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30.6.21 – SEP for individuals who are enrolled or not enrolled in Part D due to an error by a federal employee ............................................................................................42 30.6.22 – SEP for individuals who want to enroll in a 5-star plan ....................................42 30.6.23 – SEP for individuals who use the 5-star SEP to enroll in a plan without Part D 43 30.6.24 – SEP for individuals who requested materials in an accessible format ...............44 30.6.25 – SEP for individuals affected by a government-entity declared disaster or other emergency ..............................................................................................................44 30.6.26 – SEP for individuals enrolled in a plan placed in receivership ...........................45 30.6.27 – SEP for individuals enrolled in a plan identified as a consistent poor performer ................................................................................................................................45 30.6.28 – SEP for contract violations ................................................................................46 30.6.29 – SEP for individuals who disenroll in connection with CMS sanction ...............46 30.6.30 – SEP for individuals who receive a notification of a CMS or State-initiated enrollment action ...................................................................................................46 30.6.31 – SEP for individuals involuntarily disenrolled from an MA-PD plan due to loss of Part B .................................................................................................................47 30.6.32 – SEP for non-U.S. citizens who become lawfully present ..................................47 30.6.33 – SEP for significant change in provider network ................................................47 30.6.34 – SEP for individuals who enroll in Medicare premium-Part A or Part B using an exceptional condition SEP, as described in 42 CFR Parts 406.27 and 407.23 ......48 30.6.35 – SEP for integrated care ......................................................................................48 30.6.36 – SEP for other exceptional circumstances ...........................................................48 30.7 – Effective Dates of Coverage .........................................................................................49 30.8 – Effective Date of Coverage for Voluntary Disenrollments ..........................................51 30.9 – Election Periods and Effective Dates for Medicare MSA Plans...................................52 40 – Enrollment Request Mechanisms ...........................................................................................54 40.1 – Format of Enrollment Requests ....................................................................................54 40.1.1 – Paper Enrollment Forms ......................................................................................56 40.1.2 – Electronic Enrollment ..........................................................................................57 40.1.3 – Medicare Online Enrollment Center ....................................................................59 40.1.4 – Enrollment via Telephone ....................................................................................59 40.1.5 – Default Enrollment Option for Medicaid Managed Care Plan Enrollees who are Newly Eligible for Medicare – Part C only ...........................................................61 40.1.6 – Passive Enrollment by CMS ................................................................................64 40.1.7 – Simplified (Opt-In) Enrollment Mechanism – Part C only .................................67 40.1.8 – Auto- and Facilitated Enrollment .........................................................................68 40.1.9 – Reassignment of Certain LIS Beneficiaries .........................................................73 40.1.10 – Additional Enrollment Request Mechanisms for Employer/Union Sponsored Coverage ................................................................................................................76 40.1.10.1 – Group Enrollment Mechanism ..................................................................77 40.1.10.2 – Optional Mechanism for Group-sponsored Plan Enrollment ...................78 40.1.11 – Enrollment for Individuals in Qualified State Pharmaceutical Assistance Programs (SPAPs) .................................................................................................78 50 – Enrollment Processing ............................................................................................................80 50.1 – Who May Complete an Enrollment or Disenrollment Request ....................................85 50.2 – Determining Individual Eligibility to Process an Enrollment.......................................86