Page 5

4 | P a g e

60.3.1.1 – Partial Payments........................................................................................119 60.3.1.2 – Calculating the Grace Period ....................................................................119 60.3.1.3 – Optional Exception for Dual-Eligible Individuals and Individuals who Qualify for the Low-Income Subsidy ............................................................121 60.3.1.4 – Disenrollment Processing for Failure to Pay Premiums ...........................122 60.3.2 – Disruptive Behavior ...........................................................................................123 60.3.3 – Fraud and Abuse ................................................................................................126 60.4 – Disenrollment Procedures for Medicare MSA Plans ..................................................126 70 – Post-Enrollment Activities ...................................................................................................127 70.1 – Multiple Transactions .................................................................................................127 70.2 – Cancellations ...............................................................................................................128 70.2.1 – Cancellation of Enrollment or Disenrollment ....................................................128 70.2.2 – Cancellation Transaction Rejection by CMS Systems (TRC 284) ....................130 70.2.3 – Cancellation Due to Notification from CMS (TRC 015) ..................................130 70.3 – Reinstatements ............................................................................................................131 70.3.1 – Reinstatements for Disenrollment Due to Erroneous Death Indicator, Loss of Part A or Part B Entitlement or Loss of Part D Eligibility ..................................131 70.3.2 – Reinstatements for Disenrollment Due to Erroneous Incarceration or Unlawful Presence Information ...........................................................................................131 70.3.3 – Reinstatements Based on Individual Cancellation of New Enrollment .............132 70.3.4 – Reinstatements Due to Plan Error ......................................................................133 70.3.5 – Reinstatements Based on a Determination of Good Cause for Failure to Pay Plan Premiums or Part D-IRMAA Timely ..................................................................133 70.3.5.1 – Process for Good Cause Determinations for Nonpayment of Plan Premiums .......................................................................................................135 70.3.5.2 – Process for Good Cause Determinations for Nonpayment of Part D- IRMAA ..........................................................................................................138 70.4 – Retroactive Enrollments..............................................................................................140 70.5 – Retroactive Disenrollments .........................................................................................141 70.6 – Retroactive Transactions for Employer/Union Group Health Plan (EGHP) Enrollees ....................................................................................................................................142 70.6.1 – EGHP Retroactive Enrollments .........................................................................143 70.6.2 – EGHP Retroactive Disenrollments ....................................................................143 70.7 – Election of Continuation of Enrollment Option for MA Local Plans – Part C only ..144 70.8 – Storage of Enrollment and Disenrollment Records ....................................................144