• These individuals are eligible for a Guaranteed Issue Enrollment opportunity due to being within 6 months of Part B Enrollment. This is a Standard Guaranteed Issue condition. 
• When submitting applications for individuals new to Part B, answer Yes to the following question: 
  • Are you within 6 months of enrolling in Medicare Part B (Part B effective date on your Medicare card)?
• No additional supporting documentation is required for this condition.

• These individuals are being told they are no longer eligible for Medicaid. Although they may be outside the typical window for election into a Medicare Advantage plan or Guaranteed Issue enrollment into Medigap, we are required to offer them coverage into a Medigap Plan within 63 days of notice of termination according to WV Insurance Bulletin 23-05 issued on June 13 2023.
•  When submitting applications for these individuals, answer Yes to the following question:
  • Have you lost or are you losing other health insurance coverage and received a notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement insurance policy, or that you have certain rights to buy such a policy?
• Supporting documentation is required for this condition. 
  • "Notice" indicated in application question might be worded as "Medicaid eligibility change," "redetermination," or "loss of Medicaid eligibility" rather than "guaranteed issue rights" notice.
  • You must include a copy of the individual's disenrollment/termination letter.
  • When submitting applications via the Portal, when this condition is selected you will be prompted to upload a copy of the letter.
  • When submitting paper applications, a copy of the letter may be included in the envelope along with the application.
  • Failure to include the disenrollment/termination letter with the application will result in processing delays and/or denial of coverage.
  • The enrollee will receive outreach from our enrollment department and/or member services to acquire a copy of the letter. If the letter is not received within 30 days of receipt of the application, the application will be denied.

To view and download a copy of the Highmark West Virginia Medigap Blue application click here.

 

Contacts and Additional Resources