Rules for Direct Contract and “800 series” Plans

50.1.1 - Rules for Direct Contract and “800 series” Plans (Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13) CMS has waived the prior review and approval requirements for marketing materials and election forms contained in 42 CFR 422.2262 for all EGWPs. These waivers apply to “800 series” and Direct Contract plans. As a result of this waiver, Direct Contract plans and MAOs offering “800 series” EGWPs or employer-sponsored individual MA plans are not subject to the annual restriction on communications directed to Medicare eligible beneficiaries prior to October 1st. Rather, CMS strongly encourages employer/union sponsors and entities offering these plans to employers/unions to communicate to beneficiaries early in the process and to continue to communicate about their benefits frequently prior to their annual open enrollment period (which may differ from Medicare’s annual coordinated election period. Employers/unions and/or entities that offer employer-sponsored “800 series” or individual plans to employers/unions should direct beneficiaries to available resources and explain their coverage and how it coordinates with Medicare.