CurrentSelectHealthPolicy N/A

Select Health Medicare Special Enrollment Period (SEP) Circumstances

Lists selectable Special Enrollment Period (SEP) circumstances for Select Health Medicare enrollment and instructs applicants how to certify eligibility; affects individuals seeking to enroll or change Select Health Medicare plans.

Policy Summary

PayerSelectHealth

PolicySelect Health Medicare Special Enrollment Period (SEP) Circumstances

Policy CodePolicy N/A

Change TypeInformational

Effective DateN/A

Next Review DateN/A

Key ActionApplicants must write the applicable SEP circumstance number and date on the Select Health Medicare Enrollment Form to certify eligibility.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

33number of listed SEP circumstances

855-442-9940contact phone

711TTY

Special Enrollment Period (SEP) Qualification Criteria

SEP qualification criteria (enumerated)

Policy Summary

PayerSelectHealth

PolicySelect Health Medicare Special Enrollment Period (SEP) Circumstances

Policy CodePolicy N/A

Change TypeInformational

Effective DateN/A

Next Review DateN/A

Key ActionApplicants must write the applicable SEP circumstance number and date on the Select Health Medicare Enrollment Form to certify eligibility.

SourceLink

On This Page

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ANY of the following

01: I am new to Medicare.
02: I recently moved outside the service area for my current plan, or I recently moved, and this plan is a new option for me. PROVIDE MOVE DATE.
03: I recently returned to the United States (U.S.) after living permanently outside of the U.S. PROVIDE RETURN DATE.
04: I am enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
05: I requested Medicare information in an accessible format. I had less time to decide or didn't get it in time to choose a plan before my enrollment period ended.
06: This is for individuals who gained, lost, or changed their LIS/Extra help status within the last three months.
07: I am moving into, living in, or recently moving out of a Long‑Term Care Facility (e.g., a nursing home). PROVIDE MOVE DATE.
08: I recently had a change in my Medicaid (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid). PROVIDE CHANGE DATE.
09: I recently involuntarily lost my creditable prescription drug coverage (i.e., coverage as good as Medicare's). PROVIDE DRUG COVERAGE LOSS DATE.
10: I was enrolled in a plan by Medicare (or my state) and I want to choose a different plan. PROVIDE ENROLLMENT DATE.
11: I am leaving employer or union coverage. PROVIDE LEAVE DATE.
12: I belong to a state pharmaceutical assistance plan (SPAP) or have lost SPAP eligibility.
13: My plan is ending its contract with Medicare, or Medicare is ending its contract with my plan.
14: I was enrolled in a Special Needs Plan (SNP) but lost the special needs qualification required to be in that plan. PROVIDE DISENROLLMENT DATE.
15: I recently left a PACE program. PROVIDE LEAVE DATE.
16: I was recently released from incarceration. PROVIDE RELEASE DATE.
17: I recently obtained lawful presence status in the United States. PROVIDE STATUS DATE.
18: I pay a premium for Part A and I signed up for Part B during the General Enrollment Period (January 1–March 31 each year). I want to join a Medicare drug plan (Part D) or Medicare Advantage Plan with drug coverage.
19: I already have Hospital (Part A) and recently signed up for Medical (Part B). I want to join a Medicare Advantage Plan.
20: I am leaving a Medicare Advantage plan identified as a low‑performing plan. PROVIDE LEAVE DATE.
21: I am leaving a Medicare Advantage plan that has been placed in receivership. PROVIDE LEAVE DATE.
22: I am leaving a Medicare MAPD or PDP plan and enrolling in a standalone Medicare Advantage plan without drug coverage because I have other creditable drug coverage. PROVIDE LEAVE DATE.
23: I am enrolling during the Medicare Annual Enrollment Period (AEP).
24: I was affected by an emergency or a major disaster (as declared by FEMA or by the Federal, state, or local government). One of the other statements on this page applies to me, but I could not make my request because of the disaster.
25: I lost my coverage because my plan no longer covers the area that I live.
26: I have Medicare drug coverage (Part D) through a Medicare Advantage Plan. I want to join a different Medicare health plan that doesn't offer drug coverage, so I can switch to non‑Medicare creditable drug coverage.
27: I'm new to Medicare, and I was notified about getting Medicare after my Part A and/or Part B coverage started.
28: I'm in a plan that was recently taken over by the state because of financial issues. I want to switch to another plan.
29: I'm in a plan that's had a star rating of less than 3 stars for the last 3 years. I want to join a plan with a star rating of 3 stars or higher.
30: I had Medicare before, but I'm now turning 65.
31: Because of an exceptional circumstance, I had a Special Enrollment Period and signed up for either Premium‑Part A and Part B, only premium‑Part A, or only Part B. I want to join a Medicare Advantage Plan (with or without drug coverage) because I now have both Part A and Part B.
32: I signed up for premium‑Part A or Part B during a Special Enrollment Period I qualified for because of an exceptional circumstance. Now, I want to join a Medicare drug plan.
33: I live in a long‑term care facility, like a nursing home or a rehabilitation hospital.

Key Terms and Plan Information

SEP circumstances

DefinitionSpecial Enrollment Period (SEP) circumstances are specific life events or situations that allow an individual to enroll in or change Medicare plans outside regular enrollment periods.

ScopeIncludes 33 enumerated circumstances (01–33) such as becoming new to Medicare; moving into/out of a plan's service area; changes in Medicaid, LIS/Extra Help, or credible drug coverage; leaving employer coverage; release from incarceration; long‑term care moves; plan contract or performance issues; disaster‑related impacts; and other qualifying events.

Applicant requirementWhen claiming a SEP, applicants must provide dates where prompted (e.g., move date, release date, change date) corresponding to the listed circumstance.

Examples (selected)Selected examples include: 01 — New to Medicare; 02 — Recently moved (provide move date); 08 — Change in Medicaid (provide change date); 11 — Leaving employer or union coverage (provide leave date); 16 — Recently released from incarceration (provide release date).

Assistance if unsureIf none of the statements apply or eligibility is uncertain, contact Select Health toll‑free at 855‑442‑9940 (TTY: 711) for help determining SEP eligibility.

Select Health Medicare

Plan sponsor statusSelect Health is an HMO and Special Needs Plan (SNP) plan sponsor operating under a Medicare contract.

Contract dependencyEnrollment in Select Health Medicare depends on contract renewal with Medicare.

Contact for eligibility/questionsSelect Health toll‑free: 855‑442‑9940; TTY: 711.

Civil rights and language accessSelect Health follows federal civil rights laws and provides information in other languages and alternate formats at no cost.

OpenPayer

Select Health Medicare Special Enrollment Period (SEP) Circumstances

Special Enrollment Period (SEP) Qualification Criteria

Member Certification Required on Enrollment Form

Key Terms and Plan Information