Special enrollment periods have been announced for Kentucky, Virginia, and West Virginia.
This is an important announcement for agents with customers in Virginia and for those with business in the state. The counties below are under a state-designated SEP due to an emergency.
Special Enrollment Period Extension: New York Emergency Declaration - Gun Violence
Please be advised that a state of emergency declaration was extended, impacting individuals in all New York counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This SEP applies to all counties in New York.
Declaration information Extended
State declaration: Disaster (wildfires)
SEP Incident Date: 03/04/2022 – 08/28/2022
This SEP declaration is effective 03/04/2022 –10/31/2022
Impacted counties for SEP purposes: Bay, Calhoun, and Gulf
State declaration: Disaster
SEP Incident Date: 06/09/2022 – TBD
This SEP declaration is effective 06/09/2022 – TBD
Impacted counties for SEP purposes: Rio Arriba
IMPORTANT: Please be aware
- This does not mean that active marketing can occur.
- The SEP is only for the purpose of providing a 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.
Tips for completing applications
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 requires to process the application.
If you have any questions, call us today at 866-568-9649!
A special enrollment period (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.
The Centers for Medicare and Medicaid Services (CMS) has recently clarified that the COVID-19 SEP expired on June 30, 2020, and has not been renewed.