Client Alert
from
The McCart 
Group
 
November 3, 2010
Medicare Creditable Coverage Guidance
and Model Disclosure Notices

Each year, employers offering group health plan coverage with a prescription drug benefit are required to notify all Medicare participants before November 15 that coverage constitutes 'creditable'  (or non-creditable) drug coverage. For coverage to be creditable, a group health plan's expected claims payout must equal or exceed those paid under Part D. (To test, see "Creditable Coverage Simplified Determination" link below.)
 
Required recipients include not only Medicare-enrolled employees but also any retirees, COBRA beneficiaries and their spouses and dependents who are on Medicare. Because you may not know whether the participant (or spouse or dependent) is Medicare-
eligible, The McCart Group suggests that you send the notice to all covered plan participants.

If your plan includes prescription drug coverage, the Medicare Part D notice can be included in your Open Enrollment Benefits Guide.  Your McCart Benefits Account Manager can assist you if you have questions about including this notice.
  
Employers with employees who have worksite electronic access may send the creditable/non-creditable coverage disclosure notice electronically to plan participants ('worksite access' means the individual must have the ability to access electronic documents at their regular place of work as a daily part of their work duties). Employers electing this option must inform plan participants that the participant is responsible for providing a copy of the electronic disclosure to their Medicare eligible dependents covered by the group health plan.

No separate mailing to the spouse/dependents is required. A copy should also be posted on the plan's website (if applicable). 
 
Eligible employees have until December 31 each year to enroll in Part D (late enrollees will have to pay a late enrollment penalty in the form of higher premiums).

Finally, please be advised that as an employer you are required to register your plan with the Center for Medicare and Medicaid Services (CMS). This can only be done electronically by visiting: https://www.cms.gov/CreditableCoverage/45_CCDisclosureForm.asp.

Please click on the links below to find the models for the creditable and non-creditable coverage notices provided by CMS. The models can be easily customized for your employees.

Creditable Coverage Guidance & Simplified Determination
Model Language for Individual Creditable Coverage Disclosure Notice
Model Language for Individual Creditable Coverage Disclosure Notice - Spanish
Model Language for Individual Non-Creditable Coverage Disclosure Notice
Model Language for Individual Non-Creditable Coverage Disclosure Notice - Spanish

Additional information may be obtained at https://www.cms.gov/CreditableCoverage/01_Overview.asp#TopOfPage.


 
Please contact your McCart Group representative with any questions you may have.
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