BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA. Eligibility Requirements. Eligibility Period Description Eligibility Dates Attestation Requirements

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Eligibility Period Description Eligibility Dates Attestation Requirements Annual Election Period (AEP) This is also considered open enrollment.

1 Eligibility Period Description Eligibility Dates Attestation Requirements Annual Election Period (AEP) This is also considered open enrollment. Anyone who is qualified for Medicare can enroll with BlueCross at this time. Eligibility is from Oct. 15 to Dec. 7, 2011, for the 2012 plan year. The effective date will be Jan. 1. The Attestation page is optional at this time. Initial Enrollment Period (IEP) This is the first time an Applicant is enrolling into Medicare, using MAPD and PDP application. This is a one time election option for the Applicant. The effective date is the first day of the month of the entitlement, or the first day of the month after enrollment request. The eligibility period will start three months before the Applicant meets the requirements and a period that extends three months after the Applicant meets the requirements. Outside of open enrollment, I am New to Medicare must be checked to qualify for this election option. Initial Coverage Election Period (ICEP) This is the first time an Applicant is enrolling into the Medicare Advantage Plan. The Applicant must have both Part A and Part B. The effective date is the first day of the month of the entitlement, or the first day of the month after enrollment request. The eligibility period will start three months before the Applicant meets the requirements and extends three months after the Applicant meets the requirements. Outside of open enrollment, I am New to Medicare must be checked to qualify for this election option. 1

2 Eligibility Period Description Eligibility Dates Attestation Requirements Open Enrollment Period for Institutionalized Individuals (OEPI) *Note: On Attestation page, check Dual Eligibility since BlueCross does not process applications under OEPI This is for Applicants who are institutionalized in assisted living facilities. This is continuous eligibility for the Applicant as long as he or she is qualified as an institutionalized individual. The OEPI option must be checked for this election option and the Applicant must meet the requirements of an institutionalized individual. Special Election Period () The Special Election Period means that throughout the year there are scenarios that are unique, and allows an individual to be eligible outside of open enrollment. For example, an individual may move to a new service area and require a new plan provider. s eligibility varies between each election option on the Attestation page. Typically, eligibility is one month prior to the plan ending and up to two months after the plan has ended. Please confirm the scenario before using these eligibility dates. On the Attestation page, these are the most common eligibility scenarios. Outside of open enrollment, the eligibility scenario must be appropriate. 2

3 Eligibility Period Description Eligibility Dates Attestation Requirements Medicare Advantage Disenrollment Period (MADP) This is a Special Election Period that means an Applicant has an opportunity for disenrolling from Medicare private health plan and enrolling into Original Medicare. Applicants can either disenroll from their Medicare Advantage plan with drug coverage or disenroll from their Private Fee For Service (PFFS) plans that do not have prescription drug coverage and a stand alone prescription drug plan. This is only eligible for Drug plans and only from Jan. 1 to Feb. 14. This is required on the Attestation page and only available when the Applicant is requesting disenrollment in MA and enrollment in a Drug plan. 3

4 I am new to Medicare. IEP and ICEP The eligibility period begins three months in advance of the month an Applicant becomes eligible, and runs three months after the month an Applicant becomes eligible, for a total seven month period. The effective date will either be the first day of the month of the entitlement, or the first day of the month after enrollment request. If the Applicant takes advantage of the eligibility period three months prior to entitlement, then the effective date will be the first day of the month of entitlement. If the Applicant waits until after the month of entitlement, then the effective date will be the first day of the month after the enrollment request. 4

5 I recently moved outside of the service area for my current plan or I recently moved and this plan is a new option for me. I moved (insert date). The Applicant is eligible one month before the Applicant s official move date or disenrollment date and two months after the Applicant s official move date, for a total three month period. month after the official enrollment request, but never earlier than the official move date. The Applicant may also choose the effective date up to two months after the enrollment request. For example, the Applicant submits an enrollment request on April 3 and the effect date is either May 1 or up to two months after. Applicants are required to tell their plans they are moving out of the area. Should an Applicant tell the provider after the move, the Applicant has the month he or she informed the provider and two months after. month after the official enrollment request. For example, the Applicant submits an enrollment request on June 20 and the effective date will be July 1. I recently returned to the United States after living permanently outside of the U.S. I returned to the U.S. on (insert date). The Applicant must meet Part A and B requirements but does not have Medicare due to out of country residence. For example, while permanently overseas, the Applicant turned 65 but never applied for Medicare. Upon permanently moving to the United States, the Applicant is eligible one month before the official move date and two months after the official move date. month after the official enrollment request, but never earlier than the official move date. The Applicant may also choose the effective date up to two months after the enrollment request. For example, the Applicant submits an enrollment request on March 5 and the effective date will be April 1 or up to two months after. 5

6 I have both Medicare and Medicaid or my state helps pay for my Medicare premiums. The Applicant is eligible the month he or she becomes dually eligible and is continuous as long as the Applicant is receiving Medicaid benefits. month after the official enrollment request. For example, the Applicant submits an enrollment request on June 20 and the effective date will be July 1. I get extra help paying for Medicare prescription drug coverage. If the Applicant meets the requirements of Medicare, the Applicant has continuous eligibility due to low income qualifications by the government. month after the official enrollment request. For example, the Applicant submits an enrollment request on June 20 and the effective date will be July 1. I no longer qualify for extra help paying for my Medicare prescription drugs. I stopped receiving extra help on (Insert date). The Applicant will be eligible the month of the termination notice or loss of coverage. The Applicant will lose eligibility two months after the termination notice or loss of coverage, whichever is later. The effective date is the first day of the month after the request, or the Applicant may request an effective date up to three months after the enrollment request. For example, the Applicant submits an enrollment request on May 23 and the effective date will be June 1 or up to three months after. 6

7 I am moving into, live in, or recently moved out of a Long Term Care Facility (for example, a nursing home or other long term care facility). I moved/will move into/out of the facility on (insert date). OEPI *Note: On Attestation page, check Dual Eligibility, since BlueCross does not process applications under OEPI. This is continuous eligibility for the Applicant as long as he or she is qualified as an institutionalized individual. The effective date is the first day of the month after the official enrollment request. For example, the Applicant submits an enrollment request on June 20 and the effective date will be July 1. I recently left a Program of All Inclusive Care for the Elderly (PACE) on (insert date). The Applicant is eligible up to two months after the disenrollment effective date. The effective date depends on the situation. For questions on effective date, please contact BlueCross. I recently involuntarily lost my creditable prescription drug coverage (coverage as good as Medicare s). I lost my drug coverage on (insert date). The Applicant will be eligible the month after the termination notice or loss of coverage. The Applicant will lose eligibility two months after the termination notice or loss of coverage, whichever is later. The effective date is the first of the month after the enrollment request, or the Applicant may request an effective date up to three months after the enrollment application date. For example, the Applicant submits an enrollment request on July 3 and the effective date will be Aug. 1 or up to three months after. 7

8 I am leaving employer or union coverage on (insert date). The Applicant will be eligible the month after the loss of coverage. The Applicant will lose eligibility two months after loss of coverage. month after the official enrollment request, but never earlier than the disenrollment date of the previous plan. The Applicant may also choose the effective date up to three months after the enrollment request. For example, the Applicant submits an enrollment request on July 3 and the effective date will be Aug. 1 or up to three months after. I belong to a pharmacy assistance program provided by my state. Individuals belonging to a State Pharmacy Assistance Program (SPAP) program are eligible to enroll one time throughout the year, but only limited to one time a year for MADP and PDP. The effective date is the first day of the month after the official enrollment request. For example, the Applicant submits an enrollment request on June 20 and the effective date will be July 1. 8

9 My plan is ending its contract with Medicare or Medicare is ending its contract with my plan. The Applicant is eligible two months before the termination effective date of the contract or two months after the disenrollment date and has one month after effective disenrollment date for MA termination. The effective date may be selected up to two months after the month of termination, but never before the enrollment request. For example, the Applicant s termination was on April 5, and the effective date will be May 1 or up to three months after. Applicants affected by the termination with an effective date of Jan. 1 of the contract year have an beginning Dec. 8 that continues until the last day in February of the following year for non renewals. The effective date is the first day of the month after the official enrollment request. For example, the Applicant submits an enrollment request on June 20 and the effective date will be July 1. I was enrolled in a Special Needs Plan (SNP) but I have lost the special needs qualification required to be in that plan. I was disenrolled from the SNP on (insert date). An Applicant no longer meets the special needs status. Applicants are eligible the month they no longer qualify for the special needs status and will continue until either they enroll into a new plan or three months after termination, whichever happens first. The effective date is the first day of the month after the official enrollment request. For example, the Applicant submits an enrollment request on June 20 and the effective date will be July 1. 9

10 I am making this enrollment request between Jan. 1 and Feb. 14, and I recently ended my enrollment in a Medicare Advantage plan. I left my Medicare Advantage plan on (insert date). MADP *Note: The MADP qualifies as an. The Applicant is eligible between Jan. 1 and Feb. 14 and only for a PDP. An Applicant is eligible if the Applicant has a Medicare Advantage plan with drug coverage and is switching to Original Medicare. The Applicant has a Medicare Private Fee For Service (PFFS) and does not have prescription drug coverage and a stand alone prescription plan (MA and PDP). month after the official enrollment request. For example, the Applicant submits an enrollment request on Jan. 26 and the effective date will be Feb. 1. None of these statements apply to me. Applicant or Agent should call BlueCross to confirm the eligibility of the Applicant. Effective date based on eligibility. 10

Medicare Enrollment Periods

FACT SHEET Medicare Enrollment Periods (A-008) p. 1 of 6 Medicare Enrollment Periods There are certain periods when you can join, change or drop the different parts of Medicare (A, B, C, and D). In other