It is very important for consumers enrolling in a CSNP to know the following about accessing providers:
Some CSNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers for covered services, generally with higher cost sharing.
Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare’s efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider?
I. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority.
II. All data elements required to complete an enrollment request must be captured.
III. The process must include a clear and distinct step that requires the applicant to activate an “Enroll Now” or “I Agree” type of button or tool.
IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site.
Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence?
I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan’s service area.
II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan’s service area.
III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available.
IV. Henry makes a permanent move providing him with new MA and Part D options.