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• An automatic disenrollment occurred due to an erroneous death indicator, or an erroneous loss of Medicare Part A or B, or • The individual or their authorized representative did not intend to disenroll from the plan. Evidence of lack of intent to disenroll may include: o A disenrollment request signed by the individual when an authorized representative should have signed for the member; o Request by the individual for cancellation of disenrollment before the effective date (refer to § 70.2 for procedures for processing cancellations).

When a disenrollment is not legally valid, a reinstatement action may be necessary (refer to § 70.3 for more information on reinstatements). In addition, the reinstatement may result in a retroactive disenrollment from another plan (see § 70.5 for information on retroactive disenrollments).

In contrast, a member’s deliberate attempt to disenroll from a plan (e.g., sending a written request for disenrollment to the MAO or calling 1-800-MEDICARE) implies intent to disenroll. Therefore, unless other factors indicate that this disenrollment is not valid, what appears to be a deliberate, member-initiated disenrollment should be considered valid.

60.1.5 – Optional Mechanism for Employer/Union Disenrollments 42 CFR §§ 422.66(b)(3) and (f)

Plans may choose to accept voluntary disenrollment requests directly from the employer or unions who sponsor EGHP coverage for its enrollees without obtaining a written disenrollment request from each individual. This optional disenrollment request mechanism can be used in place of paper disenrollment forms and does not require a signature from the individual. The disenrollment transaction includes the data necessary for the organization or sponsor to determine each individual’s eligibility to make a disenrollment request as described in § 60.1.1 . The requirements for all other information provided to enrollees post-disenrollment, are unchanged by this option and must be satisfied.

Plans that select this option need to: • Inform the CMS account manager of its intent to use this mechanism. • Ensure the accuracy of the disenrollment record made by each individual according to the processes the employer or union has in place. • Record receipt (i.e., date) of request, which will be the date the employer’s or union’s disenrollment choice is received by the plan. • Maintain appropriate safeguards to provide data security, exchange, and confidentiality of disenrollment information (i.e., the electronic file). • File and retain disenrollment requests for current contract period and prior 10 years.

60.1.6 – Group Disenrollment for Employer/Union Sponsored MA and Part D plans 42 CFR §§ 422.74 and 423.36

CMS has provided, under our authority to waive or modify MA and Part D requirements that