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60.1.2 – Incomplete Disenrollment Requests

42 CFR §§ 422.60, 422.66, 423.32, and 423.36

When a disenrollment request is incomplete, the plan must:

• Document its efforts to obtain information to complete the disenrollment request; and, • Notify the individual (in writing or verbally) within 10 calendar days of receipt of the disenrollment request that additional information is needed.

If a written disenrollment request is submitted and the signature is not included, the plan may contact the individual by phone to confirm the individual’s intent to disenroll and document the phone call, rather than returning the written request to the individual for signature.

If any additional information needed to make the disenrollment request “complete” is not received within allowable time frames outlined below, the plan must deny the enrollment using the procedures outlined in § 60.1.3.

60.1.3 – Denial of a Voluntary Disenrollment Request 42 CFR §§ 422.60(e), 422.66(b), 423.32(c), 423.32(d), and 423.36

Generally, plans deny a voluntary disenrollment request when the request was: • Made outside of an allowable election period (see § 30 on election periods); • Initiated by someone other than the individual or individual’s authorized representative; or • Incomplete, and the required information was not provided within the appropriate time frames outlined in § 60.1.2.

If any of the above listed reasons apply, the plan must send notice of the denial for disenrollment (MA Exhibit 12a; Part D Exhibit 11) to the individual that includes an explanation of the reason for denial, within 10 calendar days of receipt of the request or expiration of the request for additional information as described in § 60.1.2.

60.1.4 –Disenrollments not Legally Valid 42 CFR §§ 422.60(e) and 423.32(c)

There are instances when a completed disenrollment can later be determined to be legally invalid. These instances may include, but are not limited to: For incomplete disenrollment requests: Information to complete request must be received: During the AEP By December 7, or within 21 calendar days of the request for additional information (whichever is later). During all other enrollment periods

By the end of the month in which the disenrollment request was initially received, or within 21 calendar days of the request for additional information (whichever is later).