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Auto-Enrollment of Full Duals Facilitated Enrollment of Other LIS Individuals auto/facilitated enrolled or by calling 1-800-MEDICARE (for PDP opt out only) • Inform of a Special Election Period (SEP) that permits individual to change plans, even after the auto/facilitated enrollment takes effect auto/facilitated enrolled or by calling 1-800-MEDICARE (for PDP opt out only) • Inform of a Special Election Period (SEP) that permits individual to change plans, even after the auto/facilitated enrollment takes effect Effective date • First day of month person qualified for LIS (will be retroactive) • Cannot be prior to start of enrollment in the MA-only plan • First day of second month after person is identified for facilitated enrollment • Cannot be prior to start of enrollment in the MA-only plan Opt out • Document and do not auto- enroll again in future • Send a notice (see MA Exhibit 29; Part D Exhibit 26) confirming the opt out, with the implications of their request. This must be sent within 10 calendar days of the opt out request. • Document and do not facilitate enrollment again in future • Send a notice (see MA Exhibit 29; Part D Exhibit 26) confirming the opt out, with the implications of their request. This must be sent within 10 calendar days of the opt out request.

Data on Transaction Auto-Enrollment of Full Duals Facilitated Enrollment of Other LIS Application date First day of month prior to enrollment effective date OR day after current application date on MA-only plan enrollment, whichever is later. First day of month prior to effective date of the enrollment

Election Type Code Z = MA auto-enrollment period* U = Dual/LIS Special Election Period Enrollment Source Code E (MA-submitted auto- enrollment)* F (MA-submitted facilitated enrollment *Use of the enrollment period of “Z” and enrollment source code of “E” permits these TC 61 transactions for retroactive auto-enrollments to bypass normal MARx suspension of processing for retroactive effective dates and process immediately.

NOTE: If an individual opts-out after a TC 61 has been submitted, the effective date of returning to the MA-only plan is normally prospective, i.e., first day of the following month. However, through the 15th of the month after the month in which the notice was sent, at a full-benefit dual