Bankers/KFA – Submission of Supplemental Policy Information for Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), Prescription Drug Plan (PDP), and Non-CNO Medicare Supplement Plans Please complete to assist in correct compensation and reporting. This detail will be included in BSPN submitted reports 1-2 business days after submission.1. Enter Policy Confirmation Number from MyHealthPolicy/Connecture(Required)2. Is the policy New to CMS/Med Advantage?(Required) Yes No Note: For compensation purposes, official notification from CMS must still be received which may take up to 90 days post issuance, the above is used for submitted business reporting only.3. Exchanges(Required)Choose only one of the below options: New to Bankers (Not an Exchanged Policy) Exchanged from MA/MAPD to MA/MAPD Exchanged from PDP to PDP Exchanged from 3rd Party Carrier Med Supp (Non CNO) to 3rd Party Carrier Med Supp (Non CNO) Exchanged from Core* Med Supp to MA/MAPD Exchanged from Core* Med Supp to 3rd Party Carrier Med Supp (Non CNO) Exchanged from MA/MAPD to 3rd Party Carrier Med Supp (Non CNO) 3rd Party Carrier Conservation Rewrite (Carrier discontinued plan coverage) *Core Med Supp = Bankers/BCLIC/Washington Nat./Colonial Penn Med Supp Note: For compensation purposes, determination of exchange type will be made based on information provided by the vendors, the above is used for submitted business reporting only.4. If this policy is being split with another agent, please go to OSCR to fill out the Third Party Split form immediately after submitting this form.