Election Periods
A window of time in which a beneficiary can make a change to their MA/MAPD plan after a life event takes place.
What is a Special Election Period
The home screen
What is EPER?
View and correct pended benefit record
A federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid.
What is to View and correct pended benefit record
When a member’s enrollment did not cleanly flow through Humana’s Automated Enrollment system
What is a pend?
What is the CMS Processing Unit
Responsible for processing responses to transactions between Humana and the Centers for Medicare and Medicaid Services
This is how election periods are defined in Humana Systems
What is an Election Type Code (ETC)
This screen houses the demographic information
What is EPDM?
CMS refers to their customers (i.e. members) as __________ .
What are beneficiaries?
What is Limited Income Newly Eligible Transition?
This is where CMS contracts with a single provider (Humana) to provide retroactive and Point of Sale (POS) prescription drug coverage for certain Low Income Subsidy (LIS) eligibles.
What is the Post Enrollment Member Services
Processes all work associated with existing enrollments
Medicare's annual Open Enrollment Period (October 15–December 7) when beneficiaries can join a Medicare Advantage or Medicare Prescription Drug plan.
What is Open/Annual enrollment period
Displays pended PCP info
What is EPPC?
A supplemental plan to pay a portion of the cost of services not covered by Original Medicare coverage.
What is a Medicare Supplement?
What is an Optional Supplemental Benefit
This is additional coverage above the scope of their MA and MAPD which may include Dental, Vision, Fitness, and others depending on the member’s plan options.
What is Medicare Advantage MA
A Medicare program that gives beneficiaries the opportunity to select private health plans. This private health plans often provide greater benefits than traditional Medicare coverage but limit the members’ choices among providers
A three-digit code used to explain the specific reason for a Special Election Period.
What is an SEP Reason Code
This screen is used to real-time once pend errors are resolved
What is EPCR?
A type of Medicare managed care plan where a group of doctors, hospitals, and other network providers agree to provide care for a set amount of money every month. You usually must get your care from the providers in the network.
What is an Health Maintenance Organization?
What is Dual Eligible?
Persons who are entitled to Medicare (Part A and/or Part B) and who are also eligible for Medicaid.
What is a PDP
Prescription drug coverage for Medicare beneficiaries. Commonly referred to as Part D coverage
The date a subscriber's health care coverage ends for a plan that was active. This date will always be the last day of the month. Example the effective date of the coverage is 01/01/2025 and the termination date is 02/28/2026
What is Termed Coverage?
View and correct pended benefit record
What is EPBR?
Medicare Advantage (MA) plan with Prescription Drug Coverage (PDP) added. These plans are offered through insurance companies and other private companies approved by Medicare. Referred to as MAPD coverage.
What is a Medicare Advantage-Prescription Drug?
What is a Pend?
When a member’s enrollment application is incomplete or missing required data, it pends in Humana’s system AE, creating a pend key. This is known as
What is a Complete Enrollment
A Medicare enrollment request that is received with all required information