E Guaranteed Enrollment Periods

Revised 06/18/2015

Policy

The guarantee period is calculated at the time the discontinuance is received by PMMIS. Eligibility for the guaranteed enrollment period is based on the reason the customer became ineligible for the AHCCCS program.

NOTE Customers receiving ALTCS or Medicare Savings Program (MSP) do not have guaranteed enrollment periods.

Guaranteed enrollment periods apply as follows:

If...

The guaranteed enrollment period is...

Unless the customer...

It is the first time the customer has ever been enrolled with an AHCCCS Complete Care (ACC) plan

Six months

· Moves out of state;

· Cannot be located and mail is returned to the agency as undeliverable;

· Is incarcerated;

· Is adopted;

· Was ineligible at the time of initial enrollment; or

· Voluntarily withdraws from the program.

It is the first time the customer has ever been approved for KidsCare.

Twelve months

· Reaches age 19;

· Moves out of state;

· Is incarcerated or in an Institution for Mental Disease (IMD);

· Is approved for another AHCCCS Medical Assistance (MA) program;

· Gets creditable coverage;

· Is adopted;

· Cannot be located and mail is returned to the agency as undeliverable;

· Does not pay the monthly premium;

· Fails to cooperate;

· Was ineligible at the time of the initial enrollment; or

· Voluntarily withdraws from the program.

Definitions

Term	Definition
Guaranteed Enrollment Period	A period of enrollment applied the first time a customer is ever enrolled with an AHCCCS Complete Care (ACC) plan or qualifies for KidsCare.

Legal Authority

Program	Legal Authorities
All Programs (except ALTCS, MSP and KidsCare)	AAC R9-22-1705
KidsCare	AAC R9-31-307