- 10 -
for a so-called Secure Blue Select plan to cover himself and Ms.
Frahm. In Mr. Frahm’s Wellmark Secure Blue Select application,
Mr. Frahm identified himself as “Applicant” and Ms. Frahm as
“Spouse”. The portion of Mr. Frahm’s application entitled
“Enrollment Information” stated in pertinent part:
1. You are applying for: (check one)Do you want the optional maternity rider? (This
9 Blue Care 9 Secure Blue : Secure Bluerider is only available at your initial
Select enrollment.)
9 Yes : No
2. This request for coverage is for: (check all3. This application is for: (check
that apply) all that apply)
: Self : Spouse 9 Child(ren): New Enrollment 9 Adding/Removing
Dependents
4. How do you want to pay your premiums?9 Automatic Account Withdrawal. If so, on what
9 Direct Bill. If so, on what basis?basis? (Include a voided check.)
9 Quarterly 9 Semi-annually 9 Monthly-what date? 9 1st of the month or
9 Annually 9 5th of the month
9 Quarterly 9 Semi-annually 9 Annually
From:
9 Checking 9 Savings
5. The amount you are submitting is: $ 742.20 (Make check payable to Wellmark Blue Cross and
Blue Shield of Iowa.)
Will your employer be paying any part of the premium for this coverage either directly or
through wage adjustments or other means of reimbursement? 9 Yes 9 No
Will your premium payments for this coverage be deductible on your federal income tax return
as a trade or business expense other than the special health insurance deduction available
to self-employed persons? 9 Yes 9 No
Wellmark approved Mr. Frahm’s Wellmark Secure Blue Select
application and issued a health insurance policy to him (Mr.
Frahm’s Wellmark Secure Blue Select policy) that covered himself
and his spouse Ms. Frahm.
During 2001, Ms. Frahm paid the following premiums totaling
$9,281.8011 for Mr. Frahm’s Wellmark Secure Blue Select policy on
11The parties stipulated that during 2001 Ms. Frahm paid to
Wellmark premiums totaling $8,164.20 for Mr. Frahm’s Wellmark
Secure Blue Select policy. That stipulation is clearly contrary
(continued...)
Page: Previous 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Next
Last modified: March 27, 2008