America’s 1st Choice Health plans H3421 and H4738 PFFS/PPO plans will not be renewed for 2017. Members will be receiving a notice by October 1st, stating their plans will be ending as of December 31st, 2016.
As per CMS Guidance, members will be informed of the following:
- Inform the enrollee that the plan will no longer be offered in 2017.
- He/she can join a new plan for a January 1, 2017 effective date between October 15, 2016 and February 28, 2017.
- Advise that the enrollee will only have Original Medicare starting January 1, 2017 if he or she does not enroll in a new plan by December 31, 2016.
- Instruct the enrollee what will happen if he or she does not join another plan.
• Plans with Part D must provide information related to loss of prescription drug coverage, including information regarding the Part D late enrollment penalty (if applicable).
• MA and Cost plans must provide information related to default placement in Original Medicare. Include the special right to enroll in a Medigap policy.
• MMPs must provide information related to Medicaid continued coverage, including contact information for the State Medicaid agency.
- Direct the enrollee to the Medicare & You handbook for a list of health and prescription drug plans in his/her area.
- Inform the enrollee they should disregard any 2017 plan materials received prior to October 2, 2016.
- Provide resources for additional information. At a minimum, the list of resources must include the local SHIP number, 1-800-MEDICARE number, Ombudsman number and State Enrollment broker (for MMPs only), and Medicare.gov link.
Brokers with America’s 1st Choice Health Plans will continue to receive their PFFS/PPO renewals for members through December 31st, 2016. No further certification is required.
America’s 1st Choice will be outreaching to members of the PFFS/PPO Plans who reside in our HMO counties of Greenville, Richland, and Spartanburg who may be interested in joining one of the HMO plans. If a member is retained, the original broker will remain as the agent of record for renewals going forward.
An email will be distributed for AFC HMO brokers who need to complete benefit training for 2017.