Blue Cross Blue Shield | Keystone: First VIP Choice Broker Newsletter

May 21, 2020

Special Enrollment Period (SEP) for Individuals Affected by a FEMA-Declared Weather-Related Emergency or Other Major Disaster: Applicable for COVID-19

CMS has released a communication to clarify for Medicare Advantage (MA) and Part D plan sponsors that the exceptional conditions Special Enrollment Period (SEP) for Individuals Affected by a FEMA-Declared Weather Related Emergency or Major Disaster is applicable and is available for beneficiaries who were eligible for but unable to make an election because they were affected by the COVID-19. This SEP is available nationwide to residents of all states, tribes, territories, and the District of Columbia effective March 1, 2020 and includes both enrollment and dis-enrollment elections. Beneficiaries will not be expected to provide proof that they were affected by the pandemic-related emergency.

Individuals who are eligible for this election period must meet the following 3 conditions:

  • Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
  • Had another valid election period at the time of the incident period; and
  • Did not make an election during that other valid election period.

Please note, dual-eligible individuals who have quarterly SEP and were able to use the election period during this Covid-19 pandemic will not meet the above conditions, therefore they will not receive an additional SEP.

Medicare Beneficiary Identifier (MBI) Plan Lookup Tool

CMS has created a secure web-based MBI Plan lookup tool in the Medicare Advantage Prescription Drug System (MARx). The MBI Plan lookup tool provides authorized users with the ability to obtain an individual beneficiary’s MBI. Although Plans are expected to have contact with a beneficiary and obtain their MBIs for enrollment purposes, CMS is providing Plans the ability to look up a beneficiary’s MBI in cases where it will allow them to provide a better beneficiary customer service experience during the enrollment process.

How it works

CMS will use the following information to return an MBI; please note all of the search criteria below are required entries:

  • First name (or the first letter of the first name)
  • Last name (or first six (6) letters for last names longer than six letters)
  • Date of birth
  • HICN, or beneficiary’s Social Security number, or a portion of the MBI (minimum of three (3) characters)

Telephonic Enrollment Process

AmeriHealth Caritas VIP Plans has implemented a temporary telephonic enrollment solution for our agents to support their production during the COVID-19 pandemic. The process is the following:

  1. The agent will complete presentation over the phone
  2. Check if prospect’s providers are in-network and medications are covered by the plan using plan website online directory. Make sure the information is noted in CRM
  3. Check the prospect’s Medicaid and Medicare eligibility by calling Broker Support 855-241-3647. They can also assist with process #2.
  4. Call VIP telephonic enrollment support line (877-703-9102) with the prospect to complete enrollment over the phone. The agent can also be transferred to the enrollment line after the eligibility verification call.

Important Contact Numbers

The listed below are the numbers that can help you with enrolling or assisting prospects/members.

  • Prospect eligibility verification number: 855-241-3647
  • Scope of appointment number: 855-241-3650
  • Telephonic enrollment number: 877-703-9102
  • Member Services: 800-450-1166 (TTY 711)

Advocate our members

Due to the COVID-19 pandemic, the number of abuse cases is increasing. If you suspect abuse to our members, please contact our Anonymous Fraud Tip Hotline at 1-866-833-9718.

Please be safe and take all the recommended precautionary measures from the CDC.

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


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