CMS Pub. 100-16, ch. mc86c17d, § 40.4.1

During the enrollment process, the cost plan must provide the enrollee with all the

necessary information about being a member of the cost plan, including the plan rules

and the member’s rights and responsibilities. The cost plan must ensure that the enrollee

is provided with the following:

• A description of the charges for which the beneficiary is liable, e.g. any

premiums, coinsurances, fees, or other amounts. For a high option, amounts

attributable to the Medicare deductible and coinsurance should be explained in

detail.

• An explanation of the beneficiary’s authorization for the disclosure and exchange

of necessary information between the cost plan and CMS that is generally

included on the application form.

• A copy of the signed and dated enrollment form, if the individual does not already

have a copy of the form.

• A letter acknowledging receipt of the completed enrollment form and showing the

effective date of coverage (Exhibit 2).

• Following receipt of the confirmation of enrollment from CMS promptly (within

14-30 calendar days) notify the enrollee in writing of the effective date of

enrollment and send a CMS-approved evidence of coverage that describes M+C

organization rules, including benefits and enrollee rights and responsibilities (42

CFR 417.436).