Common use of Default Enrollment Clause in Contracts

Default Enrollment. An enrollment process that allows a Medicare Advantage organization (MAO), following approval by the state and CMS, to enroll a MassHealth Member enrolled in an affiliated Medicaid MCO (i.e., MassHealth health plan) into its Medicare Dual Eligible Special Needs Plan (D-SNP) when that Member becomes newly eligible for Medicare (Parts A and B)– unless the Member chooses otherwise. This process is only permissible in circumstances where the Member enrolls with the One Care plan offered by their MassHealth health plan upon receiving Medicare eligibility. The Default Enrollment effective date shall always be the date of the individual’s first entitlement to both Medicare Part A and Part B.

Default Enrollment. An enrollment process that allows a Medicare Advantage organization (MAO), following approval by the state and CMS, to enroll a MassHealth Member enrolled in an affiliated Medicaid MCO (i.e., MassHealth health plan) into its Medicare Dual Eligible Special Needs Plan (D-D- SNP) when that Member becomes newly eligible for Medicare (Parts A and B)) – unless the Member chooses otherwise. This process is only permissible in circumstances where the Member enrolls with the One Care SCO plan offered by their MassHealth health plan upon receiving Medicare eligibility. The Default Enrollment effective date shall always be the date of the individual’s first entitlement to both Medicare Part A and Part B.