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Rapid Disenrollment Rate – How to Reduce It

Rapid Disenrollment Rate – How to Reduce It. What is a Rapid Disenrollment?. By definition, a rapid disenrollment is when a member disenrolls within 3 months of the original plan effective date. We see the most Rapid Disenrollments from: HMO plans D-SNPs C-SNPs PDPs .

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Rapid Disenrollment Rate – How to Reduce It

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  1. Rapid Disenrollment Rate – How to Reduce It

  2. What is a Rapid Disenrollment? • By definition, a rapid disenrollment is when a member disenrolls within 3 months of the original plan effective date. • We see the most Rapid Disenrollments from: • HMO plans • D-SNPs • C-SNPs • PDPs

  3. Possible Reasons for a Rapid Disenrollment? The agent uses only the printed directory to verify the provider at the point of sale The agent does not review all plan benefits and limitations as listed in the Summary of Benefits The agent does not look up all drugs in the plan formulary The member loses their dual eligible status and has to enroll into a different plan Other creditable coverage (PDP) The agent doesn’t provide their contact information, thus not being available to answer follow-up questions the member may have New enrollees try to use their plan’s services and learn that the plan is not what they expected Enrollees may leave a plan because they want to use a provider in a different network Qualifying for another plan based on a chronic condition

  4. How can Rapid Disenrollments be avoided? • Present the Enrollment Kit in its entirety, leave it with the consumer and ensure that the Important Enrollment Information page (enrollment receipt) is completed. • Help the consumer sign up for the most appropriate plan based on his/her needs. • Ensure the consumer understands and agrees with the plan effective date, premium (when applicable), and benefits. • Encourage consumer to select a PCP instead of having one auto-assigned.

  5. How can Rapid Disenrollments be avoided? • Ensure the consumer understands how to access a provider and explain any network or provider limitations including referral requirements when applicable. • Ensure the Enrollment Application is complete (Medicaid status, agent ID, etc.) prior to having the consumer sign it. • Provide the physical address in the residential address portion and the P.O. Box in the billing address portion of the Enrollment Application, if applicable.

  6. How can Rapid Disenrollments be avoided? • Explain that authorized representative must provide documentation of authorized representation to the health plan and/or CMS if requested. • Review Enrollment Application cancellation process with the consumer. • Review the Outbound Enrollment Verification (OEV) process with the consumer.

  7. “3 Points of Contact” • Verify the member has received their Member ID card and that they understand how to use it • Confirm that the member has scheduled and been to their initial Primary Care appointment and answer any questions they may have • Make sure they know how to use all of the benefits that are available with their plan and that they are utilizing the plan to its fullest

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