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For enrollments processed using the EGHP SEP, see § 30.6.16, the application date on the enrollment transaction submitted to CMS is the first day of the month prior to the effective date of the group enrollment. This will ensure that any subsequent individual-generated enrollment request will supersede the group enrollment in CMS systems. For the purposes of providing notices and meeting other time frame requirements as described in § 50.9, plans will use the date that they receive the enrollment request. The advance notice of group enrollment as described above is evaluated based on the effective date.

Example: The plan receives a group enrollment mechanism file on January 24 for enrollments effective February 1. The receipt date for the required notices is January 24 and the application date submitted on the enrollment transactions is January 1. The advance notice must have been sent to the enrollees at least 21 days prior to February 1.

40.1.10.2 – Optional Mechanism for Group-sponsored Plan Enrollment

Employers or unions may opt to send group enrollment requests to plans electronically, instead of using a paper enrollment process to reflect each individual’s election of coverage. This optional electronic enrollment mechanism can be used in place of paper enrollment request forms and does not require a signature since it is sent electronically. The plan should inform its Regional Office Account Manager of its intent to use this mechanism and identify the employer/union for which it will be accepting enrollments made in this manner. The employer record of each individual’s election that is sent electronically to the plan must include all the data necessary for the organization or sponsor to determine each individual’s eligibility for the plan, as described in § 20 of this chapter. The requirements for all other information provided to enrollees, both pre- and post- enrollment, as noted in § 50.9, are unchanged by this option.

See Appendix 2 for a complete list of required elements to be included in all enrollment mechanisms.

40.1.11 – Enrollment for Individuals in Qualified State Pharmaceutical Assistance Programs (SPAPs)

CMS will allow plans to accept enrollment requests in an agreed-upon electronic file format from qualified SPAPs, provided the SPAP has met the following requirements:

• Attests that it has the authority under State law to enroll on behalf of its members; • Coordinates with the plan to provide the required data elements for the organization to process and submit an enrollment request to CMS (as outlined in § 40.1); and • Provides a notice to its members in advance of submitting the request.

Notices provided to SPAP members must provide the following information:

• That the SPAP is enrolling on their behalf; • How the MA/Part D enrollment will work with the SPAP; and • How individuals can decline such enrollment.