In the memorandum issued by CMS, the agency stated that the SEP is applicable and available for beneficiaries who were eligible for, but unable to make, an election because they were affected by the ongoing public health crisis. All states, tribes, territories, and the District of Columbia (D.C.) are covered by this SEP beginning March 1, 2020, and ending June 30, 2020.
CMS considers individuals as "affected" and eligible for this SEP under FEMA if they:
- Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
- Had another valid election period at the time of the incident period; and
- Did not make an election during that other valid election period.
In addition, the SEP is available to those individuals who do not live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas. The SEP is available from the start of the incident period and for four full calendar months after the start of the incident period. Further, an eligible beneficiary would be given one opportunity to make that missed election as a result of this SEP. Beneficiaries will not be expected to provide proof that they were affected by the pandemic-related emergency.
For more information, please call Capital Health Plan Member Services at 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. - 8:00 p.m., Monday - Friday, April 1 - September 30.