What to know about offering Senior Care Options (SCO) to your clients

Publish Date

Happy 2023 AEP to our SCO broker partners! We are delighted that you have chosen to include Tufts Health Plan Senior Care Option (SCO) plan as part of your product portfolio for 2023. 


We have a dedicated Broker Relationship Manager (Lenieve Henry), our Medicare Broker Support Team at Point32Health, and you concierge SCO Business development management team (Daphnee Alva and David Ojeda) to help you every step of the way. We appreciate all your business and wish you success for the 2023 open enrollment period and beyond. Here are some useful tips that may help you along the way.


Senior Care Options Eligibility?

 

  • Enrollee must be 65 years old or older
  • Have MassHealth Standard (Medicaid)
  • PCP must be contracted

Note: Our SCO program cannot accept prospects or HMO members living in a Nursing Home at the moment.


Who can enroll in SCO During the last quarter of 2022?


November 1st and December 1st effective date:

  • Medicaid only prospects
  • Prospects who have a special election period (SEP). For example, New to MassHealth or those who has changes to their MassHealth.
  • Prospects who have an event such as (five years permanent residency, a move from either another state or a county that we are currently in network with, new to Medicare who currently has MassHealth standard.)
  • Must use the 2022 Enrollment Form (H8330_2022_43_C)
  • All applications must be received by 1pm on the last of the month or the last business day of the month

 

January 1, 2023, effective date:
During AEP (Oct 15th- Dec 7th)

  • Prospects who are dual eligible 
  • Prospects who are enrolled in a competitor SCO plan 
  • Must use the 2023 enrollment kit and form (H8330_2023_7_C)
  • All applications must be received by 1pm 12/7 on the last of the month with SEP – AEP.
  • From 12/8 – 12/31, if they meet the eligibity criteria and have a valid SEP, all applications must be received by 1pm 12/30


SCO best practices:

 

  • Prior to selling your first THP SCO plan, you must complete an additional training with Daphnee Alva-Lafleur to review product and enrollment submission processes.
  • Required: Transition forms must be submitted with all complete enrollment form. Failure to submit transition form will delay the process of getting your clients enrolled.
  • THP SCO is an HMO plan that requires you to select a PCP upon completing an enrollment. A PCP will be auto assigned if one is not selected.  
  • Fax cover form must be included 
  • Please check prospects MassHealth status prior to booking appointment by calling 1-800-332-5545 or 1-888-665-9993. (Reminder, all prospects must be 65 years or older on MassHealth Standard to be eligible for Senior Care Options.)

 

Enrollment Options:

  • Paper application – send completed form by fax to: THP Enrollment Team 617-673-0785
  • SCO Enrollment form

 

Helpful Link/Tools:

  • To order enrollment kits, Login to the broker portal, or email  David or Daphnee (contact information below).
  • Provider Directory
  • Drug Search 

Producers must be ready to sell, which means certified, contracted, and licensed in the applicable states by Tufts Health Plan in accordance with state law prior to engaging in the sale of our products.

 

If you have any questions or need any additional information, please contact:

David Ojeda 
Manager of BDM and External Growth 
David.ojeda@point32health.org 
617-460-6820
Daphnee Alva-Lafleur

 

Supervisor of Business Development and Medicare Sales Team - Massachusetts
Phone: 617-460-1540
E-mail: Daphnee.alva@point32health.org