Using the State Pharmaceutical Assistance Program (PAP) SEP
Hello, and welcome to using the State Pharmaceutical Assistance Program, or PAP, special enrollment period code.
We wanna first get started by just learning a little more about what PAP is and how do you use this SEP. Well, the Pharmaceutical Assistance Program is a limited SEP that allows individuals who belong to a qualified State Pharmaceutical Assistance program, or SPAP, or PAP, to enroll into a Part D plan outside of existing enrollment opportunities that may be available to them, such as the annual enrollment period.
For individuals who are either newly enrolled or currently enrolled into an SPAP program, they may use this SEP to either join a Part D plan when they first become eligible, switch to another Part D plan, or switch from an MAPD plan to another MAPD plan or a stand alone Part D plan. This SEP is available for beneficiaries to use once during the calendar year. Once it’s been used, it cannot be used again until the following year.
For individuals who are previously enrolled and have already lost or are losing SPAP eligibility, they may use this SEP to join a Part D or MAPD plan. In this instance, the SEP begins the month the beneficiary loses eligibility or the month they are notified of the loss, whichever is earliest, and it ends two months after either the month of the loss of coverage or notification of the loss, whichever is later.
It’s important that agents understand how and when to use this SEP and what may happen if it happens to be misused. So the SPAP or PAP special enrollment period, like other SEPs, should only be used in instances allowed by CMS, and in this case, instances referred to in this training program. Agents who are found to be misusing this or any other SCP code may receive corrective action in the form of coaching or retraining, probation, or potentially even termination of your contract. It’s important to know and understand how to use all SEPs.
Please take time to review these modules again if you have any questions regarding the SPAP or PAP special enrollment period.
Thank you for attending this session on using the State Pharmaceutical Assistance Program SEP. Now it’s time to earn that certificate.