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3) Within 10 days of receipt of DTRR confirmation of the individual’s reinstatement, the organization from which the individual was disenrolled must send the individual notification of the reinstatement.

The reinstatement notice should include:

• Confirmation of the individual’s enrollment in the previous plan with no break in coverage;

• Plan specific information (i.e., membership card, benefits), as needed; and

• Plan contact information.

In cases where a valid cancellation request is not processed timely or CMS systems cannot complete the request, the new plan submits a request to the RPC to cancel the enrollment. This request will require complete documentation, including evidence that the individual requested cancellation of enrollment in the new plan within required time frames.

If the previous plan becomes aware of an unsuccessful reinstatement, the previous plan may contact a CMS Account Manager to investigate the issue with the new plan. In addition, the previous plan may refer the individual to the “new” plan to inquire about their options since the disenrolled individual contacted the previous plan requesting to remain an enrollee of that plan.

70.3.4 – Reinstatements Due to Plan Error

When an erroneous disenrollment is the result of plan error, the plan reinstates the individual that was disenrolled.

Additionally, if the plan previously submitted the disenrollment transaction to CMS, the plan must cancel the disenrollment action from CMS’s records. Plans must use the disenrollment cancellation function to complete this action for effective dates within the parameters that CMS systems allow for such corrections. Plans should refer to the RPC’s Standard Operating Procedures (SOP) for processing retroactive enrollment and disenrollment requests available at http://www.reedassociates.org/retroactive-processing-sops/).

70.3.5 – Reinstatements Based on a Determination of Good Cause for Failure to Pay Plan Premiums or Part D-IRMAA Timely 42 CFR §§ 422.74(d)(1)(v) and 423.44(d)(1)(vi)

If an individual has been involuntarily disenrolled for failure to pay either plan premiums (under § 60.3.1) or Part D-IRMAA (under § 60.2.5), they may request reinstatement for good cause, pursuant to 42 CFR §§ 422.74(d)(1)(v) and 423.44(d)(1)(vi), only when:

1. The request is received by the plan or CMS within 60 days of the individual’s disenrollment effective date; and