|WHO||Employers who sponsor calendar-year group health plans and offer prescription drug benefits to any Medicare Part D individual on the first day of the plan year (or contract renewal year). Applies to all size employers, and to private sector, government and church plans, MEWAs, and Union plans.|
|WHAT||Must go online and notify the Centers for Medicare and Medicaid Services (CMS) whether their health plan prescription drug coverage for the current year is “creditable” (at least as good as Medicare Part D’s prescription drug benefit) or “non-creditable” (not as good) coverage with Medicare Part D.|
|WHEN||By March 1 for calendar-year plans – within 60 days from beginning of plan or policy year. Non-calendar year plans should calculate due dates.|
|WHY||Medicare-eligible participants in employer group health plans need to know whether or not the employer group coverage is “creditable.” A penalty will be imposed on a participant if, after becoming eligible for Medicare Part D coverage, there is a lapse of “creditable” prescription drug coverage for a period of at least 63 days.|
By March 1 employers who sponsor calendar-year group health plans and offer prescription drug benefits to any individual who is eligible for Medicare Part D must go online and notify the Centers for Medicare and Medicaid Services (CMS) whether their health plan prescription drug coverage for the current year is “creditable” or “non-creditable” coverage with Medicare Part D. The notice requirement applies to all sizes and types of employers (e.g., private sector, government and church) and plans (single-employer, MEWAs, Union plans).
Coverage is “creditable” if the group health plan’s expected paid claims for prescription drug coverage is at least as much as the expected paid claims under the standard Medicare Part D prescription drug plan.
This on-line notification must be made within 60 days from the beginning of the plan or policy year. Sponsors of non-calendar year group health plans should calculate the applicable deadline for disclosure to CMS. For example, for an April 1 plan year the deadline is May 30.
This notice can only be made by using the Online Disclosure to CMS Form on the CMS website, unless the employer does not have Internet access. See below for additional details. The website also requires the plan sponsor to report the date it sent the Medicare Part D notices to Medicare-eligible plan participants. Note that these are two different requirements: one to send notices to participants, and the other to notify CMS.
The notices to participants must be provided no later than October 15th each year and can be provided with open enrollment materials if they are distributed before October 15th. Before sending the notices to participants, an employer should accurately determine whether the prescription drug coverage it offers is creditable or non-creditable. For an insured plan, the employer should ask the carrier. For a self-funded plan, the employer can use the creditable coverage simplified determination method on the CMS website or can obtain an actuarial certification.
The Medicare Modernization Act requires group health plan sponsors that offer prescription drug coverage to Medicare Part D eligible participants (employees and dependents) to notify them as to whether their prescription drug coverage is creditable or non-creditable. A penalty will be imposed on a participant if, after becoming eligible for Medicare Part D coverage, there is a lapse of “creditable” prescription drug coverage for a period of at least 63 days. Thus, Medicare-eligible participants in employer group health plans need to know whether or not the employer group coverage is “creditable” so they do not unwittingly incur a late enrollment penalty.
Details on the Online Disclosure to CMS (due by March 1)
WHEN: Medicare Part D Notice to CMS must be reported within 60 days from the beginning of the plan year (contract date or renewal date, for small plans that do not file Form 5500 and do not specify a plan year). For calendar year plans, this means notice must be provided to CMS no later than March 2 for 2018. This notice must be made at the CMS website using the Online Disclosure to CMS Form. (Any employer who does not have internet access, should contact CMS and can fax a hard copy of the Part D notice it sent to participants.)
WHERE: Completing the online Form is fairly simple. Click Here
WHAT: The information you will need to complete the online submission is:
- Plan sponsor’s name, Federal Tax ID number, address, phone number, type of coverage (a drop-down box lists employer-sponsored GHP, Union GHP, government GHPs, church GHP, etc.), how many prescription drug options are offered under this coverage (e.g., if you offer both an HMO and a PPO, enter “2”), and whether all or some of the options are creditable or non-creditable. If you have some creditable Rx plans or options and others that are not creditable, you should have sent both “creditable” and “non-creditable” coverage notices by the prior October 15th. Be sure to obtain a submission confirmation (step #3).
- Period covered by the Disclosure Notice, number of Part D eligible individuals expected to be covered under these Plan(s) as of the beginning date of the plan year, date the employer provided the Notice of Creditable Coverage to Part D eligible individuals, change in Creditable Coverage status of previously disclosed information to CMS.
WHO: As part of the online disclosure, you will also need to input the name, title, and email of the Employer’s “Authorized Individual” who is completing the disclosure form. Alternatively, you can sign a written contract with another party (such as the third-party administrator) designating them as the “Authorized Individual” to complete the disclosure on behalf of the employer.
The Authorized Individual must sign a statement agreeing to the following four items:
- that this submission supersedes any previous submission of this information with dates prior to the date below.
- that the entity/plan sponsor agrees to disclose to CMS and all Medicare Part D eligible individuals any changes that would affect the creditable status of the above coverage as outlined under §423.56.
- that I am authorized to supply this disclosure of creditable coverage on behalf of the Entity; and
- that the information provided in this disclosure is true, correct, and complete to the best of my knowledge and belief.
MORE: Once you click the “Submit” button, you should receive a confirmation message. Print a copy of this page for your records. If you receive an error message or have technical problems that you are unable to fix, contact the Disclosure to CMS Technical Help line at: 1-877-243-1285.
Plan sponsors also must complete the Online Disclosure to CMS Form within 30 days after termination of a prescription drug plan or within 30 days after any change in creditable coverage status.
For additional information, the main CMS webpage that provides guidance on “creditable coverage” is: http://www.cms.gov/CreditableCoverage/
Detailed disclosure instructions and screen shots are at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/Downloads/CredCovDisclosureCMSInstructionsScreenShots110410.pdf
Medicare Part D Notices to Participants (by October 15)
As noted above, part of the submission to CMS tells them when the Medicare Part D notice was sent to Medicare-eligible participants. The notices must be provided to participants no later than October 15th because the Medicare enrollment period for prescription drug coverage is October 15th through December 7th.
Additional notices must be provided to participants throughout the year if/when any of the following occur:
- there is any change in the creditable coverage status of the employer’s prescription drug plan
- the employer terminates the prescription drug plan
- an individual requests a copy of the notice, or
- an individual first enrolls in the employer plan
The Part D Notice must be provided not only to Medicare-eligible active working employees and their dependents, but also to participants who are retired, on COBRA, or disabled and covered under the employer’s prescription drug plan. Although the requirement is only that “Medicare-eligible” individuals be provided this notice, employers often provide it to all plan participants and dependents, because of the practical difficulty of knowing who is Medicare-eligible. Most plan sponsors use the Model Medicare Part D Notices provided by CMS to notify affected plan participants. Click here for the Notice of Creditable Coverage. (If you are reading this in hard copy, you can go to: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/Downloads/ModelCreditableCoverageDisclosureNotice051711.pdf)