SEP 1
What SEP do you use if caller is moving out of service area?
Move
What SEP do you use if there was a level change in Medicaid 7/1/2025 and it is 8/27/2025
Change in level of Medicaid
Member has had Medicare and is turning 65 8/03/2025, Is there an SEP to change plans if so what is the SEP?
IEP 2 ( I have had Medicare and will be turning 65 soon)
Member had Original Medicare and a Supplement Plan Before trying there First MAPD plan. Member does not like the MAPD plan and is wanting to go back to Original Medicare and there Supplement Plan. Is there a SEP and what would it be?
Trial Period SEP
What SEP do you use If caller has Chronic Plan but the doctor did not send in the documentation to show they have a Chronic Condition and their plan is ending?
Loss of SNP ( Loss of chronic Condition)
Can you change from PDP to MAPD during OEP?
NO
Caller is enrolled into a Pace program but doesnt like it and wants to drop it to return to aetna. Are we able to enroll caller back into Aetna? If so what is the SEP?
Member lives in KY and has full Medicaid(not though Aetna Medicaid). Member is wanting a HIDE dual plan. Is there a SEP if so what is it?
No SEP as they have to apply for Aetna Medicaid first.
Member is calling because she is a snow bird and needs to change address. Current plan is PDP in NJ and is in NJ 6 and a half months of the year. Is there a SEP and if so what is it?
No SEP as they are in a NJ plan and is there more then 6 months out of the year. Transfer to PDP mso to change temporary mailing address.
Members doctor is not going to be taking there plan anymore. They received a letter stating that they will have a SEP to change to a plan the doctors take. Is there an SEP we can use? If so what is the SEP?
There is no SEP we can use for doctors not taking a plan when they receive a letter. Only SEP that can be used per letter is though CMS.
This SEP is only available within the first 3 months you get Medicare and joined an MA/PD plan
OEP-Newly Eligible
Mber was impacted by hurricane and missed AEP season, are you able to process application using FEMA SEP
NO, USE OF FEMA SEP MUST BE REFERRED back to Medicare
Member has a Chronic Condition and wants to join a C-SNP. What SEP would you use?
I want to join a Chronic plan that tailors its benefits to my condition
Caller use to be a member but CMS auto enrolled into a different plan and is wanting back with Aetna. What SEP do you use?
Auto enrolled SEP
Caller is enrolled into a Pace Program but heard about a plan with extra benefits. She is wanting to keep her Pace Plan but wanting to enroll with us as well. Is she able to do so. If so what would the SEP be?
No, You aren't able to have a Pace Program Plan and a MAPD.