plan A, B, C, F, K or Lthat is sold in the client’s state by any insurance carrier.Client must switch to Original Medicare Plan.buy any Medicare Supplement plan that is sold in yourstate by any insurance company.Client leaves an MA plan because the MA insurancecompany has not followed the rules, or has misled theclient.obtain client’s Medicare Supplement policy back ifthat carrier still sells it. If his/her former MedicareSupplement policy is not available, the client can buya Medicare Supplement Plan A, B, C, F, K or L that issold in his/her state by any insurance company.buy Medicare Supplement plan A, B, C, F, K or L thatis sold in the client’s state by any insurance company.PREMIUMCalculating PremiumBefore you begin, utilize the Height and Weight Chart on page 14 to determine eligibility for coverage, unless theapplicant is in an open enrollment or guarantee issue period.Utilize Outline of Coverage Determine Plan Find Age/Gender - Verify that the age and date of birth are the exact age as of the effective date. Determine ZIP code where the client resides and find the correct rate for that ZIP code. Determine if Tobacco rates apply. Apply Household Premium Discount, if appropriate (subject to state variation). Rate Adjustment - use the height and weight chart to determine if there should be a Class I rate adjustment of10

15% (subject to state variation). To determine annual premium, multiply by 12.UTILIZE OUTLINE OF COVERAGE EXAMPLE:Calculate Premium InstructionsDetermine Medicare Supplement insurance plan.Find Age/Gender - Verify that the age and date of birth are the exactage of the effective date.Determine ZIP code where the client resides.Determine if Tobacco rates apply.Use the Medicare Supplement plan’s monthly premium from theOutline of Coverage based on the information above.Apply Household Premium Discount, if appropriate.Rate Adjustment - Use the height and weight chart to determine ifthere should be a Class I rate adjustment of 15%.Payment Options –To determine annual premium, multiply by 12.Premium Calculation ExamplePlan F67 / Male30301Non-Tobacco 183.83 183.83 x .9 165.45 165.45 x 1.15 190.27 190.27 monthly payment 2,283.24 annual paymentUtilizing the Premium WorksheetThe Premium Worksheet is included with each application packet and provides detailed instructions for calculatingpremiums.Tobacco rates do not apply during Open Enrollment or Guarantee Issue situations in the following states:IA, ID, IL, KY, LA, MD, MI, NC, NH, NJ, PA, TN, VATypes of Medicare Policy Ratings Attained-age Rated - The premium is based on the applicant’s current age so the premium goes up as theapplicant gets older. Premiums are lower for younger buyers, but go up as they get older. In addition to change inage, premiums may also go up because of inflation and other factors. Issue-age Rated - The premium is based on the age of the applicant when the Medicare Supplement policyis purchased. Premiums are lower for applicants who buy at a younger age, and won’t change as they get older.Premiums may go up because of inflation and other factors, but not because of applicant’s age. Community Rated - The same monthly premium is charged to everyone who has the Medicare policy, regardlessof age. Premiums are the same no matter how old the applicant is. Premiums may go up because of inflation andother factors, but not based on age.11

Rate Type Available by DNENHNJNMNVOHOKPARISCSDTNTXUTVAWYWVGender RatesAttained, Issue,or CommunityRatedTobacco RatesDuring OpenEnrollmentEnrollment /Policy %*Product may not be available in all states**Other adult must have Americo Medicare Supplement policy to qualify for discount†Other adult does not have to be over age 60 to qualify for discount‡ Married couples must have lived together more than 12 months to qualify for discount12

Household Discount (Not available in all states)If question 1 in the Household Discount Section on the application is answered “Yes,” the individual may be eligiblefor the discount.Individuals are eligible for a Household Premium Discount if for the past year they have resided with at least one, butno more than three, other adults who are age 60 and older*. If they live with another adult who is a legal spouse, wewill waive both the one-year requirement and the age 60 requirement. For the purpose of this discount, a civil unionpartner or domestic partner will be considered a legal spouse when such partnerships are valid and recognized in theapplicant’s state of residence. We may request additional documentation to determine eligibility.The premium will be reduced by the percentage shown on the Outline of Coverage.The policy’s Household Premium Discount will be removed if the other adult no longer resides with the applicant(other than in the case of their death).**The Household Premium Discount provision is subject to state variation. See previous page for details.Definition of Domestic PartnerEither partner of an unmarried same or opposite sex couple in a relationship considered as being equivalent tomarriage for the purpose of extending certain legal rights and benefits.Class Rating (Not available in all states)How to determine class rating Follow instructions on the Premium Worksheet. Complete the form and return with the application.Height and Weight Charts are included on the next page of this Guide for your reference.Note: Risk class height and weight factors will not apply to open enrollees or guaranteed issues.13

EligibilityTo determine if the applicant is eligible for coverage, locate the applicant’s height, then weight (in pounds) in the chartbelow. If the applicant’s weight is in the Decline column, they are not eligible for coverage at this time. If their weightis located in the Class I or Standard column, you may continue with the application. Class I will add a 15% increase inpremium.*HeightDeclineWeightClass I - 15%*WeightStandardWeightClass I - 15%*WeightDeclineWeight4' 6''4' 7''4' 8''4' 9''4' 10''4' 11''5' 0''5' 1''5' 2''5' 3''5' 4''5' 5''5' 6''5' 7''5' 8''5' 9''5' 10''5' 11''6' 0''6' 1''6' 2''6' 3''6' 4''6' 5''6' 6''6' 7''6' 8''6' 9''6' 10''6' 11''7' 0''7' 1''7' 2''7' 3''7' 4'' 63 65 67 70 72 75 77 80 83 85 88 91 93 96 99 102 105 108 111 114 117 121 124 127 130 134 137 140 144 147 151 155 158 162 16663 – 7065 – 7367 – 7570 – 7872 – 8175 – 8477 – 8780 – 8983 – 9285 – 9588 – 9991 – 10293 – 10596 – 10899 – 111102 – 115105 – 118108 – 121111 – 125114 – 128117 – 132121 – 136124 – 139127 – 143130 – 147134 – 150137 – 154140 – 158144 – 162147 – 166151 – 170155 – 174158 – 178162 – 183166 – 18771 – 12874 – 13376 – 13879 – 14382 – 14885 – 15388 – 15890 – 16493 – 16996 – 175100 – 180103 – 186106 – 192109 – 197112 – 203116 – 209119 – 216122 – 222126 – 228129 – 234133 – 241137 – 248140 – 254144 – 261148 – 268151 – 275155 – 282159 – 289163 – 296167 – 303171 – 311175 – 318179 – 326184 – 333188 – 341129 – 170134 – 176139 – 182144 – 189149 – 196154 – 202159 – 209165 – 216170 – 224176 – 231181 – 238187 – 246193 – 254198 – 261204 – 269210 – 277217 – 285223 – 293229 – 302235 – 310242 – 319249 – 328255 – 336262 – 345269 – 354276 – 363283 – 373290 – 382297 – 392304 – 401312 – 411319 – 421327 – 431334 – 441342 – 451171 177 183 190 197 203 210 217 225 232 239 247 255 262 270 278 286 294 303 311 320 329 337 346 355 364 374 383 393 402 412 422 432 442 452 *Class I rate adjustment subject to state variation. Underwritten applicants in FL that fall outside of the Standard column are anautomatic declination, and therefore are not subject to the Class I rate adjustment.14

Completing the Premium on the ApplicationThe available premium payment modes at the time of policy issue are: Annual Direct Bill Monthly Bank Draft (Modal Factor 1/12)The payment mode should be selected on the application, with the amount of modal premium indicated in thePremium Payment section. If an application is submitted without premium, the first modal premium will be draftedon Effective Date as indicated on the application. If neither is selected on the application for the Initial Bank Draft,the first modal premium will be drafted on effective date.Note: If utilizing electronic funds transfer (EFT) as a method of payment, please complete the Authorization for Automatic FundsWithdraw form. If paying the initial premium by EFT, the authorization form must be completed and submitted with the application.Collection of PremiumFor policies other than EFT, a full modal premium must be submitted with the application. Money orders, cashier’s checks and counter checks are only acceptable if obtained by the applicant. Third partypayors cannot obtain a money order or cashier’s check on behalf of the applicant.Note: Americo Financial Life and Annuity Insurance Company does not accept post-dated checks or payments from Third Parties,including any Foundations as premium for Medicare Supplement. Immediate family and domestic partners are acceptable payors.Business ChecksBusiness checks are only acceptable if they are submitted for the business owner or the owner’s spouse.Important Consumer NoticesLeave the Important Consumer Notices with the applicant.Bank Draft Authorization FormIf paying by bank draft, the Bank Draft Authorization Form must be completed.Part 1 – Select the preferred bank draft dayTo help po

Medicare Supplement policy cannot be issued duplicating any other existing Medicare Supplement, Medicare Select, or Medicare Advantage plan. Reinstatements When a Medicare Supplement policy has lapsed within 90 days of the last paid to date, coverage may be reinstated, if the Reinstatement Request is made and the underwriting requirements are met.