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Prior to the effective date of coverage, plans must provide enrollees with information about being an enrollee of the plan, the plan rules, and the member’s rights and responsibilities. Plans must also provide the following to enrollees:

• For enrollment requests submitted via electronic enrollment or telephonic enrollment mechanisms, evidence that the enrollment request was received (e.g., a confirmation number); • A notice acknowledging receipt of the completed enrollment request showing the effective date of coverage; • Proof of health insurance coverage so the enrollee may begin using plan services as of the effective date. This proof must include the 4Rx data necessary to access benefits. See Chapter 14 of the PDBM for more information about 4Rx data.

NOTE: This proof of health insurance coverage is not the same as the Evidence of Coverage document described in the Medicare Communications and Marketing Guidelines. The proof of coverage may be in the form of member ID cards, the enrollment form, and/or a notice to the enrollee. As of the effective date of enrollment, plan systems should indicate active enrollment.

Regardless of whether an enrollment request is made in a face-to-face interview, by fax, by mail, or by other mechanisms defined by CMS, plans must explain:

• The charges for which the prospective enrollee will be liable, e.g., any premiums (this includes any Part D late enrollment penalty), coinsurance, fees, or other amounts (including general information about the low-income subsidy). • The prospective enrollee’s consent to the disclosure and exchange of necessary information between the plan and CMS; • The potential for financial liability if it is found that the individual is not entitled to Medicare Part A and enrolled in Part B (for MA plans), or eligible for Part D, at the time coverage begins and the individual has used MA plan or Part D services after the effective date. • The effective date of coverage and how to obtain services prior to the receipt of an ID card (if the plan has not yet provided the ID card). • Part C Policy: The MAO must also obtain an acknowledgment by the individual that they understand that care will be received through designated providers except for emergency services, urgently needed care, out-of-area dialysis services, and cases in which the plan authorizes use of out-of-network providers.

50.9.2 – After the Effective Date of Coverage 42 CFR §§ 422.60(e) and 423.32(g)(2)

CMS recognizes that for some enrollment requests, the plan will be unable to provide the materials to the individual, including notification of the effective date, prior to the effective date, as generally required in § 50.9.1. These cases will usually occur only when an enrollment request is received by the plan in the last few days of a month, and the effective date is the first of the upcoming month.