Effective January 31, 2020 at 11:59p.m. EST, the Centers for Medicare & Medicaid Services (CMS) imposed intermediate sanctions on Delaware Life Insurance Company.  This means that Clear Spring Health and Clear Spring Health PDP cannot accept new enrollments into our plan and/or market to enrollees at this time.  Due to an increase in enrollment, we experienced significant enrollment issues.   

While you may not have experienced this directly, the deficiencies cited by CMS include:

• Failing to timely and accurately process enrollment requests
• Failing to provide timely notices of acceptance or denials of enrollment requests
• Failing to provide proof of coverage and other plan materials prior to member effective dates
• Failing to correctly process requests for medical or drug coverage
• Failing to provide information on a timely basis to current and prospective enrollees through the customer service call center.
• Failure to provide proper oversight of the plan vendors

Clear Spring Health and Clear Spring Health PDP are working diligently to resolve these issues as quickly as possible.

This does not impact your coverage with Clear Spring Health and Clear Spring Health PDP.  The benefits you have as a member of Clear Spring Health or Clear Spring Health PDP continue while our plan is sanctioned.  You still have access to our providers and pharmacy network and coverage for medical services and drugs on our formulary.

Can I make changes to my medical or prescription drug coverage?

If you believe you have been negatively impacted by the deficiencies stated above, you may qualify for a special election period that will allow you to enroll in a new plan now.  To find out if you qualify for a special election period, please contact 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week.  TTY users should call 1-877-486-2048. 

If you are eligible for a special election period, here are your options:

Option 1: Keep your current plan. If you are satisfied with your current coverage, you do not need to do anything to stay in our plan.

Option 2: You can switch to a different Medicare Prescription Drug Plan, Medicare Advantage Plan or other Medicare health plan, including a plan that offers prescription drug coverage. Your new coverage can start as early as the month after the new plan gets your application.  Most Medicare health plans include prescription drug coverage, but not all.  If you want Medicare prescription drug coverage, be sure to join a Medicare health plan that has this coverage or join a Medicare health plan that allows you to join a separate Medicare prescription drug plan.

What if I have more questions?
If you have any questions, please contact Clear Spring Health at (877) 384-1241, Clear Spring Health PDP at (877) 317-6082 Monday to Sunday 8am - 8pm from October 1 thru March 31 and Monday to Friday 8am - 8pm from April 1 thru September 30.  TTY users should call 711.

Thank you for your continued membership in Clear Spring Health and Clear Spring Health PDP.

Getting Care during a Disaster or Emergency

If you are a Medicare Advantage member and have been affected by a disaster or emergency declaration issued by the President of the United States or a State Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services in your geographic area, then the following will apply:

1. Part A and Part B and supplemental Part C plan benefits are provided at specified non-contracted Medicare-certified facilities;
2. Where applicable, requirements for referrals or prior authorizations are waived in full;
3. Plan-approved out-of-network cost-sharing amounts are temporarily reduced; and
4. The 30-day notification requirement to members is waived, as long as all the changes (such as reduction or cost-sharing and waiving authorization) benefits the member.
5. At all times, and especially during a disaster and/or public health emergency situations, Clear Spring Health will ensure that you have adequate access to covered Part D drugs dispensed at out-of-network pharmacies if you are unable to obtain covered Part D drugs at a network pharmacy. If requested and available at the time of refill, Clear Spring Health will allow an affected member to obtain the maximum extended day supply.

When the Disaster Ends

Once the President of the United States, a State Governor, the U.S. Secretary of Health and Human Services or The Centers of Medicare & Medicaid Services (CMS) has determined that the disaster or emergency is over, or after a minimum of 30 days have passed when there is no end date declared, you will need to use the plan provider network to receive services and the normal pre-authorization/referral requirements and cost sharing will resume and as described in your Evidence of Coverage.