The Center for Medicare/Medicaid Service (CMS) requires employers to provide an annual “Notice of Creditable Coverage” to all Medicare-eligible employees and their beneficiaries, or ALL employees if you do not track Medicare-eligibility before October 15 of this year.
This notice discloses whether your group plan's prescription benefit qualifies as "creditable" under the law (actuarially equal or better than the Part D benefits). It also summarizes the rules and potential next steps for those who are Medicare-eligible.
There are three steps to fully comply with the CMS requirements. With this information in hand, it should take you no more than 30 minutes to complete the entire process.
STEP #1: IS YOUR COVERAGE CREDITABLE?
Insurance companies have noted which prescription plans are "creditable" so simply select the link below for your carrier and size (link updates will be made as provided by carriers). Self-funded plans MAY use this information as a guide, but you may contact us for additional assistance.
Find your prescription benefit listed and note whether it is deemed PASS or FAIL (the vast majority of our clients' plans will be "creditable" - the biggest exception is HSA benefits).
Anthem BCBS plans (Please note: Anthem BCBS notifies each of their clients directly.)
Find your prescription drug benefits on the list. PASS indicates that your coverage is in fact "creditable" while NOT PASS/FAIL indicates it is not.
STEP #2: CUSTOMIZE THE RIGHT NOTICE & DISTRIBUTE
Based on what you determine for your plan(s) in Step #1, select from the sample forms below - in word format - based on the CMS Model Notices. It is possible that one plan you offer is "creditable" while another is "not creditable" so you may use both forms to notify different employees of their plan's status.
Find the yellow highlights in the form - insert YOUR information in the appropriate spaces. Copy and distribute the applicable Notices to your Medicare-eligible employees or to ALL employees if you do not track or know Medicare eligibility.
STEP #3: DISCLOSE "CREDITABLE" STATUS TO CMS
The final step is your disclosure to CMS on the "creditable" status of the prescription benefits offered to employees. Again, this is simply a disclosure - there is no right or wrong answer and there is no penalty based on the answer.
Click here to complete the disclosure – it should only take 3-4 minutes.
First, enter your name, address, etc. Most likely, your "Coverage Type" will be the first listed in the drop-down, GROUP HEALTH PLAN: Employer Sponsored Plan. Note how many prescription drug options are offered - typically, this is the number of health plan options available.
Finally, select the correct option related to "Creditable" coverage based on Step #1 above.
You will then receive a Submission Confirmation. Congratulations - you're done!
A FEW IMPORTANT REMINDERS
- Notification of Creditable Coverage is a CMS requirement of employers.
- Insurance companies will NOT be providing notice to CMS on your behalf.
- In fact, if employees call the carrier to ask, we are told they likely will refer them back to the employer.
- Non-creditable status has no implication of penalty or further action by you (the notification simply states that you have determined your plan’s status).
- There is a second annual disclosure requirement. Entities must complete the Online Disclosure to CMS Form to report the creditable coverage status of their prescription drug plan. The Disclosure should be completed no later than 60 days from the beginning of a plan year (contract year, renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status.
Additional guidance is available on the CMS website by clicking here.