New Medicare SEP Announced For Texas

This is an important announcement for agents with customers in Texas and for those with business in the state. The counties below are under a state-designated SEP due to an emergency.

TEXAS

Declaration information

State declaration: (flooding)

SEP Incident Date: 08/23/2022 – Ongoing

This SEP declaration is effective 08/23/2022 – Ongoing

Impacted counties for SEP purposes: Camp, Culberson, Dallas, Duval, Ellis, El Paso, Henderson, Hopkins, Hudspeth, Kaufman, Kerr, Live Oak, Marion, Montague, Navarro, Pecos, Rains, Smith, Tarrant, Upshur, Van Zandt, Webb, and Wood

IMPORTANT: Please be aware:

• This does not mean that active marketing can occur.
• The SEP is only for the purpose of providing an SEP to impacted individuals who had a valid election during the incident and were unable to make that election due to the emergency.
• This does not mean we initiate waiving of authorization or referral requirements.
• This does not extend waiving of prior authorizations, referrals, etc.  

SEP for Government Entity-Declared Disaster or Other Emergency

42 CFR 422.62(b)(18)

(Rev. 2, Issued: August 12, 2020; Effective/Implementation: 01-01-2021)

An SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state, or local government entity who were unable to and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.

Individuals are eligible for this SEP if they: 

• Reside, or resided at the start of the SEP eligibility period described in this guidance, 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 healthcare 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.

The SEP starts 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 two 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.

For paper applications, ensure that the following fields in the “Agent Only Use” section are completed:

• Select “SEP” in the “Select Enrollment Period” field
• Enter code “DST” in the “SEP Code” field
• Enter the date the customer was affected by the disaster in the “SEP Date field”
• In the “Special Enrollment Period” section: Make sure you select the special enrollment period that applies to the customer in addition to selecting the “DST” box that states, “I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA)). One of the other statements here applied to me, but I was unable to make my enrollment because of the natural disaster.” Both are required to be completed.

For telephonic applications, ensure that the following fields are completed:

• In the “Special Enrollment Period section: Select the actual enrollment period the customer qualified for that was missed, and
• Select the check box next to the statement that reads “I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency, or by federal, my state, or my local government). One of the other statements on this page applied to me, but I was unable to make my request because of the disaster." This creates the DST and the second code Enrollment required to process the application. 

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