[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR422.50]

[Page 835]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 422--MEDICARE+CHOICE PROGRAM--Table of Contents
 
            Subpart B--Eligibility, Election, and Enrollment
 
Sec. 422.50  Eligibility to elect an M+C plan.

    Source: 63 FR 35071, June 26, 1998, unless otherwise noted.


    (a) An individual is eligible to elect an M+C plan if he or she--
    (1) Is entitled to Medicare under Part A and enrolled in Part B 
(except that an individual entitled only to Part B and who was enrolled 
in an HMO or CMP with a risk contract under part 417 of this chapter on 
December 31, 1998 may continue to be enrolled in the M+C organization as 
an M+C plan enrollee);
    (2) Has not been medically determined to have end-stage renal 
disease, except that an individual who develops end-stage renal disease 
while enrolled in an M+C plan or in a health plan offered by the M+C 
organization is eligible to elect an M+C plan offered by that 
organization;
    (3) Meets either of the following residency requirements:
    (i) Resides in the service area of the M+C plan.
    (ii) Resides outside of the service area of the M+C plan and is 
enrolled in a health plan offered by the M+C organization during the 
month immediately preceding the month in which the individual is 
entitled to both Medicare Part A and Part B, provided that an M+C 
organization chooses to offer this option and that CMS determines that 
all applicable M+C access requirements of Sec. 422.112 are met for that 
individual through the M+C plan's established provider network. The M+C 
organization must furnish the same benefits to these enrollees as to 
enrollees who reside in the service area;
    (4) Has been a member of an Employer Group Health Plan (EGHP) that 
includes the elected M+C plan, even if the individual lives outside of 
the M+C plan service area, provided that an M+C organization chooses to 
offer this option and that CMS determines that all applicable M+C access 
requirements at Sec. 422.12 are met for that individual through the M+C 
plan's established provider network. The M+C organization must furnish 
the same benefits to all enrollees, regardless of whether they reside in 
the service area;
    (5) Completes and signs an election form and gives information 
required for enrollment; and
    (6) Agrees to abide by the rules of the M+C organization after they 
are disclosed to him or her in connection with the election process.
    (b) An M+C eligible individual may not be enrolled in more than one 
M+C plan at any given time.

[63 FR 35071, June 26, 1998; 63 FR 52611, Oct. 1, 1998, as amended at 65 
FR 40316, June 29, 2000]