Nebraska Department of Insurance

Home Consumer Producer Company About NDOI Quick Links Outside Links

THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM

JULY 2003 NICA NEWS

CHANGES

NICA Volunteer Manual Updates

In April, all volunteers should have received new pages for the green NICA Manual. These pages replace the entire outdated version. Please take a look at the new manual, and note some significant changes. Some specific items to note:

C10 & K5 - Special Enrollment Periods. Regardless of employer plan group size, all beneficiaries who continue working past age 65 and are covered under an employer group health plan are eligible for a Special Enrollment Period, allowing them to enroll in Medicare with no penalty for delay.
F31 - Guarantee Issue Period. According to Nebraska Department of Insurance interpretation of the state regulation, a person who has an employer group health plan paying secondary to Medicare, and who voluntarily quits the plan, does not have a guarantee issue right to a Medicare Supplement Policy.
I10 - Disregarded Premiums. This new addition to the manual lists the insurance premiums that beneficiaries can use to lower their monthly income, in order to reach Medicaid eligibility guidelines.
K14 - Updated Flow chart reflects the Special Enrollment Period rights for persons continuing to work past age 65
K17 - COBRA. Exhaustion of COBRA continuation coverage does trigger a guarantee issue opportunity for a Medsupp policy. However, COBRA coverage does not extend the Special Enrollment Period after group health plan coverage is lost.
K19 - VA benefits. New section details benefits available to Veterans, including Tricare for Life and Champva for Life.
N 17-29 - Medicare + Choice. Information on the new Private Fee-for-Service (PFFS) plans, Preferred Provider Organization (PPO), and Health Maintenance Organization (HMO) option available in Nebraska.

NICA Volunteers - Check your Manual!

For a more complete review of creditable coverage as it applies to Medicare Supplement insurance, please review your new NICA Manual, pages F25 through F31. The manual discusses in detail pre-existing condition waiting periods, creditable coverage, continuous coverage, and special considerations given during an open enrollment period, guarantee issue opportunity, or when replacing one Medsupp policy with another. Waiting periods may or may not be required - depending on applicable creditable coverage - during the six-month open enrollment period, under the certain specific circumstances granting a guarantee issue opportunity, and when replacing one Medsupp policy with another.

Please note specifically that if a person is replacing a Medsupp policy with a new Medsupp policy, the time spent under the old policy will count toward any pre-existing condition waiting period under the new policy. However, if a person will receive benefits under the new policy that were not in the old policy, a pre-existing condition exclusion can be imposed on those new benefits for a maximum of six months. The new policy does not have to be purchased from the same company.

The NICA Manual, F25-31, clarifies these details. NICA Volunteers with further questions can contact the regional representative in his/her area, or the state program office.

Expanded Coverage of ICDs

CMS announced on June 6th that it will expand the number of Medicare beneficiaries who qualify to receive implantable cardiac defibrillators (ICDs), limiting coverage to patients who appear the most likely to benefit from the device. Medicare currently covers ICDs for 27,000 beneficiaries who have had heart attacks and are considered at the highest risk for sudden death because of abnormally rapid heartbeats. A March 2002 study found that the devices reduced death rates by 31% for patients who had had heart attacks and impaired blood-pumping ability but not fast heartbeats. CMS decided to expand coverage of the procedure to those who stand to benefit most from the implant-an additional 10,000 patients per year. CMS may further expand coverage of the devices next spring, after the results of another clinical trial are released (New York Times, 6/7)

New Medicare + Choice PFFS Plan Available

On April 1, 2003, a new Private Fee-for-Service plan became available for residents in 77 Nebraska counties. UniCare, a division of WellPoint Health Networks, Inc, released its SecurityChoice PFFS plan. While beneficiaries do continue to pay the Part B premium, $58.70/month in 2003, SecurityChoice is being marketed with a $9 monthly premium. There are further details about PFFS plans in general, and UniCare's specific copayment amounts beginning on page N28 of the updated NICA Volunteer Manual. A PFFS flyer can also be obtained from the NICA Program Office to help with beneficiary questions.

SecurityChoice will be available to residents of the following counties in Nebraska: Adams, Antelope, Arthur, Banner, Blaine, Boone, Box Butte, Brown, Buffalo, Butler, Cass, Cedar, Chase, Cherry, Cheyenne, Clay, Colfax, Cuming, Custer, Dawes, Dawson, Deuel, Dixon, Dundy, Fillmore, Franklin, Frontier, Furnas, Gage, Garden, Garfield, Gosper, Grant, Greeley, Hall, Hamilton, Harlan, Hitchcock, Holt, Hooker, Howard, Jefferson, Johnson, Kearney, Keith, Keya Paha, Kimball, Knox, Logan, Madison, Merrick, Morrill, Nance, Nemaha, Nuckolls, Otoe, Pawnee, Phelps, Pierce, Platte, Polk, Richardson, Rock, Saline, Scotts Bluff, Seward, Sheridan, Sherman, Sioux, Stanton, Thayer, Valley, Washington, Wayne, Webster, Wheeler, and York.

WELCOME

The NICA Program office is happy to welcome Sue Kuzelka to the staff. Sue has been the part-time Staff Assistant for the NICA program since early April. Sue also works part-time in the Legal Division of the Department of Insurance, which brings a great new level of knowledge into the program.

Sue has caught on very quickly, and is already doing an excellent job answering the NICA hotline. And for the new volunteers who attended the Initial Training this spring, or to those volunteers that attended the conference in Lincoln in June, you've already seen the results of her hard work - Sue is the reason everything was so organized and ran so smoothly!

Welcome aboard, Sue!