MA - Wellpoint SEP

July 16, 2009

Special Enrollment Period for Certain Beneficiaries disenrolled from Wellpoint plans

On July 2, 2009, the Centers for Medicare & Medicaid Services sent the following email to State Health Insurance (SHIP) Programs:

WellPoint disclosed that approximately 4600 beneficiaries that enrolled in Wellpoint at the end of last year were not properly informed that their plan was being terminated in 2009. As a result, these individuals are eligible for a special enrollment period (SEP) during July, August, and September 2009 allowing them to enroll in another health plan or prescription drug plan. Beneficiaries eligible for the SEP will receive the attached letter shortly after July 6, 2009 and if they are interested in the SEP, they should contact 1-800 MEDICARE.

With the email came the template of the letter to be sent to the affected Wellpoint subscribers, as well as a spreadsheet showing the number of affected beneficiaries by state. The SEP begins the month they receive the letter - presumably July - and runs for two additional months.

The Center for Medicare Advocacy made a trial call to 1-800 MEDICARE to see how these calls will be handled. As is the standard procedure, our caller spoke to a "Level 1" customer service representative who, after learning about the call's purpose, transferred the caller to a specialist who provided the following information.

Beneficiaries should call 1-800-MEDICARE and be prepared to provide their Medicare number as well as their name, date of birth, and address. It really doesn't matter what category (i.e. claims, enrollment) they select from the menu because the Level 1 CSR with whom they will initially speak will transfer them to a specialist or supervisor (Level 2 personnel) in order to assist them with this SEP issue.
It would be helpful, but it is not absolutely necessary, to have the notice letter on hand when a beneficiary calls; there is no special code or confirmation number or the like that beneficiaries must provide over the phone. However, beneficiaries should provide the date upon which their Wellpoint drug coverage was dropped, the date of the notice letter, and explain that they received a notice letter indicating that they are entitled to the SEP.
Beneficiaries who want to take advantage of the SEP may enroll for Part D over the phone. The specialist assured the caller that the CSR will ask whether the beneficiary would like his or her Part D coverage to retroactively apply effective January 1, 2009.

The 1-800-MEDICARE specialist with whom the Center's caller spoke was friendly and attentive, although she seemed unfamiliar with the SEP for former Wellpoint prescription drug enrollees whose coverage was dropped. During the call, she essentially read from the model letter and consulted a colleague. To the best of her knowledge, she hadn't yet received any calls regarding this issue.

For additional assistance, contact your state's SHIP program. Find your program at www.shiptalk.org.