Guaranteed Acceptance Guide
Blue Shield CALIFORNIA
This is just a summary of the major reasons. Check this entire page and website for all situations and Insurance Carriers.
Enrolled in Medicare and are age 65 or older; or New to Medicare, are age 64 or younger, and do not have end-stage renal disease
You enrolled with A Medicare Advantage Plan and the plan is being terminated;
terminated from any employer-sponsored health plan,
moved outside the plan’s service area.
disenrolled from the plan or program within twelve (12) months of the effective date of that enrollment.
You terminated enrollment in a Medicare Supplement plan and subsequently enrolled, for the first time, in any of the following:
• A Medicare Advantage Plan;
The company substantially violated a material provision of the contract; or
The company or its agent materially misrepresented a provision of the plan in marketing the contract to you.
You enrolled in a Blue Shield Medicare Advantage Plan, and Blue Shield either:
Reduced any of its benefits;
Increased the amount of cost-sharing or premium;
You are no longer eligible for Medi-Cal benefits.
Blue Shield Authorized Agent
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Special enrollment on your birthday
On your birthday, you can change Medi Gap plans, guaranteed issue!
An individual shall be entitled to an annual open enrollment period lasting 30 days or more, commencing with the individual’s birthday, during which time that person may purchase any Medicare supplement policy that offers benefits equal to or lesser than those provided by the previous coverage.
Thus, if your looking to go from F to Blue Cross Innovative F or Blue Shield Plan F Extra, those are BETTER – more than equal plans and it’s not guaranteed issue. You would have to pass underwriting. If you can’t pass underwriting one would still be able to use the Birthday Rule GI right for plan A, F, G or N.
During this open enrollment period, no issuer that falls under this provision shall deny or condition the issuance or effectiveness of Medicare supplement coverage, nor discriminate in the pricing of coverage, because of health status, claims experience, receipt of health care, or medical condition of the individual if, at the time of the open enrollment period, the individual is covered under another Medicare supplement policy or contract.
An issuer shall notify a policyholder of his or her rights under this subdivision at least 30 and no more than 60 days before the beginning of the open enrollment period., CA Insurance Code §10192.11 (h) (1)