Each year, group health plan
sponsors that provide prescription drug coverage to Medicare Part
D-eligible individuals must disclose to the Centers for Medicare
& Medicaid Services ("CMS") whether that coverage is
"creditable" or "non-creditable." This disclosure
requirement applies to all plan sponsors that provide prescription
drug coverage, even when a plan does not offer prescription drug
coverage to retirees.
Group health plan sponsors
satisfy this obligation by submitting an electronic Disclosure Notice
to CMS on an annual basis. Calendar year plans must submit this
year's Disclosure Notice to CMS by March 1.
Background. Individuals who fail to enroll in Medicare Part
D prescription drug coverage when first eligible may be subject to
late enrollment penalties if they go 63 consecutive days or more
without creditable coverage. Prescription drug coverage is
"creditable" when it is at least actuarially equivalent to
Medicare Part D Coverage.
Medicare Part D-eligible
individuals, and CMS, must be informed whether a group health plan's
prescription drug coverage is creditable or non-creditable.
Accordingly, plan sponsors that provide prescription drug coverage must:
(i) furnish Part D-eligible individuals with a notice disclosing the
creditable or non-creditable status of their coverage, and (ii)
disclose to CMS on an annual basis (and at certain other times)
whether the plan's coverage is creditable.
Timing of Disclosure
Notice. A plan sponsor subject
to the disclosure requirement must submit a new Disclosure Notice to
CMS no later than 60 days following the beginning of the new plan
year (i.e., March 1, 2015 for calendar year plans).
A new Disclosure Notice must
also be filed with CMS during the plan year if any prescription drug
coverage change affects the plan's creditable coverage status.
Specifically, a plan must file a new Disclosure Notice with CMS
within 30 days following: (i) the termination of the prescription
drug plan; or (ii) any change in the creditable coverage status of
the prescription drug plan.
Information Needed to
Complete the Disclosure Notice.
When completing the Disclosure Notice, plan sponsors need to:
- Identify the
number of prescription drug options the plan offers to
the number of benefit options offered that are creditable
coverage and non-creditable coverage.
- Estimate the
total number of Medicare-eligible individuals expected to have
coverage under the plan at the start of the plan year. This
plan enrollees who are active employees,
Medicare-eligible dependents of the above individuals.
How to Complete the
Disclosure Notice. A plan
sponsor must submit the Disclosure Notice to CMS by completing the
Creditable Coverage Disclosure Form on the CMS Creditable Coverage
Disclosure webpage. This is the only method available for complying
with the disclosure requirement.
The CMS Creditable Coverage
Disclosure webpage is accessible at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html