Page 58

57 | P a g e

Plans must have, at minimum, a paper enrollment form available for potential enrollees to request enrollment in a plan. Plans must accept paper enrollment requests received in paper format in a face-to-face interview, by mail, or by fax.

Example: Mr. Chester meets with a broker to fill out a paper enrollment form during a face-to-face interview with a pen-and-ink signature. The broker receives (accepts) the completed paper enrollment request and conveys that information to the plan via an electronic mechanism. As outlined in this section, receipt by the agent or broker employed by or contracting with the plan, is considered receipt by the plan. Furthermore, the enrollment mechanism is determined based on how the plan receives the request. In this example, the plan received Mr. Chester’s enrollment request in paper format.

Plans can utilize model enrollment forms included in MA Exhibits 1–3a or Part D Exhibits 1–1c or choose to develop their own materials subject to CMS marketing requirements. See 42 CFR §§ 422.2261(b), 422.2267, 423.2261(b), and 423.2267 for more information.

Plans can use the model short enrollment form (“short form”) for enrollment requests into another plan offered by the same parent organization. For determining the appropriate use of the short form, CMS defines parent organization as the contract numbers (H#) and legal entities that are owned and operated by a single organization in a single State. Organizations must ensure that the short form contains all elements required for enrollment requests into a particular plan type. As a result, a short form may be used only for enrollment requests into another plan of the same type (i.e., HMO to HMO, PPO to PPO, or PFFS to PFFS).

40.1.2 – Electronic Enrollment

Plans may develop and offer electronic enrollment mechanisms made available via an electronic device or through a secure internet website. Plans also have the option of obtaining technical support, (e.g., licensed software) and related services from downstream entities, such as a broker or third-party website, as a means of facilitating and capturing the electronic enrollment request.

Plans may accept enrollment requests via electronic communications, including email, provided consent to use email to send enrollment information or other protected health information (PHI) has been obtained from the individual in advance. Additionally, plans must ensure reasonable safeguards are applied when transmitting PHI to ensure the confidentiality and integrity of data.

Example: Ms. Riva contacts the plan to confirm receipt of her enrollment application. The plan is unable to locate the enrollment request and suggests Ms. Riva or the agent/broker email a copy of her scanned paper application instead of requesting she re-fax or mail the application. Ms. Riva emails a copy of the scanned paper application to the plan. The plan receives the enrollment application through a secure portal or email encryption method and processes the emailed application according to the requirements for electronic enrollment mechanisms.