Aetna | Guidelines for the disaster/emergency SEPAetna

June 3, 2024

Review requirements for the disaster/
emergency Special Enrollment Period (SEP)

Overview of the SEP for Government Entity-Declared Disaster or Other Emergency

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. 

This SEP allows for enrollment and disenrollment elections. For more information, go to CY 2024 MA Enrollment and Disenrollment Guidance [42 CFR 422.62(b)(18)].

When can this SEP be used? 

A disaster/emergency SEP is only applicable to those beneficiaries who were prevented from submitting an enrollment or disenrollment request during a given election period due to a declared disaster or emergency.
CMS strictly limits when the disaster/emergency SEP may be used.  

Individuals are eligible for this SEP if they: 

  • Reside, or 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.

Enrollment instructions

IMPORTANT: Remember, you cannot use this SEP opportunity to proactively market to beneficiaries. However, you can assist any clients who contact you about this SEP.

  • If an individual wants to enroll and believes they may qualify for this SEP, you need to ask the beneficiary if they can show proof that they lived/live in an impacted area at the start of the incident period. If they do not have proof, ask them to verbally attest. 
  • 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.  

Questions? We’re here to help

If you have any questions, please contact your local Aetna Medicare Broker Manager for assistance. Login to Producer World to find contact information for Broker Managers in your state.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com


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