CMS Pub. 100-16, ch. 9, § 30.7

In general, the notice requirements contained in Appendix 1 (Summary of Notice Requirements)

of the Medicare Managed Care Manual, Chapter 2 (Medicare Advantage Enrollment and

Disenrollment) apply to all employer/union group health plan-sponsored enrollments in

individual MA plans or EGWPs, with the following clarification that employer/union-sponsored

group health plans can be customize each model beneficiary notice, which is applicable, to the

extent the modifications will more clearly and accurately reflect the employer group plan.

Certain notices contained in the Medicare Managed Care Manual, Chapter 2 (Medicare

Advantage Enrollment and Disenrollment), Appendix 1, are not applicable to employer/union

group health plan-sponsored enrollments in individual MA plans or EGWPs, as identified below:

• Exhibit 27: MA Model Notice to Inform Full-Benefit Dual Eligible Member of Auto-Enrollment in MA-PD Plan;

• Exhibit 27a: MA-PFFS Model Notice to Inform Full-Benefit Dual Eligible Member of

Auto-Enrollment in PDP;

• Exhibit 28: MA Model Notice to Inform Member of Facilitated Enrollment into MA-PD

plan; q

• Exhibit 28a: MA Model Notice to Inform Member of Facilitated Enrollment into PDP;

and

• Exhibit 29: Acknowledgement of Request to Opt Out of Auto/Facilitated Enrollment.