Aetna | Get ready for AEP: New business tips
Tips for your new business
With so many consumers making decisions about their healthcare needs this time of year, it’s easy to make some incorrect assumptions, which can result in delays or even a lost sale. We’re here to help you avoid those costly mistakes.
Choosing the type of application
When taking a Medicare Supplement application, be sure to pay attention to the type of application. The Medicare Annual Enrollment Period (AEP) does not mean the application is automatically Open Enrollment (OE) or Guaranteed Issue (GI).
Open enrollment applies only to persons who are first enrolling in Medicare Part B or turning age 65.
The guaranteed issue applies only to Medicare beneficiaries who are losing (or disenrolling) in their current health care coverage under a qualifying GI provision and these applications must include proof of creditable coverage which supports the qualifying GI event. Be sure to include the proof of creditable coverage with the application.
Underwritten applies to all other applications, where the applicant must answer all of the health questions.
Review the list of medications before submitting an app
Your applicant may not know about a declinable condition listed on their application. But, their prescribed medication may indicate they have a declinable condition.
Important: Some medications can be prescribed for multiple conditions. If your application is prescribed a medication that has multiple uses, you must provide the condition the medication is prescribed to treat.
Also, don’t leave the list of medications blank on the application. If the applicant doesn’t take any medications, list “none.”
We offer a list of commonly prescribed medications for declinable conditions to help you when you’re completing applications.
How our automated underwriting works
All applications submitted through Aetna Quote & Enroll will receive one of the following automated decisions within 2 minutes of submission: approved, declined, or review.
More than 64% of applications receive an automated “approved” or “declined” decision.
“Review” means that the applicant’s prescription and/or medical claims history conflicts with our underwriting guidelines and a manual underwriting review will be conducted next.
Point of sale declined applications are due to prescription fills and/or medical claim data indicating one or more health questions should have been marked “yes.”
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Contact a Pinnacle Representative if you have any questions.
1 (800) 772-6881
support@pfsinsurance.com
