TN 1 (03-14)

HI 00803.220 Special Enrollment Period for Expanded Medicare Pilot Program for Asbestos Related Disease (April 1, 2014 to March 31, 2015)

A. SEP background

To encourage participation in the expanded Medicare Pilot Program for Asbestos Related Disease, a limited special enrollment period (SEP) is available for certain Environmental Health Hazards (EHH) Medicare beneficiaries who are not currently entitled to Part B (Supplementary Medical Insurance, SMI) and wish to participate in the pilot. See HI 00803.200 for information about the pilot.

B. SEP eligibility and policy

The SEP begins April 1, 2014, and ends March 31, 2015.

An EHH Medicare beneficiary is eligible for the SEP if he or she is not currently entitled to SMI, resides in one of the ZIP codes listed in HI 00803.200B, and is not currently in an initial enrollment period (IEP), see HI 00805.275 and HI 00803.060.

EHH Medicare beneficiaries who previously resided in one of the ZIP codes listed in HI 00803.200B but currently do not live in one of the specified ZIP codes are not eligible for the SEP. Beneficiaries whose EHH Part A (Hospital Insurance, HI) entitlement date is December 2014 or later are not eligible for this SEP because they are still in their IEP as of the end of the SEP. If these beneficiaries do not enroll during their IEP, they may only enroll during the general enrollment period, other applicable SEP, or subsequent IEP, see HI 00805.010.

The SMI application for the EHH SEP must be filed between April 1, 2014, and March 31, 2015. The SMI effective date is the first day of the month following the month the SMI application was filed. To determine when we consider a mailed application for SMI filed, follow the rules in HI 00805.130.

There is no premium surcharge for enrollment during the SEP and no retroactive entitlement to SMI. In addition, if the EHH Medicare beneficiary enrolled in SMI during the SEP and SMI later terminates, he or she may reenroll in SMI using the SEP if the application is filed by March 31, 2015. The SMI effective date is based on the month of the second SMI application.

Northeastern Program Service Center (NEPSC) will send a letter with a brochure about the pilot program and a modified form CMS-40B and a courtesy return envelope to EHH Medicare beneficiaries not enrolled in SMI who currently reside in the ZIP codes listed in HI 00803.200B. See attached copies of the outreach letter and modified form CMS-40B.

    

EHH-SEP Outreach Letters 2014 pg 1

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EHH-SEP Outreach Letters 2014 pg 2

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EHH-SEP page 1

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EHH-SEP page 2

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Brochure - Medicare Pilot Program for Asbestos Related Disease (page 1)

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Brochure - Medicare Pilot Program for Asbestos Related Disease (page 2)

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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 his or her IEP, check the MBR to see if the beneficiary has Medicare and an EHH indicator. The indicator will appear on the MBR as “HI-HHAZ”.

If the beneficiary has EHH Medicare and wants to enroll in SMI, and resides in one of the ZIP codes listed in HI 00803.200B:

  1. Annotate form CMS-40B with “EHH-SEP” at the top in red.

  2. Mail form CMS-40B along with a Pilot Program brochure to the beneficiary.

  3. Include a courtesy return envelope addressed to:

    NEPSC
    Attention: OAS-PH
    155-10 Jamaica Avenue
    Jamaica, NY 11432

NOTE: Do NOT enter the SEP enrollment via POS.

If the beneficiary’s ZIP code is not on the list:

  1. Explain the SMI enrollment period rules.

  2. Complete form CMS-40B and fax the information into the Non-disability Repository for Evidentiary Documents (NDRED).

  3. Send an email to ^Libby Cases NEPSC, including the following language: “Please process denial, claimant outside of pilot area”.

D. Procedure – Northeastern Program Service Center (NEPSC) processing

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 of 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.

E. References

  • HI 00803.200 Medicare Pilot Program for Asbestos Related Disease

  • HI 00805.010 Rules on Enrollment Periods

  • HI 00805.130 When an Enrollment Received by Mail is Considered Filed

  • HI 00805.275 Special Enrollment Period (SEP) Enrollments

  • SM 00850.550 Special Enrollment for International Volunteers


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600803220
HI 00803.220 - Special Enrollment Period for Expanded Medicare Pilot Program for Asbestos Related Disease (April 1, 2014 to March 31, 2015) - 04/23/2015
Batch run: 04/23/2015
Rev:04/23/2015