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Part C Policy: The policy to retain individuals is based upon nonpayment of premiums for the standard benefit package of the MA plan. If the organization chooses this option, dually and other LIS-eligible individuals who fail to pay premiums for any optional supplemental benefit offered would be downgraded to the standard benefit package within that MA plan.

60.3.1.4 – Disenrollment Processing for Failure to Pay Premiums 42 CFR §§ 422.74(d)(1), 423.44(d)(1)

Plans must always provide enrollees the opportunity to pay premiums owed before initiating any disenrollment action.

If the plan chooses to disenroll an individual for failure to pay monthly premiums, the steps include:

Step 1. Plan demonstrates to CMS that it made a resonable effort to collect the unpaid premium amount. Step 2. Plan alerts the enrollee that the premiums are delinquent. Step 4: Plan explains whether full payment within the grace period is required to avoid termination of enrollment. Step 3. Plan provides the member with a grace period, that is, an opportunity to pay past due premiums in full. The length of the grace period must: • Be at least two whole calendar months; and • Begin on the first day of the month for which the premium is unpaid or the first day of the month following the date which premium payment is requested, whichever is later. Step 5. Plan provides the individual a notice of the disenrollment within three business days following the last day of the grace period: • Explains why the individual is being disenrolled and effective date of disenrollment • Informs of individual's rights under the plan's grievance procedures Step 6. Plan submits the disenrollment transaction to CMS within three business days following the last day of the grace period; however, in no case may the disenrollment notice to the individual be sent after the transaction is submitted to CMS.