Aetna: New Enrollment Process For Individuals Affected By A Disaster

Aetna has made updates to their process for validating MA applications with an SEP code.

Overview of Special Election Period (SEP) for government entity-declared disaster or other emergency

Special Election Periods constitute periods outside of the usual IEP, AEP, or MA OEP when an individual may elect a plan or change his/her current plan election.

This Disaster SEP (DST) allows for incremental time towards the original election period (AEP, OEP or SEP) enrollment and disenrollment elections. However, the valid election period must have occurred during the Disaster SEP timeframe. A valid election period must have been impacted to enact the DST special enrollment period.

If available, it's effective as of the date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier. The SEP ends 2 full calendar months following the end date identified in the declaration or, if different, the date the end of the incident is announced, whichever is later. Enrollments are effective the first of the month after the plan receives the enrollment request. You can find more information in the CY2021 MA Enrollment and Disenrollment Guidance.

IMPORTANT: Remember, you cannot use this SEP opportunity to proactively market to beneficiaries. However, you can assist any client who contacts you about a Disaster SEP.

  • If an individual wants to enroll and believes he/she may qualify for a disaster SEP, ask the beneficiary to verbally attest that he/she lived/lives in an impacted area at the start of the incident period.
  • When helping eligible clients enroll, please select the weather-related or major disaster option in the "Reasons for Special Enrollment Period Eligibility" section of the application.

As a reminder, there is no longer an eligible DST SEP for COVID-19.

Example scenario

A beneficiary/member was eligible for a SEP because they moved from one state to another in January. With the move, he/she was able to use the change in residence SEP until March 31, 2022. Due to a hurricane disaster that occurred in March, the opportunity to change plans was missed. The hurricane disaster SEP started in March 2022 and ended on May 31, 2022. This disaster SEP extended the change in residence SEP for this beneficiary/member until May 31, 2022.

What you need to know

On April 1, Aetna implemented a new process including an automated disaster SEP eligibility check. Their goal was to ensure alignment with CMS SEP regulations and reduce the amount of time to process disaster SEP exceptions.

During the first few weeks of the implementation of this change, some applications with DST designations failed the review for various reasons. Aetna has been working to resolve those issues and have developed a process to minimize further impact going forward.

They are now pre-validating the SEP scripts used by partners (including the SEP election period attestation) to enable their team to approve SEP designations in less time.

Any application with DST designation will still require validation of the applicable disaster (e.g., FEMA, federal, state or local) impacting the original election period.

It’s important that applications are submitted with both the original valid enrollment period and the DST to ensure the most expedient process.

FAQ

Who's eligible for a Disaster SEP?

  • Individuals who were eligible for an enrollment period but were prevented from making an election because of a declared disaster.
  • Beneficiaries who enrolled in a plan during AEP are generally not permitted to make another election under this SEP unless they were eligible for a different enrollment but couldn’t use it because of the disaster.

Additional eligibility details:

  • The enrollee must reside or have resided at the start of the SEP eligibility period, in an area for which a federal, state or local government entity has declared a disaster or other emergency. Or, they do not reside in an affected area, but rely on help making health care decisions from one or more individuals who reside in an affected area; and
  • Were eligible for another election period at the time of the SEP eligibility period; and
  • Did not make an election during that other valid election period due to the disaster or other emergency.

Is there currently an active COVID-19 DST?
The DST SEP for COVID-19 ended in 2021. If your client believes he/she is impacted by COVID-19 and requires a SEP, please have them call Medicare at 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov for assistance.

Enrollment instructions

If you have a client that you believe was denied in error from April 1 - 19 (and hasn't enrolled into another plan), please confirm that he/she still wishes to enroll and submit a new application for your client. You also need to confirm the DST SEP eligibility using the process outlined above.

If you have questions, call us today at 866-568-9649!

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