TO:Issuers Offering Medicare Supplemental Insurance Health Maintenance Organizations (HMOs) Offering Medicare Managed Care Plans
FROM:Linda Ruthardt, Commissioner of Insurance
DATE:September 8, 2000
RE:Required Open Enrollment Period To Be Held Pursuant to M.G.L. c. 176K

The purpose of this bulletin is to inform all issuers offering Medicare Supplement insurance policies and HMOs offering Medicare managed care plans that are subject to the provisions of M.G.L. c. 176K of their obligation to participate in a required open enrollment period pursuant to M.G.L. c. 176K, sections 2(b) and 3(g), as well as 211 CMR 71.10(6). The Division is scheduling such an open enrollment period to be held between October 1, 2000 and December 15, 2000. The Division has been notified by the federal Health Care Financing Administration (HCFA) that its contracts with Fallon Community Health Plan, Inc. (Fallon), Harvard Pilgrim Health Care, Inc. (HPHC) and United Healthcare of New England, Inc. (UHCNE) in the locations identified below will no longer be in effect after December 31, 2000 for the purposes of individual/direct pay enrollment.

  • Fallon's Medicare managed care plan marketed as Senior Saver - for the Essex and Suffolk County service areas, as well as the following cities/towns within the Middlesex County service area: Arlington, Belmont, Burlington, Cambridge, Everett, Lexington, Lincoln, Malden, Medford, Melrose, Newton, North Reading, Reading, Somerville, Stoneham, Wakefield, Waltham, Watertown, Weston, Wilmington, Winchester and Woburn.
  • HPHC's Medicare managed care plan marketed as First Seniority - for the Barnstable, Bristol, Plymouth and Worcester County service areas.
  • UHCNE's Medicare managed care plan marketed as Medicare Complete statewide.

Only those persons who are enrolled in these Medicare HMOs and who live in the affected locations will be eligible for the state guaranteed issue provisions of the special open enrollment period that is required under 211 CMR 71.10(6). This required open enrollment period will be for carriers marketing Medicare Supplement plans and Medicare HMO products within the Medicare-approved service areas of these plans and is scheduled to take place between October 1, 2000 and December 15, 2000.

During this special open enrollment period, carriers must make available to all affected individuals all Medicare Supplement policies or Evidences of Coverage of Medicare managed care plans currently available from the carrier. Please note that according to the provisions of the federal Balanced Budget Refinement Act of 1999 (BBRA), carriers must ensure that applicants who apply during this special open enrollment period are given the opportunity to make their coverage effective before January 1, 2001 coincident with the date that the applicant has disenrolled from his or her Medicare HMO plan and returned to traditional Medicare coverage. Carriers should prepare their systems to ensure that there is a seamless transition to Medicare Supplement coverage regardless of when applications are processed. The attached documents from the federal Department of Health and Human Services describe issuer obligations under BBRA.

Carriers are reminded that mandatory participation in this special open enrollment period is in addition to compliance with all other required enrollment rights afforded to individuals pursuant to M.G.L. c. 176K, as well as the federal Balanced Budget Act of 1997 and BBRA. Any questions regarding this bulletin should be directed to Kevin Beagan, Director of the Health Unit of the State Rating Bureau at the Division of Insurance, at (617) 521-7347, or faxed to (617) 521-7773.