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The SEP can be used only once upon a significant change in provider network. It begins the month enrollees are notified of eligibility for the SEP. The SEP ends two calendar months after the month in which enrollees are notified of their eligibility.

NOTE: When instructed by CMS, the MA plan that has significantly changed its network must notify its enrollees, in the form and manner directed by CMS, of the enrollees’ eligibility for this SEP and how to use the SEP.

Coordinating Part D SEP: MA enrollees using this SEP to disenroll from an MA plan may use this coordinating SEP to request enrollment in a PDP. This coordinating SEP begins the month the individual is notified of eligibility for the SEP and continues for two additional months. This SEP permits one enrollment and ends when the individual has enrolled in the PDP. An individual may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment to the MA plan or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan.

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 42 CFR §§ 422.62(b)(26) and 423.38(c)(34)

An SEP exists for individuals who enroll in Medicare premium-Part A or Part B using an exceptional condition SEP as described in 42 CFR §§ 406.27 and 407.23. The SEP begins when the individual submits their premium-Part A or Part B application and ends after the first two months of enrollment in premium Part A or Part B. The Part C or D plan enrollment is effective the first of the month following the month the plan receives the enrollment request.

30.6.35 – SEP for integrated care 42 CFR § 423.38(c)(35)

The integrated care SEP allows enrollment once per month into a FIDE SNP, HIDE SNP, or AIP D-SNP for dually eligible individuals who are enrolled in or in the process of enrolling in the D- SNPs affiliated Medicaid MCO. The integrated care SEP is available only to facilitate aligned enrollment, as defined in § 422.2, in the FIDE SNP, HIDE SNP, or AIP D-SNP and the affiliated Medicaid MCO.

The SEP may be used once per month with an effective date of the first of the following month.

30.6.36 – SEP for other exceptional circumstances 42 CFR §§ 422.62(b)(26) and 423.38(c)(36)

CMS will establish an SEP, on a case-by-case basis, for exceptional circumstances related to enrollment into or disenrollment from an MA or Part D plan that are not otherwise captured in regulation. Consistent with current practice, CMS will consider granting an enrollment or disenrollment opportunity in situations such as the following: