Special enrollment  on your birthday 
 On your birthday, you can change Medi Gap plans, guaranteed issue!

If you can’t pass underwriting one would still be able to use the

Birthday Rule GI Guaranteed Issue right for plan A, F, G or N.

An individual shall be entitled to an annual open enrollment period lasting 60 days or more, commencing with the individual’s birthday, during which time that person may purchase any Medicare supplement coverage that offers benefits equal to or lesser than those provided by the previous coverage.  

The application may be submitted 90 days in advance, for Blue Cross, but the effective date would be for the month after the clients birthday unless their birth date was on the 1st.  CA Health Care Advocates  * excerpt of email from BC 6.2.2020

During this open enrollment period, an issuer that falls under this paragraph shall not 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

Blue Cross Innovative F or G or Blue Shield Plan F or G Extra,  count the same as F or G and don’t require underwritingCA Health Care Advocates *# *

Blue Shield – Birthday Rule

Typical Guidelines

Guaranteed Issue Guide

Guaranteed Issue Guide - Birthday Rule

Blue Shield Authorized Agent
No extra charge to you -
Learn more and enroll online

Blue Shield Logo & Enroll

Paper Application
MAPD Medicare Advantage

* Short Form - Transfers  65 Inspire, Plus, Choice & Trio

Medi Gap  Paper Application

set a phone, skype, Zoom or face to face complementary consultation

Get Plan Documents 
Be sure though to use THIS link to enroll, so we get paid for helping you!

Steve Video @ Blue Shield Headquarters

MediGap Plans from Anthem Blue Cross –
Click for Information and ONLINE enrollment

blue cross medi gap

Paper Application 

Excerpt of CA Law

if, at the time of the open enrollment period, the individual is covered under another Medicare supplement policy, certificate, or contract. An issuer that offers Medicare supplement contracts shall notify an enrollee of their rights under this subdivision at least 30 and no more than 60 days before the beginning of the open enrollment period, and on any notice related to a benefit modification or premium adjustment.  1358.11. (h) (1)    *  SB 407  Effective 7.1.2020? 
 
(2) For purposes of this subdivision, the following provisions apply:
 
(A) A 1990 standardized Medicare supplement benefit plan A shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan A.
(B) A 1990 standardized Medicare supplement benefit plan B shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan B.
(C) A 1990 standardized Medicare supplement benefit plan C shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan C.
(D) A 1990 standardized Medicare supplement benefit plan D shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan D.
(E) A 1990 standardized Medicare supplement benefit plan E shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare benefit plan D.
(F) 
(i) A 1990 standardized Medicare supplement benefit plan F shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare benefit plan F.
 
(ii) A 1990 standardized Medicare supplement benefit high deductible plan F shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit high deductible plan F.
(G) A 1990 standardized Medicare supplement benefit plan G shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan G.
(H) A 1990 standardized Medicare supplement benefit plan H shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan D.
(I) A 1990 standardized Medicare supplement benefit plan I shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan G.
(J) 
(i) A 1990 standardized Medicare supplement benefit plan J shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan F.
(ii) A 1990 standardized Medicare supplement benefit high deductible plan J shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit high deductible plan F.
(K) A 1990 standardized Medicare supplement benefit plan K shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan K.
(L) A 1990 standardized Medicare supplement benefit plan L shall be deemed to offer benefits equal to those provided by a 2010 standardized Medicare supplement benefit plan L.
 
 
(M) New or innovative benefits, as described in subdivision (f) of Section 1358.9 and subdivision (f) of Section 1358.91, shall not be included when determining whether benefits are equal to or lesser than those provided by the previous coverage.
(i) An individual enrolled in Medicare Part B is entitled to open enrollment described in this section upon being notified that, because of an increase in the individual’s income or assets, they meet one of the following requirements:
(1) They are no longer eligible for Medi-Cal benefits.
(2) They are only eligible for Medi-Cal benefits with a share of cost and certifies at the time of application that they have not met the share of cost.  1358.11. (h) (1)    *  SB 407  Effective 7.1.2020? 

Transfer Application

No need to fill out Health Questions

 

When you fill out the transfer application under the birthday rule, whether ONLINE or Paper, check off the equal or lesser plan that you want.

which medi gap plan do you want?

Then put down the rule – situation # for the Insurance Company that you are using.

Birthday rule guaranteed #

When you get to the Statement of Health, you don’t have to fill out any questions.

Don't have to fill out medical questions

 

While these pictures are from the Blue Shield application, the general principles apply to all Insurance Companies.

Guaranteed Acceptance Guide
Blue Shield CALIFORNIA
Blue Cross CA

This is just a summary of the most common ways you can get a Medi Gap plan without having to answer health questions.

Get more detail at:

CA Health Care Advocates
Federal Choosing a Medi Gap Policy  #02110
Guaranteed Acceptance Guide Blue Shield

Guaranteed Acceptance – Medi-Gap – Supplemental Plans

On some pages you can Scroll down for our cut & paste of the ACTUAL CA Law

7 comments on “Birthday Rule

  1. I’m transferring from Plan F to Plan G under the birthday rule to save premium. How come the Insurance Company called and asked about tobacco usage? It’s guaranteed issue isn’t it?

    • My initial thought is that if you are currently on a Medi Gap plan and paying the Tobacco Rate, that the new plan would have the tobacco rate too. Just because you change would not eliminate that surcharge. Let me see if I can find a citation. That’s one reason I prefer email for complex questions. So I can get the CORRECT answer and not some off the cuff answer. Even “Quick Questions” generally don’t have simple or quick answers.

      CA Insurance Code 10192.11. (h) (1) … annual open enrollment period … 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.

      So, is tobacco usage protected under health status?

      Resource Brokerage.com Central States Indemnity agent underwriting guide – CA requires Tobacco usage question even in Open Enrollment or Guaranteed Issue

      Alisprotect.com says tobacco rates don’t apply

      (24)(36) “Health status” means the determination bya carrier ofthe past, present, or expected risk of an individual or the employer due to the health conditions of THE INDIVIDUAL OR the employees of the employer.
      (24.5) (37) “Health-status-related factor” means any of the following factors:
      (a) Health status;
      (b) Medical condition, including both physical and mental illnesses;
      (c) Claims experience;
      (d) Receipt of health care; Ch. 217 Insurance 913
      (e) Medical history;
      (f) Genetic information;
      (g) Evidence of insurability, including conditions arising out of acts of domestic
      violence; and
      (h) Disability. Colorado.Gov

      One might also check with https://cahealthadvocates.org/ for their research, which isn’t answered on their website

      d. Tobacco Use – If a carrier reflects tobacco usage in the calculation of rates, then it shall do so according to the following requirements:

      (3) Any rate adjustment attributable to an individual (and all similarly situated individuals) based upon tobacco usage shall be applied to that individual (and all similarly situated individuals), and shall not be distributed to the entire group; and,

      h. Health status and claims experience may not be used as case characteristics. A health questionnaire, requesting reasonable information, may be used to obtain information about the health status of group enrollees. However, the health questionnaire may not be used in any way to determine the premium rate or any rating factor that is used in the determination of the premium rate that is charged to the group, except as provided in Subparagraph (d) of this paragraph. Colorado Secretary of State

      UHC Confidential Agent Manual 2017

      Members who have smoked tobacco cigarettes or used any tobacco product at any time within the past 12 months will pay the tobacco rate. Non-tobacco rates apply to all applicants who meet open enrollment or guaranteed issue requirements.

      Obamacare/ACA doesn’t allow health questions, but it does allow tobacco usage to be surcharged 50%. CA though doesn’t allow the surcharge. Our Website

  2. If I sign up for a Hi-F Medicare Supplement plan now, can I easily switch to a regular Plan F later?

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