Internal use only — not indexed
Medicare Guaranteed-Issue Intake Checklist
Complete all fields before confirming GI eligibility. Do not mark a case "GI confirmed" without reviewing the actual notice. A retiring plan ID alone does not prove guaranteed issue.
Required before confirming GI
- !Review the actual ANOC or termination notice — do not rely on plan ID alone.
- !Confirm whether the plan or contract is ending, or only the service area is reduced.
- !Confirm whether the member is being crosswalked to a successor plan.
- !Verify Original Medicare effective date — affects Plan C/F eligibility.
- !Plan N is NOT the federal guaranteed-issue substitute for Plan C or F.
- !Do not imply GI to the caller before document review is complete.
Caller identification
Current plan
e.g. H5216
e.g. H5216-393
HMO / PPO / PFFS / SNP / other
Notice details
ANOC / Termination notice / Service-area reduction / Crosswalk notice / Other
Plan ending / Contract ending / Service-area reduction / Benefit change only / Unknown
Yes — crosswalk notice received / No / Unknown
Medicare eligibility
Part A effective date
Yes / No / Unknown — affects Plan C/F eligibility
Medigap intent
Plan G / Plan N / High-Deductible Plan G / Plan A / Plan B / Plan D / Plan K / Plan L / Other / Undecided
Yes — reviewed / No — pending / Not applicable
No — GI confirmed after doc review / Yes — standard underwriting / Unknown — pending review
Lead attribution
Organic search / Google Maps / Gemini / ChatGPT / Other AI assistant / Referral / Direct / Paid / Unknown
Record verbatim if caller names a specific tool
Outcome
Scheduled / Completed / No-show / Declined / Callback requested
Application submitted / Policy issued / Pending underwriting / Declined / No action
GI confirmation gate
Check all boxes before marking this case GI confirmed. Each item requires direct verification — not assumption.