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Required Involuntary Disenrollment Reason Effectuated Plan CMS Plan Notice Required Encouraged reimbursement for third party coverage (§ 60.2.8)

Where required, the notice sent by the plan must advise the enrollee that they will be disenrolled and the reason for the disenrollment action.

In addition, where an involuntary disenrollment is required for the reasons listed below, the notice must be sent to the individual before the disenrollment transaction is submitted to CMS and must include an explanation of the individuals’ right to file a grievance with the plan. • Individual no longer resides in a plan’s service area; • Failure to pay premium; • Loss of special needs status (Part C); • Loss of MSA eligibility; • Fraudulent information on election form or abuse of enrollment card ; • Disruptive behavior.

For disenrollments effectuated by CMS due to incarceration or nonpayment of Part D-IRMAA, the disenrollment notice must advise the individual that the plan has disenrolled them and why such action is occurring. This notice should be mailed within 10 calendar days of receiving the disenrollment TRC on the DTRR from CMS.

Plans are strongly encouraged, but not required, to send notices for certain CMS-effectuated disenrollments, including: • Death (MA and Part D Exhibit 13); • Loss of entitlement (Exhibit 14); and • Unlawful presence in the United States (MA Exhibit 38, Part D Exhibit 37).

60.2.1 – General Rule for Enrollees Who Change Permanent Address 42 CFR §§ 422.50 (a)(3)(ii), 422.74(d)(4), 422.74(e)(2), 423.44(b)(2)(i), 423.44(c), and 423.44(d)(5)

In general, an enrollee’s permanent residence must be within the plan’s service area for the individual to remain eligible to stay in the plan. The plan must disenroll an individual in any of the following circumstances:

• Enrollee permanently moves out of the service area and, for MA, new residence is not in a continuation area (see § 20.3.1 on CMS-approved continuation areas); • Part C Policy: Enrollee is an out-of-area member (as defined in § 10) and permanently moves from the residence in which they resided at the time of enrollment in the MA plan to an area that is not in the service area or continuation area;