US · guidance
CMS Pub. 100-01, ch. 2, § 40.3.7.2
SEP for Individuals Affected by a Health Plan or Employer
Misrepresentation
(Rev. 12046, Issued:05-18-23, Effective:01-01-23, Implementation:06-21-23)
Individuals who do not enroll in Part B or Premium Part A when first eligible due to
misrepresentation or reliance on incorrect information provided by their employer or
GHP, agents or brokers of health plans, or any person authorized to act on behalf of such
entity may enroll during this SEP.
An eligible person must demonstrate (by documentation or written attestation) both of the
following:
• They did not enroll in Part B or Premium Part A during another enrollment
period in which they were eligible based on information received from an
employer or GHP, agents or brokers of health plans, or any person authorized to
act on such organization’s behalf.
• An employer, GHP, agent or broker of a health plan, or their representative
materially misrepresented information or provided incorrect information relating
to enrollment in Part B or Premium Part A.
The SEP begins the day an individual notifies the Social Security Administration and
ends six months later.
Coverage begins the first day of the month following enrollment.
History
(Rev. 12046, Issued:05-18-23, Effective:01-01-23, Implementation:06-21-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
14a2dbf3c5cd5cf654e0bc69414f76749e5501f4a4a2945a7574b5bc4a8741cd
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