Blue Shield – Blue Cross Medicare Trial Rights, Birthday Rules to get
Medi Gap – Supplemental plans Plans – California

Introduction
Medi Gap Guaranteed Issue

There are only certain times (Special & Open Enrollment) when you can enroll in a Medi-Gap – Supplemental plans without Medical Health Underwriting questions.   These times are called Guaranteed Acceptance – Issue.

Medi Gap is not like Medicare Advantage, where if you enroll when you turn 65 or at AEP Annual Open Enrollment, there are no health questions asked, or ACA under 65 Health Care Reform, where no questions are asked if you enroll at Open Enrollment (Age 65) or a Special Enrollment, See below.

The basic most common time, is when you turn 65.

See below of a summary of the times, then check with us [email protected]  or the actual documents we’ve linked to for the exact rules.  

• What is a better choice for Me?
  • Medi-Gap or Medicare Advantage?

FAQ’s just turned  Age 65 or newly enrolled in Part B”

• Hello – I just signed up for Medicare Part B using the current  GEP General Enrollment Period Timetable and Guaranteed Issue Availability  Since I relied on Cobra coverage, which isn’t considered Employer Coverage, I will be subject to a penalty   Am I entitled to a guaranteed issue Medigap policy, and how soon before July do I have to obtain the policy?
  • Yes, under situation # 1 above, you are entitled to guaranteed issue Medi Gap as it says 65 and enrolled in Part B!
  • I grant you, I don’t like the wording… but I’ve checked with the carriers and have actually had coverage issued.
  • I suggest you enroll, as soon as you get confirmation that Part B has been approved!
  • See our Medi Gap Pages for Blue Cross ,  UHC United Health and  Blue Shield,
    • There is no extra charge for our expertise. You can enroll online or we can help you in a Zoom meeting.
• From what I understand, the door is closing on signing up for Plan F
  • If you mean the new rules under MACRA that starts in 2020 for those who are newly eligible. You would be OK as long as you were first eligible prior to January 2020.  Otherwise, go for Plan G, the only difference is the $233   *  Out of Hospital Medical Deductible
• 1 Is it true that one has to sign up for a Medigap plan within 6 months of starting Medicare?   
  2 I will be starting in June, [that’s when I turn 65] so can I wait until November to sign up for a Medi-gap plan ? (to save money?)
  • 1 Yes, see above for details
    2 Yes, if I’m counting on my fingers correctly. Your six months would start in June.
    • I do not recommend that you wait. If this is your plan, you might be better off finding another agent to help you. Purposely waiting can only lead to a malpractice claim and a major hurt to your pocket book. If one knew when they were going to have a claim or be in an accident, they just wouldn’t leave the house that day.
    • Will your next question be, how long can you wait to sign up for Part B?
      • 3 months after the month you turn 65. That would save you $134/month.
    • If you are on a budget, how about Hi F? You pay the first 2k of bills, not paid by Medicare A or B and you save around $100/month on premium. Get quotes and enroll online.

FAQ’s on “Birthday Rule”

• California’s  birthday rule DOES NOT APPLY for Plan C Medicare Advantage
  • MAPD Changes can be made only during end-of-year period AEP October 15 through December 7th or a special enrollment  MAPD Open & Special Enrollments
    • Set up a Zoom meeting here.
• When is an application submitted?
  • Received?
  • By agent?
  • Wrong Department of the Insurance Company?
    • § 70.305 Timely mailing treated as timely filing.
    • (a) General rule. Title 26 U.S.C. 7502 provides that, if the requirements of such section are met, a document shall be deemed to be filed on the date of the postmark stamped on the cover in which such document was mailed.
    • (iii) (A) If the postmark on the envelope or wrapper is made by the U.S. Postal Service, such postmark must bear a date on or before the last date, or the last day of the period, prescribed for filing the document. https://www.law.cornell.edu/cfr/text/27/70.305
    • From agent contract
    • ***to present or propose to another for review, consideration, or decision merriam-webster.com/submit
    • ***arstechnica.com/
    • Date Calculator  time and date.com/
• 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?
  • 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
  • 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.
• If I sign up for Plan G,  Hi-F Medicare Supplement plan now, can I easily switch to a regular Plan F or something higher later?
  • The birthday rule above used to only allow you to change from one plan to another of the same or lesser value on your birthday.  See the Medi Gap Plans A – N Chart.
  • Underwriting Holiday or Freedom to Switch may allow you to do that. 
  • If you are healthy when you want to make a change, you can do that anytime. Here’s typical underwriting questions.

FAQ’s

Loss of Employer Coverage

• Where can one find the Official list for Medicare Advantage Plans, being as they differ from Medi Gap Plans?
  • medicare.gov/Understanding-Medicare-Part-C-D
• Are Medigap policies written during the 8-month Special Enrollment Period issued subject to the same terms as terms, with regard to pre-existing conditions, as those written during the Initial Enrollment Period?
  • The waiver of Pre X would be the same. Situation # 4 above says the enrollment period is 6 months. It gets QUITE confusing with different rules for different enrollments… Part B Outpatient, Part D Rx, Medicare Advantage, etc. One has to check each option with a fine tooth comb!
    • See links above to enroll online with Blue Cross and Blue Shield,  email us for UHC United Health Care
      • Here’s our scheduler to set a zoom meeting with screen sharing. set-a-meeting/
• I already have Medicare A and want part B. I am covered by a federal employee health plan (FEHB). Medicare (SSA) says I need to have a form filled out by my company president to verify employment- my W2 and tax form indicating coverage is not enough. Online it says my Medicare part B won’t start until July.
  • We will answer that question on our page about if you have employer coverage – do you have to enroll in parts A, B & D?
  • If you want more information and details – Please send a copy of your termination notice and if at all possible, all documents from your Employer’s Health Plan. Don’t hold back. We need to see if your under situation 4 or 11.
  • Did the employer plan supplement Medicare or not?
• If one gets terminated from their spouses retiree benefits plan when the spouse passes away is there a guaranteed enrollment period into Medi Gap and how does it work?
  • Yes. See situation # 4 above.
• If you cancel your Part B, then you to reinstate Part B later will you have guaranteed issue rights for Medi Gap?
  • Excerpt from Medicare Medi Gap Guide # 02110 * Medicare.Gov *
    • It’s also important to understand that your Medi gap rights may depend on when you choose to enroll in Medicare Part B. If you’re 65 or older, your Medigap Open Enrollment Period begins when you enroll in Part B and it can’t be changed or repeated.In most cases, it makes sense to enroll in Part B and purchase a Medi gap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and you might miss your Medi gap Open Enrollment Period. However, there are exceptions if you have employer coverage.
  • From prior conversations and emails, you’ve stated that you have an application pending for Part B, but have not been enrolled. I’d check and see if you can get the application cancelled, as if you never asked to be enrolled in Part B.
  • Either you or I can write to HICAP – CA Advocates and see what light they can put on the subject.
    • This may be a question to learn when you got Part B and if you can get guaranteed issue at a later date…

Employer loss of Coverage Guaranteed Issue

CA Insurance Code  §10192.11

• Interaction between COBRA and Medigap Guaranteed Issue Requirements in Situations Involving Termination of Employer Group Coverage

FAQ’s

MAPD Trial Period – Come back to Medicare and Medi-Gap”

• Question I enrolled in a Medi-Gap plan, last year when I turned 65.  If I enroll in a Medicare Advantage plan, can we go back to our Medi Gap plan anytime  or do we have to wait for Open Enrollment, 10.15 to 12.7 annually?
  .
• Answer If you cancel the MAPD plan within 12 months, you can go back to your Medi Gap plan.
  • If you stay in the MAPD plan longer than a year, you would have to meet underwriting – health questions to get a Medi Gap policy. There might be some Insurance Companies more liberal, but the law doesn’t require it.
  • Check with us when you’re ready to change. Sometimes there are “limited time” special offers, underwriting holidays – freedom to switch 
  • The Open Enrollment Period is only for MAPD and Part D Rx guaranteed sign up, switching plans or going back to original medicare, Parts A & B.
  • Again, if you are in a MAPD plan longer than a year, it’s not guaranteed issue to get your Medi Gap plan back
  • The Trial right is only for the first time you drop Medi Gap to try MAPD
    .
• Question If I understand it, this benefit – Right to get a Medi Gap Plan occurs because there is a “trial” period for MA in certain cases.  However, those cases don’t seem to include the case in which MA was obtained upon returning from overseas.  What am I missing?
  .
  • Answer Federal Guaranteed Rights to get Medi Gap is shown in Publication 02110 above
  • You are right, in your case, as you are not currently living in the USA you wouldn’t be joining at age 65, since you are not resident in any MAPD Service area.
  • Check the other guaranteed issue rights, like if there is a change in premium or benefits.
  • Blue Shield is liberal… Plus CA has or may have more liberal rights for guaranteed issue into Medi Gap Check out situation 14 Check out Situation # 17 if you get another company who changes benefits or premium 15% or more…
  • One must read all these rules at least 3 times and then when you think you understand it, read it again. Justice Felix Frankfurter
    .
• Question Do I understand correctly that a MAPD plan that was guaranteed issued, as I was living overseas and returned to USA as we discussed in this can be reverted to original Medicare + Medigap also on a guaranteed issue basis after a year?
  • Answer Yes. That’s what this whole section  is about. See above for details and explanation. If you have further questions, email us

FAQ’s “Under 65 disabled & Medicare Qualified”

• I have been trying to get a Medicare supplement for two years. NO one will give me one. I get denied for anything, for an H. Pylori infection. Every company I apply with denies me. I was born in 1957 and have Medicare but no company will give me a supplement. They all want to give me prescription drug plan while denying the medical plan. I live in California.
  • How about Medicare Advantage at the next Open Enrollment? Medicare Advantage is guaranteed issue, while Medicare Supplements where you can go to any doctor or hospital that accepts Medicare is not. Check out our page on when Supplements are guaranteed issue. See also the subpage where if you take a Medicare Advantage Plan and don’t like it, you can then get a supplement. Let’s talk privately about some companies that have an unofficial practice of being more liberal…
  • Please note that Medicare Supplements are not like Obama Care, there is no right to guaranteed issue, any time. Even Obama Care has certain open enrollment periods. See our page on Medical Loss Ratio, the Insurance Companies take in a small premium…from lots of people, but have to be able to pay all claims from all policy holders. See also the new page – under construction we are building on Donald Care. It appears that many of our leaders don’t understand medical underwriting and the law of large numbers.
• Hi. I’m looking for the best price on a Pre-65 Plan N supplement. We have Anthem at $249/month. My wife is on Social Security Disability. Birthdate: 10/25/1954. The price for Anthem started at $174 and after six months they raised it to $249.  Any possibilities we should look into?
  • I’ve responded to you privately. Use the menu above to check out other companies for Medi-Gap… but there may be a problem with Guaranteed Issue. In October there is Medicare Advantage.

“Underwriting #Holiday”

Freedom to Switch

Blue Shield is offering a Underwriting Holiday offer beginning on  June 1 through December 31, 2023. ^{Email 8.31.2022 & 9.27.2022}

This offer allows you to enroll in ANY* available Blue Shield of California Medicare Supplement plan without answering any health questions or obtaining underwriting approval.  You can enroll in ANY* available Blue Shield of California Medicare Supplement Plan without answering any health questions or obtaining underwriting approval.

email us [email protected] for more details

Sometimes, The Insurance Companies might have  a “Underwriting Holiday” or Freedom to Switch where you can change to the Insurance Company celebrating the Holiday with NO health questions, as long as you currenlty have a Medi Gap Plan and sometimes a Medicare Advantage Plan.

We don’t have a crystal ball and the Companies don’t seem to allow us to post information about the holidays.  So, email us [email protected] and we can let you know the current offerings.

Be sure to do this early in AEP so that there isn’t any lapse in getting Part D Rx…  See our webpage on Part D enrollment periods.

*Plan F is limited to those who became Medicare eligible before 1.1.2020, learn more MACRA

CA Insurance Code §10192.11 (h) open enrollment  birthday Rule

(h) (1) 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. 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 Health Advocates   More

CA Insurance Code §10192.12

(a)

(1) With respect to the guaranteed issue of a Medicare supplement policy, eligible persons are those individuals described in subdivision (b) who seek to enroll under the policy during the period specified in subdivision (c), and who submit evidence of the date of termination or disenrollment or enrollment in Medicare Part D with the application for a Medicare supplement policy.

(2) With respect to eligible persons, an issuer shall not take any of the following actions:

(A) Deny or condition the issuance or effectiveness of a Medicare supplement policy described in subdivision (e) that is offered and is available for issuance to new enrollees by the issuer.

(B) Discriminate in the pricing of that Medicare supplement policy because of health status, claims experience, receipt of health care, or medical condition.

(C) Impose an exclusion of benefits based on a preexisting condition under that Medicare supplement policy.

(b) An eligible person is an individual described in any of the following paragraphs:

(1) The individual is enrolled under an employee welfare benefit plan that provides health benefits that supplement the benefits under Medicare and either of the following applies:

(A) The plan either terminates or ceases to provide all of those supplemental health benefits to the individual.

(B) The employer no longer provides the individual with insurance that covers all of the payment for the 20-percent coinsurance.

Definitions  leginfo.legislature.ca.gov

(g) “Employee welfare benefit plan” means a plan, fund, or program of employee benefits as defined in Section 1002 of Title 29 of the United States Code (Employee Retirement Income Security Act).   erisa

law.cornell.edu/uscode/text/29/1002

(1)  The terms “employee welfare benefit plan” and “welfare plan” mean any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment, or vacation benefits, apprenticeship or other training programs, or day care centers, scholarship funds, or prepaid legal services, or (B) any benefit described in section 186(c) of this title (other than pensions on retirement or death, and insurance to provide such pensions).

(2) The individual is enrolled with a Medicare Advantage organization under a Medicare Advantage plan under Medicare Part C, and any of the following circumstances apply:

(A) The certification of the organization or plan has been terminated.

(B) The organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides.

Health Net Guide Rev. 7.2015 # 5 on page 6

medicare advocacy.org/when-a-medicare-advantage-plan-does-not-renew-its-contract

(C) The individual is no longer eligible to elect the plan because of a change in the individual’s place of residence or other change in circumstances specified by the secretary. Those changes in circumstances shall not include termination of the individual’s enrollment on the basis described in Section 1851(g)(3)(B) of the federal Social Security Act where the individual has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under Section 1856 of the federal Social Security Act, or the plan is terminated for all individuals within a residence area.

(D)

(i) The Medicare Advantage plan in which the individual is enrolled reduces any of its benefits or increases the amount of cost sharing or premium or discontinues for other than good cause relating to quality of care its relationship or contract under the plan with a provider who is currently furnishing services to the individual. An individual shall be eligible under this subparagraph for a Medicare supplement policy issued by the same issuer through which the individual was enrolled at the time the reduction, increase, or discontinuance described above occurs or, commencing January 1, 2007, for one issued by a subsidiary of the parent company of that issuer or by a network that contracts with the parent company of that issuer. If no Medicare supplement policy is available to the individual from the same issuer, a subsidiary of the parent company of the issuer, or a network that contracts with the parent company of the issuer, the individual shall be eligible for a Medicare supplement policy pursuant to paragraph (1) of subdivision (e) issued by any issuer, if the Medicare Advantage plan in which the individual is enrolled does any of the following:

(I) Increases the premium by 15 percent or more.

(II) Increases physician, hospital, or drug copayments by 15 percent or more.

(III) Reduces any benefits under the plan.

(IV) Discontinues, for other than good cause relating to quality of care, its relationship or contract under the plan with a provider who is currently furnishing services to the individual.

(ii) Enrollment in a Medicare supplement policy from an issuer unaffiliated with the issuer of the Medicare Advantage plan in which the individual is enrolled shall be permitted only during the annual election period for a Medicare Advantage plan, except where the Medicare Advantage plan has discontinued its relationship with a provider currently furnishing services to the individual. Nothing in this section shall be construed to authorize an individual to enroll in a group Medicare supplement policy if the individual does not meet the eligibility requirements for the group.

See our new page on the cost sharing rule

(E) The individual demonstrates, in accordance with guidelines established by the secretary, either of the following:

(i) The organization offering the plan substantially violated a material provision of the organization’s contract under this article in relation to the individual, including the failure to provide on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide the covered care in accordance with applicable quality standards.

(ii) The organization, or agent or other entity acting on the organization’s behalf, materially misrepresented the plan’s provisions in marketing the plan to the individual.

(F) The individual meets other exceptional conditions as the secretary may provide.

• • • Question  I lost employer coverage MAPD and was not informed of my right to purchase a Medi Gap plan. Would that be a material violation under item # 13 of the Blue Shield listing?
      .
    • Here’s Our Research Check out these references:
    • Official Guide to Medi Gap Page 3, right to buy Medi Gap policy and page 4 ESRD and Employer Coverage
    • ca health advocates.org

(3) The individual is 65 years of age or older, is enrolled with a Program of All-Inclusive Care for the Elderly (PACE) provider under Section 1894 of the federal Social Security Act, and circumstances similar to those described in paragraph (2) exist that would permit discontinuance of the individual’s enrollment with the provider, if the individual were enrolled in a Medicare Advantage plan.

(4) The individual meets both of the following conditions:

(A) The individual is enrolled with any of the following:

(i) An eligible organization under a contract under Section 1876 of the federal Social Security Act (Medicare cost).

(ii) A similar organization operating under demonstration project authority, effective for periods before April 1, 1999.

(iii) An organization under an agreement under Section 1833(a)(1)(A) of the federal Social Security Act (health care prepayment plan).

(iv) An organization under a Medicare Select policy.

(B) The enrollment ceases under the same circumstances that would permit discontinuance of an individual’s election of coverage under paragraph (2) or (3).

(5) The individual is enrolled under a Medicare supplement policy, and the enrollment ceases because of any of the following circumstances:

(A) The insolvency of the issuer or bankruptcy of the nonissuer organization, or other involuntary termination of coverage or enrollment under the policy.

(B) The issuer of the policy substantially violated a material provision of the policy.

(C) The issuer, or an agent or other entity acting on the issuer’s behalf, materially misrepresented the policy’s provisions in marketing the policy to the individual.

(6) The individual meets both of the following conditions:

(A) The individual was enrolled under a Medicare supplement policy and terminates enrollment and subsequently enrolls, for the first time, with any Medicare Advantage organization under a Medicare Advantage plan under Medicare Part C, any eligible organization under a contract under Section 1876 of the federal Social Security Act (Medicare cost), any similar organization operating under demonstration project authority, any PACE provider under Section 1894 of the federal Social Security Act, or a Medicare Select policy.

(B) The subsequent enrollment under subparagraph (A) is terminated by the individual during any period within the first 12 months of the subsequent enrollment (during which the enrollee is permitted to terminate the subsequent enrollment under Section 1851(e) of the federal Social Security Act).

(7) The individual upon first becoming eligible for benefits under Medicare Part A at 65 years of age enrolls in a Medicare Advantage plan under Medicare Part C or with a PACE provider under Section 1894 of the federal Social Security Act, and disenrolls from the plan or program not later than 12 months after the effective date of enrollment.

Some companies are more liberal and offer two years. More detail

(8) The individual while enrolled under a Medicare supplement policy that covers outpatient prescription drugs enrolls in a Medicare Part D plan during the initial enrollment period terminates enrollment in the Medicare supplement policy, and submits evidence of enrollment in Medicare Part D along with the application for a policy described in paragraph (4) of subdivision (e).

(c)

(1) In the case of an individual described in paragraph (1) of subdivision (b), the guaranteed issue period begins on the later of the following two dates and ends on the date that is 63 days after the date the applicable coverage terminates:

(A) The date the individual receives a notice of termination or cessation of all supplemental health benefits or, if no notice is received, the date of the notice denying a claim because of a termination or cessation of benefits.

(B) The date that the applicable coverage terminates or ceases.

(2) In the case of an individual described in paragraphs (2), (3), (4), (6), and (7) of subdivision (b) whose enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the individual receives a notice of termination and ends 63 days after the date the applicable coverage is terminated.

(3) In the case of an individual described in subparagraph (A) of paragraph (5) of subdivision (b), the guaranteed issue period begins on the earlier of the following two dates and ends on the date that is 63 days after the date the coverage is terminated:

(A) The date that the individual receives a notice of termination, a notice of the issuer’s bankruptcy or insolvency, or other similar notice if any.

(B) The date that the applicable coverage is terminated.

(4) In the case of an individual described in paragraph (2), (3), (6), or (7) of, or in subparagraph (B) or (C) of paragraph (5) of, subdivision (b) who disenrolls voluntarily, the guaranteed issue period begins on the date that is 60 days before the effective date of the disenrollment and ends on the date that is 63 days after the effective date of the disenrollment.

(5) In the case of an individual described in paragraph (8) of subdivision (b), the guaranteed issue period begins on the date the individual receives notice pursuant to Section 1882(v)(2)(B) of the federal Social Security Act from the Medicare supplement issuer during the 60-day period immediately preceding the initial enrollment period for Medicare Part D and ends on the date that is 63 days after the effective date of the individual’s coverage under Medicare Part D.

(6) In the case of an individual described in subdivision (b) who is not included in this subdivision, the guaranteed issue period begins on the effective date of disenrollment and ends on the date that is 63 days after the effective date of disenrollment.

(d)

(1) In the case of an individual described in paragraph (6) of subdivision (b), or deemed to be so described pursuant to this paragraph, whose enrollment with an organization or provider described in subparagraph (A) of paragraph (6) of subdivision (b) is involuntarily terminated within the first 12 months of enrollment and who, without an intervening enrollment, enrolls with another such organization or provider, the subsequent enrollment shall be deemed to be an initial enrollment described in paragraph (6) of subdivision (b).

(2) In the case of an individual described in paragraph (7) of subdivision (b), or deemed to be so described pursuant to this paragraph, whose enrollment with a plan or in a program described in paragraph (7) of subdivision (b) is involuntarily terminated within the first 12 months of enrollment and who, without an intervening enrollment, enrolls in another such plan or program, the subsequent enrollment shall be deemed to be an initial enrollment described in paragraph (7) of subdivision (b).

(3) For purposes of paragraphs (6) and (7) of subdivision (b), an enrollment of an individual with an organization or provider described in subparagraph (A) of paragraph (6) of subdivision (b), or with a plan or in a program described in paragraph (7) of subdivision (b) shall not be deemed to be an initial enrollment under this paragraph after the two-year period beginning on the date on which the individual first enrolled with such an organization, provider, plan, or program.

(e)

(1) Under paragraphs (1), (2), (3), (4), and (5) of subdivision (b), an eligible individual is entitled to a Medicare supplement policy that has a benefit package classified as Plan A, B, C, F (including a high deductible Plan F), K, L, M, or N offered by any issuer.

(2)

(A) Under paragraph (6) of subdivision (b), an eligible individual is entitled to the same Medicare supplement policy in which he or she was most recently enrolled, if available from the same issuer. If that policy is not available, the eligible individual is entitled to a Medicare supplement policy that has a benefit package classified as Plan A, B, C, F (including a high deductible Plan F), K, L, M, or N offered by any issuer.

(B) On and after January 1, 2006, an eligible individual described in this paragraph who was most recently enrolled in a Medicare supplement policy with an outpatient prescription drug benefit is entitled to a Medicare supplement policy that is available from the same issuer but without an outpatient prescription drug benefit or, at the election of the individual, has a benefit package classified as a Plan A, B, C, F (including high deductible Plan F), K, L, M, or N that is offered by any issuer.

(3) Under paragraph (7) of subdivision (b), an eligible individual is entitled to any Medicare supplement policy offered by any issuer.

(4) Under paragraph (8) of subdivision (b), an eligible individual is entitled to a Medicare supplement policy that has a benefit package classified as Plan A, B, C, F (including a high deductible Plan F), K, L, M, or N and that is offered and is available for issuance to a new enrollee by the same issuer that issued the individual’s Medicare supplement policy with outpatient prescription drug coverage.

(f)

(1) At the time of an event described in subdivision (b) by which an individual loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization that terminates the contract or agreement, the issuer terminating the policy, or the administrator of the plan being terminated, respectively, shall notify the individual of his or her rights under this section and of the obligations of issuers of Medicare supplement policies under subdivision (a). The notice shall be communicated contemporaneously with the notification of termination.

(2) At the time of an event described in subdivision (b) by which an individual ceases enrollment under a contract or agreement, policy, or plan, the organization that offers the contract or agreement, regardless of the basis for the cessation of enrollment, the issuer offering the policy, or the administrator of the plan, respectively, shall notify the individual of his or her rights under this section, and of the obligations of issuers of Medicare supplement policies under subdivision (a). The notice shall be communicated within 10 working days of the date the issuer received notification of disenrollment.

(g) An issuer shall refund any unearned premium that an insured paid in advance and shall terminate coverage upon the request of an insured.

(Amended by Stats. 2012, Ch. 162, Sec. 113. Effective January 1, 2013.)