If you’re a Medicare Advantage member and have been affected by a disaster or emergency declaration issued by the President of the United States, a state governor, or a county mayor, or an announcement of a public health emergency by the Secretary of Health and Human Services in your geographic area, then the following will apply:

1. Part A and Part B and supplemental Part C plan benefits are provided at specified non-contracted Medicare-certified facilities;
2. Where applicable, requirements for referrals or prior authorizations are waived in full;
3. Plan-approved out-of-network cost-sharing amounts are temporarily reduced; and
4. The 30-day notification requirement to members is waived, as long as all the changes (such as reduction or cost-sharing and waiving authorization) benefits the member.
5. At all times, and especially during a disaster and/or public health emergency situations, HMSA will ensure that you have adequate access to covered Part D drugs dispensed at out-of-network pharmacies if you’re unable to obtain covered Part D drugs at a network pharmacy. If requested and available at the time of refill, HMSA will allow an affected member to obtain the maximum extended day supply.

Enrollment and Disenrollment

A Special Enrollment Period (SEP) exists for beneficiaries affected by the disaster of emergency who were unable to and did not make an election during another valid election period, like the Annual Enrollment Period (AEP).  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 health care 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. Contact our representatives at the phone numbers listed in Contact Information for information and assistance.

When the Disaster Ends

Once the President of the United States, a state governor, a county mayor, the U.S. Secretary of Health and Human Services, or the Centers of Medicare & Medicaid Services has determined that the disaster or emergency is over, or after a minimum of 30 days have passed when there’s no end date declared, you’ll need to use the plan provider network to receive services and the normal pre-authorization/referral requirements and cost sharing will resume and as described in your Evidence of Coverage.

If we’re unable to resume normal operations, we’ll continue to keep you informed about how to receive covered care and prescription drugs by posting updates on our website and when you call us at 808-948-6000 or 1-800-660-4672, 8 a.m. to 8 p.m. seven days a week. TTY users, call 711. We will also notify the Centers of Medicare & Medicaid Services