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1 | P a g e
20.6 – Agreeing to Abide by Plan Rules..................................................................................18 20.7 – Submitting the Enrollment Request During a Valid Enrollment Period.......................19 20.8 – Additional Policies for MA Plans .................................................................................19 20.8.1 – Eligibility for and Election of Hospice Benefits ..................................................19 20.8.2 – Eligibility for MA Religious Fraternal Benefit (RFB) Plans ...............................19 20.8.3 – Eligibility for Medicare Medical Savings Account (MSA) Plans .......................20 20.8.4 – Eligibility for Enrollment in MA Special Needs Plans (SNP) .............................20 30 – Election Periods and Effective Dates .....................................................................................22 30.1 – Part D IEP .....................................................................................................................23 30.2 – Initial Coverage Election Period (ICEP).......................................................................25 30.3 – Annual Election Period (AEP) ......................................................................................27 30.4 – Medicare Advantage Open Enrollment Period (MA OEP) ..........................................28 30.5 – Open Enrollment Period for Institutionalized Individuals (OEPI) ...............................29 30.6 – Special Election Periods (SEPs) ...................................................................................30 30.6.1 – SEP for individuals age 65 (SEP65) ....................................................................32 30.6.2 – SEP for individuals whose Medicare entitlement determination was made retroactively ...........................................................................................................32 30.6.3 – SEP for individuals who enroll in Part B during the Part B GEP ........................33 30.6.4 – SEP for individuals who terminated a Medigap policy upon enrolling for the first time in an MA plan and are still in a trial period ...................................................33 30.6.5 – SEP for individuals who are institutionalized ......................................................33 30.6.6 – SEP for individuals who use the OEPI to disenroll from an MA-PD plan ..........33 30.6.7 – SEP for dual- or other LIS-eligible individuals ...................................................34 30.6.8 – SEP for individuals who gain, lose, or have a change in their dual- or LIS- eligible status .........................................................................................................34 30.6.9 – SEP for individuals who belong to a qualified SPAP or who lose SPAP eligibility ................................................................................................................35 30.6.10 – SEPs for individuals whose plan or contract is terminated or non-renewed, including service area reductions ...........................................................................35 30.6.11 – SEP for individuals who are enrolled in a cost contract that is non-renewing for the area in which the enrollee resides ....................................................................37 30.6.12 – SEP for individuals in the Program of All-inclusive Care for the Elderly (PACE) ...................................................................................................................37 30.6.13 – SEP for individuals who lose special needs status.............................................38 30.6.14 – SEP for individuals who are eligible or are found ineligible to enroll in a C- SNP ........................................................................................................................38 30.6.15 – SEP for individuals disenrolling from a cost plan with optional supplemental Part D benefits........................................................................................................39 30.6.16 – SEP for individuals who elect into or out of employer sponsored coverage .....39 30.6.17 – SEP for individuals who involuntarily lose creditable prescription drug coverage .................................................................................................................39 30.6.18 – SEP for individuals who were not adequately informed of a loss of creditable prescription drug coverage .....................................................................................40 30.6.19 – SEP for individuals who disenroll from Part D to enroll in or maintain other creditable coverage ................................................................................................40 30.6.20 – SEP for individuals who change permanent residence ......................................41