TN 1 (03-14)
HI 00803.210 Special Enrollment Period for Medicare Pilot Program for Asbestos-Related Disease (July 1, 2011 to June 30, 2012)
A. SEP background
To encourage participation in the Medicare Pilot Program for Asbestos Related Disease, a limited special enrollment period (SEP) was established for beneficiaries who were not currently entitled to Part B (Supplementary Medical Insurance, SMI) and resided in certain ZIP codes of Lincoln or Flathead County, Montana. See HI 00803.200 for information about the pilot.
B. SEP policy
The SEP occurred from July 1, 2011, to June 30, 2012. An Environmental Health Hazards (EHH) Medicare beneficiary was eligible for the SEP if they were not currently entitled to SMI as of May 2012 and during the time of the SEP and resided in one of the following ZIP codes:
Beneficiaries whose EHH Part A (HI) entitlement date is March 2012 or later were not eligible for this SEP because they were still in their initial enrollment period.
There was no premium surcharge for enrollment during the SEP. The SMI effective date in this SEP was the first day of the month following the month the SMI application was filed. In addition, if the EHH Medicare beneficiary enrolled in SMI during the SEP and SMI was later terminated, he or she was allowed to reenroll in SMI using the SEP, provided the SMI application was filed by June 30, 2012.
C. Procedure – Field Office (FO) and Teleservice Center (TSC)
If a beneficiary contacts an FO or the TSC to enroll in SMI, and is not in their initial enrollment period (IEP), check the MBR to see if the beneficiary has Medicare and an EHH indicator.
If the beneficiary has EHH Medicare and wants to enroll in SMI, and resides in one of the ZIP codes listed above in HI 00803.210B:
Annotate form CMS-40B with “EHH-SEP” at the top in red.
Mail form CMS-40B along with a Pilot Program brochure to the beneficiary.
Include a courtesy return envelope addressed to: NEPSC
155-10 Jamaica Avenue
Jamaica, NY 11432
If the beneficiary’s zip code is not on the list:
Explain the SMI enrollment period rules.
Complete form CMS-40B and fax the information into the Non-disability Repository for Evidentiary Documents (NDRED).
Send an email to ^Libby Cases NEPSC.
D. Procedure – Northeastern Program Service Center (NEPSC) processing
The NEPSC should follow the instructions in SM 00850.550D to process EHH-SEP SMI enrollments, except for the special message in SM 00850.550D. Annotate the SMI information shown, but include a special message via the SMG screen to indicate “EHH-SEP.” There is no reason to annotate the MACADE HID or HPH screens. There is no premium surcharge for enrollment during the SEP.
For denials for SMI SEP applications received from EHH beneficiaries not residing in the listed ZIP codes, place the following special message on the MBR via MACADE – “EHH-SEP Claimant Outside of Pilot Area.” Use paragraph E3605.1 or PCSMI1009 in the notice, which explains that the claimant is not within an enrollment period.
HI 00803.200 Medicare Pilot Program for Asbestos Related Disease
HI 00805.010 Rules on Enrollment Periods
SM 00850.550 Special Enrollment for International Volunteers