We have an important announcement for those of you with customers in Arizona, California, Florida, Iowa, Nevada, New Hampshire, Oregon, Texas, and Utah, or for those conducting business in these states. Several counties in these states are currently under a federal or state designated Special Enrollment Period (SEP) due to recent emergencies.
Key Points to Note:
- Application Validity: Disaster SEP applications are only valid while the SEP declaration is active. If an end date isn’t listed, refer to the Ongoing SEP tracker in Producers’ University for the most current information. Applications submitted outside of the SEP declaration date will be rejected.
- Marketing Restrictions: Active marketing is not permitted during this period.
Purpose: The SEP is intended to provide enrollment opportunities to impacted individuals who had a valid election during the incident and couldn’t make that election due to the emergency. - Authorization Requirements: This SEP does not imply that Cigna Healthcare will waive authorization or referral requirements. It does not extend to waiving prior authorizations or referrals.
SEP for Government Entity-Declared Disaster or Other Emergency
Regulation: 42 CFR 422.62(b)(18)
An SEP is available for individuals affected by a disaster or emergency declared by a federal, state, or local government entity, who were unable to make an election during another valid election period. This includes both enrollment and disenrollment elections.
Eligibility Criteria:
- Reside or resided at the start of the SEP eligibility period in an area where a disaster or emergency was declared.
- Were eligible for another election period during the Disaster Election Period (DST) eligibility period.
- Did not make an election during that period due to the disaster or emergency.
The SEP begins on the date the declaration was made or the incident start date, whichever is earlier, and ends two full calendar months following the end date of the declaration or incident.
SEP Declarations by State
Arizona
Shake Fire: Pinal County (Effective 07/09/2024 – Ongoing)
Rose Fire: Maricopa County (Effective 06/12/2024 – 08/31/2024)
California
Thompson Fire: Butte County (Effective 07/02/2024 – 09/30/2024)
Florida
May North Florida Tornadoes: Multiple Counties (Effective 05/10/2024 – 11/30/2024)
Iowa
Severe Storms, Flooding, Straight-line Winds, and Tornadoes: Multiple Counties (Effective 06/16/2024 – Ongoing)
Nevada
Trail Fire: Washoe County (Effective 06/11/2024 – 08/31/2024)
Sullivan Fire: Washoe County (Effective 06/11/2024 – 08/31/2024)
New Hampshire
Severe Winter Storm and Flooding: Multiple Counties (Effective 04/03/2024 – 09/30/2024)
Oregon
Darlene 3 Fire: Deschutes County (Effective 06/25/2024 – 09/30/2024)
Larch Creek Fire: Wasco County (Effective 07/10/2024 – Ongoing)
Texas
Hurricane Beryl: Multiple Counties (Effective 07/05/2024 – 09/02/2024)
Severe Storms, Straight-line Winds, Tornadoes, and Flooding: Multiple Counties (Effective 04/26/2024 – 09/30/2024)
Utah
Silver King Fire: Piute County (Effective 07/07/2024 – Ongoing)
Updates to DST Application Process
Key Updates:
1. The date of the disaster is no longer required on DST applications.
2. The missed election period is not required on most applications.
Application Instructions:
- Select “SEP” in the Select Enrollment Period field.
- Enter code “DST” in the SEP Code field.
- If applicable, enter the date for the missed election period (e.g., moving, losing group coverage, Medicaid status changes).
DST is not a stand-alone election period. For questions about DST eligibility, please review the Cigna Election Period grid, found in the Cigna Resource Center of Producers’ University.
For more details and answers to any questions you may have about SEP/DEP, please reach out to your Agility support team at (866) 590-9771.
