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 accommodations are available:

1. Covered Part A, Part B, and supplemental Part C benefits are available at Medicare-certified facilities, including facilities that aren’t contracted with the plan.
2. Referral and prior authorization requirements are waived, when applicable.
3. Plan-approved out-of-network cost-sharing amounts are temporarily reduced; and
4. The 30-day advance notice requirement for certain plan changes is waived when the changes benefit members, such as reducing cost sharing or waiving authorization requirements.

Access to Part D Prescription Drugs

Medicare Advantage plans must ensure that members have adequate access to covered Part D prescription drugs during a disaster, emergency, or public health emergency.

If you’re an HMSA member and unable to get your covered prescription drugs at a network pharmacy, you may obtain covered Part D drugs at an out-of-network pharmacy, when appropriate. If requested and available at the time of refill, HMSA will allow affected members to get the maximum extended-day supply available under their plan.

Enrollment and Disenrollment

A Special Enrollment Period (SEP) is available for individuals affected by a disaster or emergency who were unable to make an enrollment or disenrollment election during another valid election period, such as the Annual Enrollment Period (AEP).

You may qualify for this SEP if you:

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

The SEP starts 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 two full calendar months following:

• The end date identified in the declaration or, if different,
• The date the end of the incident is announced, or, if no date is identified or announced,
• The date the incident automatically ends under applicable state or local law, or one year after the SEP start date, or renewal or extension.

If an incident end date isn’t identified, the maximum length of the SEP is 14 full calendar months after the SEP start date, or, if applicable, the date of a renewal or extension of the emergency or disaster declaration.

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. Or 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 for Medicare & Medicaid Services