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20.7 – Submitting the Enrollment Request During a Valid Enrollment Period 42 CFR §§ 422.60(a), (c), and 423.32

To be eligible to enroll in a plan, an individual must submit the request to the plan within a valid enrollment period. Plans may request that the individual attest to being eligible for an enrollment period during the enrollment process, but it may not request or require evidence. The plan must deny enrollment to any individual, not enrolling during the AEP, who is not eligible for a valid enrollment period or does not provide an attestation of eligibility for an enrollment period, when asked.

20.8 – Additional Policies for MA Plans

There are additional requirements for eligibility that apply only to enrollments into MA plans: • The election of hospice benefits (§ 20.8.1); • Religious Fraternal Benefit (RFB) plans (§ 20.8.2); • Medicare Medical Savings Account (MSA) plans (§ 20.8.3); • Special Needs Plans (SNP) (§ 20.8.4).

20.8.1 – Eligibility for and Election of Hospice Benefits 42 CFR §§ 422.50, 422.56, 422.110, and 422.320

An MAO must not deny enrollment to any eligible individual on the basis that they have elected the hospice benefit (except in the case of a Medicare MSA plan, as outlined in § 20.8.3). Until the MAO acknowledges that it has received the completed enrollment request and gives a coverage effective date to the individual, the MAO must not ask any questions related to the existence of a terminal illness or election of the hospice benefit. Such questions will be considered impermissible health screening.

The MAO may not disenroll any individual on the basis of the enrollee electing the hospice benefit either before or after becoming an enrollee of the MA plan.

NOTE: The election of hospice benefits entitles the individual to continue to receive through the MA plan any MA benefits other than those that are the responsibility of the Medicare hospice.

20.8.2 – Eligibility for MA Religious Fraternal Benefit (RFB) Plans 42 CFR §§ 422.2, 422.50, and 422.57

This MA plan is one that an RFB society may offer only to members of the church, or convention or group of churches with which the society is affiliated. The requirement for membership can be met by any documentation establishing membership issued by the church, or by using the church’s records of membership. An individual must also meet all the other requirements to elect an MA plan.