Guaranteed Issue (GI) rights are rights the beneficiary has in certain situations when insurance companies must offer certain Medigap policies.
There are ONLY 7 situations where Guaranteed Issue Rights apply. Two of the most common are:
- Beneficiary is in a Medicare Advantage Plan, and the plan is leaving Medicare or stops giving care in their area, or the beneficiary moves out of the Medicare Advantage plan’s service area.
- Beneficiary has Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.
Just like with the Medigap Open Enrollment Period, during a Guaranteed Issue:
- No eligibility questions are permitted
- Coverage must be provided for Pre-existing conditions
- Insurer cannot charge beneficiary more due to current/past health issues
- Only Non-Tobacco Rates apply
As always, please contact your Total Benefit Solutions, Inc health insurance specialists with any questions or concerns at (215)355-2121.