Seniors Choice is filed with each approved state as a Group Plan. It cannot be sold to individuals who are not covered under a signed contract between MBA and the sponsoring employer, which is called an Employer Trust Participation Agreement. Covered individuals are those either currently working for the employer or who have worked for the employer in the past.
Can we take an employee who currently is working for an employer who has 20+ employees that is 65 years old and eligible for the employer group plan and offer them Seniors Choice?
Due to TEFRA regulations, an employer with 20+ full-time or part-time employees must comply. If this employer has someone 65+ years of age and is eligible for the employer group plan, they must be offered that plan and are ineligible for Seniors Choice or any type of Medicare Supplement plan.
Can we take someone 65+ who works for an employer with less than 20 full-time and part-time employees and remove them from the group plan and put them on Seniors Choice?
Yes. The group is not a TEFRA group, therefore Medicare is primary for that individual which makes them eligible for Seniors Choice.
Can that same individual in the last question be forced off the group plan and onto Seniors Choice?
Yes. As long as the coverage with Seniors Choice is equal to or better than the group plan under which they are currently covered.
What is the definition of an eligible Seniors Choice group?
Only one person is required to create an eligible group. Even if there are no current enrollees, a group may submit an Employer Trust Participation Agreement , anticipating future eligible retirees.
What type of documentation, if any, is required for proof of a business entity?
Various types of documents are accepted depending on what your state has such as: a Schedule C, copy of business license or other city/legal documentation that can be provided.
Is there ever a time that a health statement is required for enrollment?
No. Seniors Choice is always guaranteed issue.
If the member is contributing, can they pay by credit card or bank draft?
Yes, a member may remit premium by bank draft or credit card. We accept all major credit cards.
How often should we anticipate rate changes and how are renewals handled?
Although Seniors Choice has no rate guarantee, the history of the program has shown that when a rate increase occurs, it is in conjunction with open enrollment, January 1st. One of the unique features of the Seniors Choice program is the renewal process. One way rate increases are minimized is that the entire block renews together, therefore each member is part of a large pool and is never singled out for rate increases (all groups are offered the same applicable set of rates for the same plan for the age band and area).
When can a member make a change to their current Seniors Choice plan?
At renewal each employer, member and agent will receive a renewal notice. At this time, an employer may make changes to the benefits they offer their retirees. Members may make changes during the open enrollment period if the benefit is offered by their employer. If a higher benefit level plan has been made available by the employer, the member can buy up with no health statements or underwriting required.