Page:United States Statutes at Large Volume 111 Part 1.djvu/307

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 283 "(i) 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 "(ii) the organization (or an agent or other entity acting on the organization's behalf) materially misrepresented the plan's provisions in marketing the plan to the individual; or "(D) the individual meets such other exceptional conditions as the Secretary may provide. Effective as of January 1, 2002, an individual who, upon first becoming eligible for benefits under part A at age 65, enrolls in a Medicare+Choice plan under this part, the individual may discontinue the election of such plan, and elect coverage under the original fee-for-service plan, at any time during the 12- month period beginning on the effective date of such enrollment. "(5) SPECIAL RULES FOR MSA PLANS. —Notwithstanding the preceding provisions of this subsection, an individual— "(A) may elect an MSA plan only during— "(i) an initial open enrollment period described in paragraph (1), "(ii) an annual, coordinated election period described in paragraph (3)(B), or "(iii) the month of November 1998; "(B) subject to subparagraph (C), may not discontinue an election of an MSA plan except during the periods described in clause (ii) or (iii) of subparagraph (A) and under the first sentence of paragraph (4); and "(C) who elects an MSA plan during an annual, coordinated election period, and who never previously had elected such a plan, may revoke such election, in a manner determined by the Secretary, by not later than December 15 following the date of the election. "(6) OPEN ENROLLMENT PERIODS. —Subject to paragraph (5), a Medicare+Choice organization— "(A) shall accept elections or changes to elections during the initial enrollment periods described in paragraph (1), during the month of November 1998 and each subsequent year (as provided in paragraph (3)), and during special election periods described in the first sentence of paragraph (4); and "(B) may accept other changes to elections at such other times as the organization provides. "(f) EFFECTIVENESS OF ELECTIONS AND CHANGES OF ELEC- TIONS.— "(1) DURING INITIAL COVERAGE ELECTION PERIOD.— An election of coverage made during the initial coverage election period under subsection (e)(1)(A) shall take effect upon the date the individual becomes entitled to benefits under part A and enrolled under part B, except as the Secretary may provide (consistent with section 1838) in order to prevent retroactive coverage.

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