Ins 3.39(34)(b)2.a. a. The certification of the organization or plan under Medicare Part C has been terminated; or

Ins 3.39(34)(b)2.b. b. The organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides.

Ins 3.39(34)(b)2.c. c. The individual is no longer eligible to elect the plan because of a change in the individual’s place of residence or other change in circumstances specified by the secretary, but not including termination of the individual’s enrollment on the basis described in section 1851 (g) (3) (B) of the federal Social Security Act (where the individual has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under section 1856), or the plan is terminated for all individuals within a residence area.

Ins 3.39(34)(b)2.d. d. The individual demonstrates, in accordance with guidelines established by the secretary that, at least one of the following has occurred; the organization offering the plan substantially violated a material provision of the organization’s contract under this part in relation to the individual, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide such covered care in accordance with applicable quality standards, or the organization, or agent or other entity acting on the organization’s behalf, materially misrepresented the plan’s provisions in marketing the plan to the individual.

Ins 3.39(34)(b)2.e. e. The individual meets such other exceptional conditions as the secretary may provide.

Ins 3.39(34)(b)3. 3. The individual is enrolled with any of the following:

Ins 3.39(34)(b)3.a. a. An eligible organization under a contract under Section 1876 of the Social Security Act (Medicare cost);

Ins 3.39(34)(b)3.b. b. A similar organization operating under demonstration project authority, effective for periods before April 1, 1999;

Ins 3.39(34)(b)3.c. c. An organization under an agreement under Section 1833(a)(1)(A) of the Social Security Act (health care prepayment plan); or

Ins 3.39(34)(b)3.d. d. An organization under a Medicare select policy; and

Ins 3.39(34)(b)3m. 3m. The enrollment ceases under the same circumstances that would permit discontinuance of an individual’s election of coverage under subd. 2.

Ins 3.39(34)(b)4. 4. The individual is enrolled under a Medicare supplement policy and the enrollment ceases because:

Ins 3.39(34)(b)4.a. a. Of the insolvency of the issuer or bankruptcy of the nonissuer organization or of other involuntary termination of coverage or enrollment under the policy;

Ins 3.39(34)(b)4.b. b. The issuer of the policy substantially violated a material provision of the policy; or

Ins 3.39(34)(b)4.c. c. The issuer, or an agent or other entity acting on the issuer’s behalf, materially misrepresented the policy’s provisions in marketing the policy to the individual;

Ins 3.39(34)(b)5. 5.

Ins 3.39(34)(b)5.a. a. The individual was enrolled under a Medicare supplement policy and terminates enrollment and subsequently enrolls, for the first time, with any Medicare Advantage organization under a Medicare Advantage plan under Medicare Part C, any eligible organization under a contract under section 1876 of the Social Security Act, Medicare cost, any similar organization operating demonstration project authority, any PACE provider under section 1894 of the Social Security Act, or a Medicare select policy; and

Ins 3.39(34)(b)5.b. b. The subsequent enrollment under subd. 5. a. is terminated by the enrollee during any period within the first 12 months of such subsequent enrollment (during which the enrollee is permitted to terminate such subsequent enrollment under section 1851(e) of the federal Social Security Act); or

Ins 3.39(34)(b)6. 6. The individual, upon first becoming eligible for benefits under Medicare Parts A and B at age 65, enrolls in a Medicare Advantage plan under Medicare Part C, or with a PACE provider under section 1894 of the Social Security Act, and disenrolls from the plan or program by not later than 12 months after the effective date of enrollment.

Ins 3.39(34)(b)7. 7. The individual enrolls in a Medicare Part D plan during the initial enrollment period and, at the time of enrollment in Medicare Part D, was enrolled under a Medicare supplement, Medicare replacement, Medicare cost or Medicare select policy that covered outpatient prescription drugs and the individual terminates enrollment in the Medicare supplement, Medicare replacement Medicare cost or Medicare select policy and submits evidence of enrollment in Medicare Part D along with the application for a policy described in par. (e) 4.

Ins 3.39(34)(b)8. 8. The individual is eligible for benefits under Medicare Parts A and B and is covered under the medical assistance program and subsequently loses eligibility in the medical assistance program.

Ins 3.39(34)(c) (c) Guaranteed issue time periods.

Ins 3.39(34)(c)1. 1. In the case of an individual described in par. (b) 1., 1m., or 1s., the guaranteed issue period begins on the later of the following dates:

Ins 3.39(34)(c)1.a. a. The date the individual receives a notice of termination or cessation of some or all supplemental health benefits, or, if a notice is not received, notice that a claim has been denied because of a termination or cessation, and ends 63 days after the date the applicable coverage is terminated.

Ins 3.39(34)(c)1.b. b. The date the individual receives notice that a claim has been denied because of such a termination or cessation, if the individual did not receive notice of the plan’s termination or cessation, and ends 63 days after the date of notice of the claim denial.

Ins 3.39(34)(c)2. 2. In the case of an individual described in par. (b) 2., 3., 5., 6. or 8., whose enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the individual receives a notice of termination and ends on the date that is 63 days after the date the applicable coverage is terminated.

Ins 3.39(34)(c)3. 3. In the case of an individual described in par. (b) 4. a., the guaranteed issue period begins on the earlier of either: the date that the individual receives a notice of termination, a notice of the issuer’s bankruptcy or insolvency, or other such similar notice, if any; or the date that the applicable coverage is terminated. The guaranteed issue period ends on the date that is 63 days after the date such coverage is terminated.

Ins 3.39(34)(c)4. 4. In the case of an individual described in par. (b) 1r., 2., 4. b. or c., 5., or 6. who disenrolls voluntarily, the guaranteed issue period begins on the date that is 60 days before the effective date of the disenrollment and ends on the date that is 63 days after the effective date.

Ins 3.39(34)(c)5. 5. In the case of an individual described in par. (b) 7., the guaranteed issue period begins on the date the individual receives notice pursuant to Section 1882 (v) (2) (B) of the Social Security Act from the Medicare supplement issuer during the 60-day period immediately preceding the initial Medicare Part D enrollment period and ends on the date that is 63 days after the effective date of the individual’s coverage under Medicare Part D.