Devoted Health: Important reminders for CMS Special Election Period Rules

Adhering to CMS Guidelines for Special Election Periods (SEPs)

As Devoted Health continues to serve beneficiaries with the highest standards of care and compliance, it is worth taking a moment to remind agents of the critical importance of adhering to the Centers for Medicare & Medicaid Services (CMS) guidelines regarding Special Election Periods.

Importance of Verifying SEP Eligibility

It is imperative that all agents fully understand and comply with the guidelines established by CMS regarding SEPs. This is to ensure that the integrity of Medicare Advantage Plans are upheld and to provide beneficiaries with the services they need during their time of transition.

CMS Marketing Guidelines for Special Election Periods

As a reminder, before enrolling a beneficiary during an SEP, agents must determine if the individual qualifies for such a period by reviewing specific qualifying events that allow for enrollment outside the standard enrollment periods. SEPs may occur due to a variety of qualifying events, including:

• Moving out of the service area
• Losing current health coverage
• Gaining new eligibility (e.g., through Medicaid)
• Other qualifying life events as specified by CMS

Agents will typically ask questions about the beneficiary’s current situation and recent events to determine if they meet the criteria for an SEP. It is important for the agent to verify the specific dates and conditions of these events to ensure eligibility and compliance with CMS Medicare requirements. Agents must provide clear, accurate information to beneficiaries regarding their eligibility for SEPs and the implications of their choices.

Consequences of Non-Compliance

CMS continuously monitors marketing practices. Devoted takes the adherence to these guidelines very seriously. Devoted Health will be closely monitoring agent activities regarding SEP eligibility verification. Any misuse identified may lead to corrective action, up to and including termination, depending on the severity of the violation.

Devoted is committed to ensuring that agents have the necessary resources and support to navigate these guidelines effectively. It is crucial that everyone operates with transparently and ethically while providing beneficiaries the care they deserve.

Agents are encouraged to familiarize themselves with the CMS marketing guidelines on SEPs available on the CMS website and to refer to the Devoted guide on Eligibility and Enrollment Period.  

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