Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Election Types
PLANS
AEP (A) OEPI (T) SEP (Note 2) IEP (E/F) MADP ICEP (I)
MSA Y N Y N N Y
MSA Demo Y Y N Y
Note 1: For code usage, refer to the previously released MMA Guidance and PDP Guidance.
Note 2: For election type SEP, use the following values under these specific circumstances:
U - for Duals and Individuals with LIS
W - for EGHP
V - for permanent moves
Y - CMS Casework use only (not submitted by Plans)
S - Any other SEP as provided in guidance that is not one of the above values.
Note 3: In addition to these election period identifiers, CMS provides a valid value of ‘X’ for use
in the election period identifier field. This value is an Administrative Action and Plans may use
when a submitted transaction is not reflective of an actual Beneficiary election, as follows:
Plan submitted “rollover”- Year-end processing occasionally requires that Plans submit
transactions to accomplish the Plan crosswalk from one contract year to another. When
required, as defined in the CMS Call Letter instructions, Plans should use the ‘X’ value
in the election period field of the enrollment transaction submitted for this purpose.
Involuntary Disenrollment - In limited circumstances, Plans may involuntarily disenroll
individuals for specific reasons and when meeting all of the conditions provided in CMS
enrollment guidance. Since these actions are not “elections,” Plans should use the value
of ‘X’ in the election period field of the disenrollment transaction submitted for this
purpose.
Premium Option Change - Plans may submit changes to an individual’s premium
withholding status via a 72 transaction. When doing so, Plans should use the ‘X’ value in
the election period field of the 72 transaction submitted for this purpose.
Plan-submitted “canceling” Transaction - Since beneficiaries may choose to cancel an
enrollment or disenrollment request prior to the effective date of the request,
occasionally Plans submit “canceling” transactions to CMS to cancel an already
submitted action. Plans should use the value TC 80 to cancel an enrollment or TC 81 to
cancel a disenrollment transaction.
December 28, 2012 M-2 Valid Election Types for
Plan-Submitted