LEP
Give an example of creditable drug coverage and non-creditable drug coverage
Employer Group Health Plans with Rx coverage
VA Coverage
PACE or PACEnet
Tricare
Indian Health Services
Medigap plan with Rx coverage
Medicaid
Incarcerated or Out of the Country
non-creditable
Workers’ Compensation
Employer Group Health Plans without RX coverage
Discount Prescription Programs
Pharmacy Prescription Saving Cards
Hospice
What are the types of addresses members can have on their account?
Mailing, Permanent, Temporary/travel
How many days do the member have to respond to the EGHP letter they received?
30 days
Loss of entitlement means
Loss of Part A/B or D medicare
Aetna is required to contact the member within _____
of receipt of enrollment request.
15 calendar Days
How would a member dispute the LEP they have assessed?
they will submit their appeal to C2C Innovative Solutions, Inc to be reviewed.
What are the tools we can use to verify the county and plan info?
Market prominence, member website, GPS
How can a member respond to the EGHP notification?
By returning the form they receive or by calling in to the SET department number listed on the letter.
When reinstating due to LOE, what is the turn around time for using benefits
2 business days
Where would you locate the members OEV letter in GPS?
In the communication tab
A late enrollment penalty is an additional charge that is added to a member's Medicare premium when they did not have creditable coverage for
63 Days or more
True or False? Members who are incarcerated are not considered OOA.
FAlSE- members who are incarcerated are considered OOA and will be disenrolled from their plan.
What is the timeframe a member can choose and effective date of coverage?
are able to choose an effective date of up to 3 months following the application date based on loss of Employer Coverage.
A member can be reinstated ______ when working on their entitlement after a termination
Twice/ 2x
if a member is wanting to cancel their plan AFTER the date listed on the OEV letter, how would you process this?
as a disenrollment request
True or False: If the member was incarcerated or living outside of the United States, we can waive the LEP from being assessed for the timeframe that the member was incarcerated or living out of the country
TRUE
What is the tracking timeframe for members with an temporary OOA address?
6 months, 12 months if they have travel advantage plan
Why would a member receive a EGHP letter?
This happens when the member is enrolled in an active employer health plan that includes Part D, but has also attempted to enroll in Medicare MAPD plan.
If a member reports having ____ days of medication on hand this is seen as an immediate need and the LOE issue can be override.
3 or less days
What is the purpose of the OEV letter?
This process requires plan sponsors to make outreaches to members that completed an enrollment with an agent/broker to ensure beneficiaries requesting enrollment understand the plan rules.
What is the Timeframe for the LEP Attestation Process?
The member has 30 days from the date on the initial LEP attestation letter they received in the mail. The member is also given an additional 60 day timeframe from the date of the 30 day deadline to provide any LEP information to the plan to reduce or remove the penalty that was assessed on their account.
Why is determining the type of move important?
The member can be in danger of being disenrolled or tracked unnecessarily if we do not note the type of move.
True or False? member choosing to continue with enrollment in their selected Aetna plan may lose any medical or prescription they have with their employer or union group?
TRUE
what are some common reasons mm experiences LOE?
termination due to non-payment of premiums
SSA error or Loss of eligibility for Part A/B or D
The OEV process allows the member to ________ their plan by the due date on the letter
cancel