Bulletin, December 6, 2001, Guaranteed Issue Requirements under Special Enrollment Periods for Medicare + Choice Enrollees

Last Updated: December 7, 2001

Date: December 6, 2001
To: All Medicare Supplement Insurers
From: Connie L. O'Connell, Commissioner of Insurance
Subject: Electronic Appointment/Termination of Insurance Agents

​The purpose of this Bulletin is to notify you that Medicare + Choice enrollees in the State of Wisconsin have a December Special Election Period with the same guaranteed issue protections as if their plan had terminated. Therefore, Medicare supplement and Medicare select insurers must issue coverage without any pre-existing condition exclusions to those Medicare + Choice enrollees who choose to leave the Medicare + Choice organization.

The Secretary for the U.S. Department of Health and Human Services, by memo of June 14, 2001, established a Special Election Period (SEP) from December 1 through December 31, 2001 for all Medicare + Choice enrollees. According to information we have received from the Center for Medicare and Medicaid Services (CMS), disenrollment is one of the plan choices a Medicare + Choice enrollee may make. Concomitant with this decision, according to CMS the Medicare + Choice enrollee has guaranteed issue rights into Medicare supplement and Medicare select plans. Section 1882(s)(3)(B)(ii) of the Social Security Act (the Medicare supplement section of the law) gives the guaranteed issue right when specific circumstances permitting discontinuance of the individual's election of the plan arise.

CMS will not be mailing to Medicare + Choice enrollees notice of their guaranteed issue rights as a result of the SEP. It is our understanding that the Medicare + Choice enrollees, as a result of the SEP, have guaranteed issue into a Medicare supplement or a Medicare select policy until March 4, 2002, or 63 days after they disenroll from the Medicare + Choice plan, whichever is sooner.

Medicare supplement and Medicare select insurers should review the applicable federal laws and the CMS website for more details.

Questions concerning this Bulletin may be directed to Jerry Zimmer or Kevin Zwart in our Market Regulation Bureau. Mr. Zimmer can be reached by e-mail at jerry.zimmer@oci.state.wi.us or by phone at (608)266-9894. Mr. Zwart can be reached by e-mail at kevin.zwart@wisconsin.gov or by phone at (608)266-0093.

Thank you.