General Underwriting Rules Rating and Underwriting

Below are some general underwriting rules that you should keep in mind when working with your customers.

• There is no automatic transfer from any existing Keystone, Personal Choice, or other Independence Blue Cross plan into the Individual medically underwritten programs.
• All of the Individual medically underwritten plans are subject to a preexisting condition exclusion. This means that they exclude coverage for preexisting conditions for the first 12 months of coverage except for applicants under age 19 and dependent children under age 19. For the HMO plans, the look-back period is 90 days prior to the effective date of coverage. For PPO plans, the look-back period is 12 months prior to the effective date of coverage. There are two ways in which applicants may be able to waive or reduce the waiting period for a preexisting condition — through creditable coverage or a Blue-to-Blue transfer.
• An application, whether online or paper, must be received by IBC within 21 days of signature.
• A pending application will remain open no more than 90 days from the signature date. If underwriting cannot be completed within 90 days of the signature date, a new application will be required. However, an underwriter may close out (decline) an application earlier than 90 days if it is determined that there has been no response to IBC’s requests for additional information from either the applicant or medical providers. If an application is declined for nonreceipt of information and the outstanding information is later received, a new application will be required in order to reopen for consideration.
• Applicants making a paper application must complete the form in black ink.
• All family members must select the same plan with the same effective date.
• Any altered information (answers to questions or otherwise) in the application must be initialed by the primary applicant, regardless of who made the change.
• If medical or other information is provided on a separate sheet of paper, it is to be completed in ink, signed, and dated by the primary applicant and spouse (if applying), and stapled to the application submission.
• Applications with numerous omissions, alterations, or delayed submission (more than 21 days after signature) will be rejected and a new application will be required. The unacceptable application will be returned to the applicant.
• If coverage is approved on a modified basis (either a substandard rating or a family member declined), IBC will provide an offer letter (either online or through the mail) to the applicant with details on the effective date of coverage, the terms of coverage, and the premium. Coverage will not take effect until the applicant has formally accepted the offer. If the offer is not accepted within 15 days, the underwriter may withdraw the offer, and any future requests for coverage will be subject to a new application and medical underwriting. Formal acceptance may also be required in certain instances for a standard-issue approval if the underwriter requires review and sign-off on application changes.
• Declination notices (if an application or one or more applicants are declined), will be sent only by mail, never by email. Acceptance offers may be sent by email or mail, depending on whether the application was submitted online or via paper and on the preference of the applicant.
• Modified approval is not given for applicants requesting an Individual and child(ren)-only plan. If the primary applicant is declined, the entire application is declined. IBC will not write a contract for child(ren)-only coverage.
• If an application requests “husband and wife” or “family” coverage and the primary applicant is declined, the Independence Blue Cross Underwriting Department will determine if an offer is possible for the remaining family members. If it is, an offer will be extended. The offer may include the requirement that a new application be completed.
• If acceptance of coverage is received after the advised coverage effective date in the coverage offer, the effective date will be moved to the next 1st or 15th of the month and the member will be appropriately notified.
• If there has been any change in medical history or any other change since the original application was signed and submitted, the applicant must bring the change to the attention of the Underwriting Department so that any questions concerning insurability and/or eligibility can be resolved.