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70 – Post-Enrollment Activities 42 CFR §§ 422.60, 422.66, 423.32, and 423.36

Post-enrollment activities occur after the plan receives the enrollment request from the individual (e.g., cancellations) and lasts until a decision is made with respect to an individual’s enrollment request (e.g., retroactive transactions).

Post-enrollment activities include: • Enrollment and disenrollment cancellations; • Enrollment reinstatements; and • Retroactive enrollments and disenrollments.

70.1 – Multiple Transactions

Multiple transactions occur when CMS receives more than one enrollment request for the same effective date. An individual may generally not be enrolled in more than one MA, Cost, or PDP plan at any given time; however, an individual may be simultaneously enrolled in a cost plan and a separate PDP plan or in certain MA plan types and a separate PDP plan.

Generally, the last enrollment request the individual makes during an enrollment period will be accepted as the plan into which the individual intends to enroll. If an individual elects more than one plan for the same effective date and with the same application date, the first transaction successfully processed by CMS will take effect. When simultaneous enrollment in certain MA plan types and a separate PDP is permitted, CMS systems will accept both enrollments.

Example: Two MAOs receive enrollment forms from one individual for an April 1 effective date. MAO #1 receives a form on March 4 and MAO #2 receives a form on March 10 for an April 1 effective date. Both organizations submit enrollment transactions, including the applicable effective date and application date. The enrollment in MAO #2 will be the transaction that is accepted and will be effective on April 1 because the application date on the enrollment transaction is the later of the two submitted. Both plans receive the appropriate reply on the DTRR.

Example: Two PDP sponsors receive enrollment requests from one individual for an April 1 effective date. PDP #1 receives a paper enrollment form with all required information on March 5. The individual completed an enrollment request for PDP #2 by telephone on the same day, March 5. Both enrollment requests have the same application date since they were received by the PDP on the same date. PDP #1 transmitted the enrollment to CMS on March 5, the day it received the enrollment request; however, PDP #2 waited until March 8 to transmit the enrollment to CMS. The enrollment for PDP #1 will be the transaction that is effective on April 1, as it was the first transaction successfully processed by CMS.