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36 | P a g e
A. Non-Renewals This SEP is for an individual whose plan or contract is non-renewed effective January 1 (i.e., termination or service area reduction, see 42 CFR §§ 422.506 and 423.507). It begins December 8 of the contract year and ends the last day of the following February. Enrollment requests received from December 8 through December 31 will have an effective date of January 1. Enrollment requests received in January will have an effective date of February 1. Enrollment requests received in February will have an effective date of March 1.
B. Termination or Modification by MAO, Part D Sponsor, or Mutual Consent This SEP is for an individual whose plan or contract is terminated by an MAO or Part D sponsor or whose contract is terminated or modified by mutual consent (see 42 CFR §§ 422.508, 422.512, 423.508, and 423.510). It begins two months before the termination effective date and ends one month after the month of termination.
NOTE: An individual may request an effective date for the month after notice is given, or up to two months after the effective date of the termination, but the effective date may not be earlier than the date the new MAO receives the enrollment request.
Example: If a Part D sponsor contract terminates for cause on April 30, an SEP lasts from March 1 through May 31. In this scenario, an individual could choose an effective date of April 1, May 1, or June 1 in a new PDP; however, the effective date may not be earlier than the date the new Part D sponsor receives the enrollment request.
Part C Policy: If an individual does not elect a plan prior to the termination effective date, they will be defaulted to Original Medicare on the effective date of the termination. However, the SEP will still be in effect for one month after the effective date of the termination should the individual wish to subsequently elect an MA plan (for a prospective, not retroactive, effective date).
Part D Policy: If an individual does not enroll in another PDP before the termination effective date, they will be disenrolled on the effective date of the termination. However, the SEP will still be in effect for one month after the effective date of the termination should the individual wish to subsequently elect an MA plan (for a prospective, not retroactive, effective date).
C. CMS Termination of Contract This SEP is for an individual whose contract is terminated by CMS (see 42 CFR §§ 422.510 and 423.509). It begins one month before the termination effective date and ends two months after the termination effective date.
Part C Policy: If an individual does not elect a plan prior to the termination effective date, they will be defaulted to Original Medicare on the effective date of the termination. However, the SEP will still be in