Enrollment Guidance – Policy Changes and Updates for Contract Year 2019

August 2, 2018

Below is important information from The Centers for Medicare and Medicaid Services (CMS) regarding Special Enrollment Period (SEP) changes and limitations for dual-eligible and other Low Income Subsidy (LIS) eligible individuals.

              Duals/LIS Special Enrollment Period (SEP) Changes and Limitations

SEP for Dual-eligible Individuals and Other LIS-Eligible Individuals

There are new limitations on the use of the Special Election Period (SEP) for dually-eligible and other low income subsidy (LIS) beneficiaries to once per calendar quarter during the first three quarters of the year (January – September). Extra limitations exist for this group of beneficiaries identified as potential at-risk or at-risk for misuse or abuse of a frequently abused drug.

SEP for Individuals who Gain, Lose, or Have a Change in their Dual or LIS-Eligible Status

Separate from the duals/LIS SEP, CMS established an SEP for beneficiaries notified of a change of LIS or dual status.

SEP for CMS and State-Initiated Enrollments

This new SEP is available for individuals who are assigned into a plan by CMS or their state (e.g., auto-assignment, reassignment, passive enrollment).

We are sure there will be more information forthcoming from the carriers with dual eligible plans, so please be sure to watch for any future carrier communications. 

As always, we thank you for your support and cooperation. For questions or comments, please email us at Compliance@NSGACommunications.com or you may call the toll-free number listed below.

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