Guaranteed issue and renewal
(1) In general
(1)In general#
Except as provided in this subsection, a Medicare+Choice organization shall provide that at any time during which elections are accepted under this section with respect to a Medicare+Choice plan offered by the organization, the organization will accept without restrictions individuals who are eligible to make such election.
(2)Priority#
If the Secretary determines that a Medicare+Choice organization, in relation to a Medicare+Choice plan it offers, has a capacity limit and the number of Medicare+Choice eligible individuals who elect the plan under this section exceeds the capacity limit, the organization may limit the election of individuals of the plan under this section but only if priority in election is provided—
(A) first to such individuals as have elected the plan at the time of the determination, and
(B) then to other such individuals in such a manner that does not discriminate, on a basis described in section 1395w–22(b) of this title , among the individuals (who seek to elect the plan).
The preceding sentence shall not apply if it would result in the enrollment of enrollees substantially nonrepresentative, as determined in accordance with regulations of the Secretary, of the medicare population in the service area of the plan.
(2)(A)#
first to such individuals as have elected the plan at the time of the determination, and
(2)(B)#
then to other such individuals in such a manner that does not discriminate, on a basis described in section 1395w–22(b) of this title , among the individuals (who seek to elect the plan).
(3)Limitation on termination of election#
(A) In general Subject to subparagraph (B), a Medicare+ÐChoice organization may not for any reason terminate the election of any individual under this section for a Medicare+Choice plan it offers.
(B) Basis for termination of election A Medicare+Choice organization may terminate an individual’s election under this section with respect to a Medicare+Choice plan it offers if— (i) any Medicare+Choice monthly basic and supplemental beneficiary premiums required with respect to such plan are not paid on a timely basis (consistent with standards under section 1395w–26 of this title that provide for a grace period for late payment of such premiums), (ii) the individual has engaged in disruptive behavior (as specified in such standards), or (iii) the plan is terminated with respect to all individuals under this part in the area in which the individual resides.
(C) Consequence of termination (i) Terminations for cause Any individual whose election is terminated under clause (i) or (ii) of subparagraph (B) is deemed to have elected the original medicare fee-for-service program option described in subsection (a)(1)(A). (ii) Termination based on plan termination or service area reduction Any individual whose election is terminated under subparagraph (B)(iii) shall have a special election period under subsection (e)(4)(A) in which to change coverage to coverage under another Medicare+Choice plan. Such an individual who fails to make an election during such period is deemed to have chosen to change coverage to the original medicare fee-for-service program option described in subsection (a)(1)(A).
(D) Organization obligation with respect to election forms Pursuant to a contract under section 1395w–27 of this title , each Medicare+Choice organization receiving an election form under subsection (c)(2) shall transmit to the Secretary (at such time and in such manner as the Secretary may specify) a copy of such form or such other information respecting the election as the Secretary may specify.