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Part II - General questions
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A. Do you have a (or pending applications for) Medicare Supplement policy or certificate in force?
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2. If so, do you intend to replace your current Medicare Supplement policy with this policy?
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B. Do you have any other health insurance coverage that provides Medicare benefits?
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No
If so, with which company?
What kind of policy?
C. Are you covered for medical assistance through the state Medicaid program:
Please give details to "yes". Include insured or spouse name.
1. As a Specified Low-Income Medicare Beneficiary (SLMB)
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No
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2. As a Qualified Medicare Beneficiary (QMB)
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3. For other Medicaid medical benefits?
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No
If yes, please describe
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D. Are you covered or will you be covered under:
Medicare Part A (Hospitalization)
Yes
No
Effective Date Insured:
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Effective Date Spouse:
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Medicare Part B (Medical Expenses)
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Effective Date Insured:
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Effective Date Spouse:
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Home
About
Articles
Resources
Products & Services
Life Insurance
Life Basices
Term Life
Permanent Life Ins
Term Life Glossary
Universal Life Quote
Whole Life Quote
Term Life Quote
Burial/Final Expense Quote
Health Insurance
Intro to Health Insurance
Implementing A Cafeteria Plan
Individual Health Quote
Employer Group Health Plan Quote
Group Health Employee
Health Savings Account
Travel Medical Insurance
Medicare Plans
Intro to Medicare
Medicare Advantage
Medicare Part A
Medicare Part B
Medicare Part D
Medigap Policies
Medicare Supplement Plan Quote
Long-Term Care
Intro to Long-Term Care
Understanding Long Term Care
Long Term Care Quote
Disability Coverage
Intro to Disability Ins
Disability Statistics
Disability News Source
Council for Disability Awareness
Social Security Program Fact Sheet
Disability Ins Quote
Homeowners
Homeowners Coverage
Homeowners Quote
Manufactured Home Quote
Homeowners Links
Contact Us
Auto Insurance
Intro to Auto Ins
Auto Ins Coverage
Kelley Blue Book
Edmunds.com
Auto Ins Quote
Add/Change a Vehicle/Driver
Recreational
Intro to Recreational Vehicle Ins
Travel Trailer Quote
Motor Home Quote
Snowmobile Ins Quote
Boat Ins Quote
Business Owners
Intro to Business Ins
Business Owners Quote
Financial Vision
Financial Planning
Estate Planning
Client Questionnaire
Tax Center
Federal Benefits
Life Settlements
Get a Quote
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