Member

Disaster Events Policy

In the event of a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, ConnectiCare will:

  • Waive referrals
  • Reduce cost-sharing amounts for out-of-network service to in-network cost-sharing amounts
  • Make plans for care such as:
    • Being discharged from a facility
    • Home care approvals
    • Durable medical equipment
    • Provide transportation
    • Move the member from a participating to non-participating facility
    • Help the member return to the prior facility
  • Make sure members can get covered Part D drugs filled at out-of-network pharmacies if the member is not able to get covered Part D drugs at a network pharmacy
  • Allow the member to get the maximum supply of part D drugs if it is in supply at the time of refill

 

A SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections. Individuals are eligible for this SEP if they: 

  • Reside, or resided at the start of the SEP eligibility period described in this guidance, in an area for which a federal, state or local government entity has declared a disaster or other emergency or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and 
  • Were eligible for another election period at the time of the SEP eligibility period; and
  • Did not make an election during that other valid election period due to the disaster or other emergency. 

The SEP starts as of the date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier. The SEP ends 2 full calendar months following the end date identified in the declaration or, if different, the date the end of the incident is announced, whichever is later.

Last update 10/01/2021

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