Devoted | Important reminders for CMS Special Election Period Rules
Adhering to CMS Guidelines for Special Election Periods (SEPs)
As we continue to serve our beneficiaries with the highest standards of care and compliance, we want to take a moment to remind you 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 we uphold the integrity of our Medicare Advantage Plan and provide our 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. We 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.
We are committed to ensuring that our agents have the necessary resources and support to navigate these guidelines effectively. It is crucial that we operate transparently and ethically while providing beneficiaries the care they deserve.
We encourage you to familiarize yourself with the CMS marketing guidelines on SEPs available on the CMS website and to refer to theDevoted guide on Eligibility and Enrollment Period.
Please do not hesitate to reach out to your local sales leader if you have any questions or need further clarification regarding SEP eligibility requirements.
Thank you for your continued dedication to compliance and for serving our beneficiaries with integrity.
