Licensed agents in Texas, Louisiana, Florida, Georgia, South Carolina, Alabama, Mississippi, Puerto Rico, and the U.S. Virgin Islands can assist beneficiaries affected by the hurricanes with their MAPD and PDP plans until December 31st.
FEMA has updated their list of eligible locations to now include the whole state of Alabama and Mississippi. As a result of Hurricanes Harvey, Irma, and Maria, and Tropical Storm Nate, CMS will provide all affected beneficiaries a Special Enrollment Period (SEP) that gives them an additional opportunity to change their MAPD or PDP plan in the event they were unable to make an election during another qualifying election period. This includes the opportunity to enroll, disenroll, or make a plan change.
Individuals will be considered “affected” and eligible for this SEP if they reside, or resided at the start of the incident period, in an area for which the Federal Emergency Management Agency (FEMA) has declared an emergency or a major disaster. In addition, the SEP is available to those individuals who don’t live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas.
This SEP is effective from the start of the incident period and runs until December 31, 2017. The effective date for the new health plan coverage will be the first day of the month following the date the plan receives the enrollment request. If the SEP is being used to disenroll from an existing plan, the effective date of the disenrollment will be the last day of the month. If the individual is changing plans, the plan change will disenroll the individual from their current plan; a separate disenrollment transaction is not required. This is a one-time SEP.
To determine eligibility, an attempt to obtain proof that the individual resided in an affected county (i.e. driver’s license, utility bill) should be made. If the individual is unable to provide such proof, or does not have access to such documentation, the applicant’s attestation that he or she lived in an affected county will be accepted.
Please note that this SEP is in addition to the AEP and any other enrollment period for which the beneficiary may be eligible. Considering this SEP runs concurrently with the AEP, agents should recommend using the AEP election period whenever possible. Those enrolling via their AEP election will have an effective date of January 1, 2018. Those enrolling via an SEP election in November will have a December 1, 2017 effective date. Agents should work with eligible individuals to determine which election period is desired.
How Do You Handle These Enrollments?
If you are approached by someone who was impacted by these hurricanes, field agents should follow the normal compliant sales process:
- Execute a Scope of Appointment prior to the appointment
- At the meeting, attempt to obtain proof that the beneficiary resided in an affected county (e.g., driver’s license, utility bills, etc.).
- If the beneficiary is unable to provide such proof, accept the beneficiary’s verbal attestation that he/she resided in an affected county. Agents should make every effort to verify that the beneficiary qualifies for this SEP, but do not have to collect proof from the beneficiary.
- Conduct a full and compliant sales presentation and when they are ready to enroll complete the application and indicate “SEP-OTH” with “Weather incident” as the reason.
Note: All ESRD eligibility requirements remain the same. Agents should not enroll someone with ESRD in an MA plan unless they qualify for an ESRD exception.
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