DEFINITIONS
DIF- MARx
Xcode must be present before a PDP plan is listed to use this SEP
DST
*Live in a Disaster area and missed an election code
*EXTENSION to a diff SEP
How long is the beneficiary eligible for SEP- MOV?
*The month BEFORE the move
*2 months after the move
(3 months)
"Has your plan been discontinued?" Is a probing question for which SEP?
EOC
Clients have 2 months from the declaration end date in FEMA website.
If using carrier tools. The end date is what is listed in the carrier tool.
NLS
Loss/gain/change in level of Extra Help
Beneficiary has other creditable coverage
How long is the beneficiary eligible for SEP- MRD?
7 months =
*3 months before
*the month of
*3 months after
What is a probing question for OEP-N
Are you unsatisfied with your first MAPD that recently went into effect?
During OEP, if a beneficiary has recently moved, which SEP would you use?
OEP
LTC
Moving into/living in/move out of a skilled nursing facility, nursing home, intermediate care facility for the mentally disabled, psychiatric
hospital, rehabilitation hospital or long-term care hospital
*Enrolling into a PDP
OEP-I
Beneficiary is moving into,living in, or moved out of a nursing home, rehab, skilled nursing facility, or long term care facility.
How long is the beneficiary eligible for SEP- MCD?
3 months from time of change
What is a probing question for PAP?
Are you enrolled OR recently dis-enrolled in a state Pharmacy Assistance Program?
What's the phone number to Humana's Medicaid eligibility line?
(800) 309-3163
MRD
Was enrolled in Medicare before 65 but are NOW turning 65
LEC
Loss of employer or union coverage
(inc. COBRA)
How long is the beneficiary eligible for SEP- CSN
Once per calendar year
"Have you recently lost Medicare Part B and are in need of prescription drug coverage?" Is a probing question for which SEP?
INV
What is Aetna's Broker Support number to verify a disaster SEP?
(866) 714-9301
OSD
Bene dropped my Cost Plan with drug coverage and switched to Original Medicare.
12G
Beneficiary dropped their Med Supp for a MA/MAPD for the first time and now they want to return to OM + PDP.
**12 month Trial Right
How long is the beneficiary eligible for SEP- MYT?
Starts 2 months before the plan's contract with Medicare ends, and ends 1 full month after the contract ends.
"Were you automatically enrolled into a plan by Medicare within the last 3 months?" Is a probing question for which SEP?
DIF
What penalty percentage is the beneficiary responsible for if they did not enroll into Part B when they could have?
10% (per 12-month period)