US · guidance
CMS Pub. 100-16, ch. 9, § 20.3
Mid-Year Benefit Customization/Enhancements
The EGWP program is designed explicitly to allow flexibility for MAOs to negotiate different
customized plans with particular employer/union groups throughout the year. This design also
takes into account that employers/unions offering group health plans may operate on different
bidding and negotiation timelines. Therefore, MAOs are allowed to offer “800 series”
customized plans at any time during the contract year (i.e., MAOs are implicitly allowed to offer
enhanced benefits throughout the year to individual employers/unions that differ from the
benefits reflected in their bid). Also, when utilizing individual MA plans open to general
enrollment for their members, employer/union sponsors are also free to enhance benefits mid-year for the part of the package that is a “wrap-around” or enhancement to the MA plan. See 422
CFR 106.
History
(Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
521918cef50686bba6d454e53dc7c954237b93b804e5f26ceb70273f32cf17d4
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