Wellcare | DST-SEP Best Practices and Reminders

June 5, 2024

With AEP quickly approaching, we wanted to take this time to communicate some important reminders, best practices and eligibility requirements when it comes to Special Enrollment Periods (SEP).

As a reminder, an SEP is a time outside of the Initial Coverage Election Period (ICEP), Medicare Advantage Open Enrollment Period (MA OEP) and Annual Enrollment Period (AEP), during which a member can make changes (enroll in, disenroll from or switch) to their Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plans.

A DST-SEP may be granted to individuals who reside in an affected service area where a federal, state, or local government entity has declared a state of emergency, impacting individuals in a specific geographical area. The declaration allows for a one-time SEP, in the event an individual was unable to make an election during another qualifying election period.

Eligibility Requirements

An opportunity for a DST-SEP is ONLY available to beneficiaries who:

  • 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.

Wellcare will communicate any changes or updates to these SEPs, if necessary, when they become available.

Important Reminder

In order for a member to benefit from an SEP, the agent and member must both acknowledge that the beneficiary was impacted by the DST-SEP. Agents cannotassume that using the DST-SEP is compliant because the member resides in a county included in a disaster declaration; rather, the member must state what SEP was missed because of the disaster declared by FEMA or the state.

Please reach out to WellcareSEP@centene.com with any questions and visit the DST-SEP Landing Page to see all current DST-SEP information.

As always, thank you for your continued partnership!

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


Submit a Comment

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.