Before processing enrollments, technicians must confirm that eligibility for another
Special Enrollment Period (SEP) does not apply, the individual is not in their Initial
Enrollment Period (IEP) nor is filing for End Stage Renal Disease (ESRD).
Do not use the OEC SEP in lieu of Equitable Relief. If Equitable Relief applies, see
HI 00830.001.
To be eligible for this SEP, an individual must ensure that the following two conditions
are met:
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They must demonstrate that conditions outside of their control that occur on or after
January 1, 2023, caused them to miss an enrollment period, and
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•
It is determined that the conditions were exceptional in nature.
This includes, but is not limited to:
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A serious medical emergency that prevented the beneficiary from access to enroll in
Medicare,
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• Example: Being in a coma or admitted for a long-term in-patient stay, during an enrollment
period or suffering from long-term illness such as Dementia or Alzheimer or suffering
that impacted their ability to enroll timely.
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•
A natural or emergency disaster in a foreign country where a beneficiary resides disrupts
mailing and transportation processes during an enrollment period.
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•
An elderly or disabled individual experiencing involuntary restraint due to abuse
or neglect from a caretaker.
Factors that are not eligible for the SEP
Eligibility for this SEP will only be granted in conditions that are truly exceptional
in nature and will not be used to grant individual’s enrollment due to:
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•
lapse in premium payments.
Note: The individual must have missed an enrollment period due to the exceptional
condition to be eligible for this SEP.