How to Produce AEP Documents & Manage Plan Benefits with Compressed Timelines

November 15, 2021

The second post in our AEP Best Practices series focuses on the critical path of the Annual Enrollment Period—how to produce AEP documents efficiently & manage plan benefits effectively with compressed timelines. It’s important to understand the risks and challenges with compressed timelines for health plans with several Plan Benefit Packages (PBPs). Here’s a graphic that lays out key milestones in the process.

AEP Timeline

AEP Compressed Timelines

As you can see, the timeline to prepare for AEP is highly compressed. Health plans start preparing for the new contract year while still working on the previous year’s AEP. The process begins in November of the prior year with “submission of notices” of intent to apply. “Applications” are released in January and due to CMS in February. The “bid pricing tools” are released every year in April. And the next big milestone is the “submission of bids” due to CMS on the first Monday in June. Plans then work with CMS to “finalize the bid” so “contracts” can be executed by the end of August.

Lastly, all documents and functions of the approved benefit package must be completed in accordance with CMS deadlines—including the training, systems configuration, other operational processes, and documentation, as well as the marketing and communication materials noted below:

Pre-Enrollment Materials and Sales Kits, Application Forms, and Summary of Benefits
CMS required notices, including Enrollment/Disenrollment Notices, Appeals and Grievances Notices, Organization Determination Notices
Outbound Enrollment Verification Letter of Script
Member ID Card Letters and Card Templates
Annual Notice of Change, LIS (Low Income Subsidy) Rider, Evidence of Coverage
Provider/Pharmacy Directory and Drug Formulary

Plan Benefit Packages

For plans with several Plan Benefit Packages, the creation of PBP-specific documentation in short timeframes can be difficult. Another factor to consider is the variable environment. Data and documents go through multiple revisions before being finalized or new versions are created as updated guidance or models are released.

The PBP data is the source of numerous activities needed to implement the new contract year:

Populating benefit information into plan documents
Training staff on the new benefits and providing the tools and job aids needed for them to communicate this information accurately and
Communicating with your providers and FDRs, so they have the information they need

Since this data is used in many activities, data integrity is vital to the successful and compliant launch of the new contract year. New models come out annually for some materials, and in some cases, there are corrections, or revisions to those models. A robust internal review process is essential to implement the models as they are released or revised to ensure all stakeholders are using the most recent versions. In this variable environment, compounded by compressed timelines, it’s critical Plans work efficiently and effectively to create compliant documents and processes to meet CMS deadlines.

AEP Compressed Timelines

Plan Benefit Packages

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