Medicare Part D Guidance Notifications

A summary of the creditability rules for your reference:  

  1. Plan must provide coverage for brand and generic
  2. Plan must provide reasonable access to retail providers and optionally mail order
  3. Plan must pay at least 60% of a member’s prescription drug expenses
  4. Plan must have one of the following:
    • For freestanding RX plans: No RX maximum or a maximum of at least $25,000 per year or
    • For freestanding RX plans: The RX coverage has an actuarial expectation of paying at least $2,000 of per Medicare eligible member per year
    • For integrated plans: The plan has no more than a $360 deductible (for the year 2016) per year (applicable to RX) and no annual max (or a max of $25,000 or more)

CLICK HERE TO SEE IF YOUR BEN-E-LECT PLAN IS CONSIDERED CREDITABLE COVERAGE 

CREDITABLE COVERAGE DISCLOSURE NOTICE TO MEDICARE ELIGIBLE EMPLOYEES
Employers that provide prescription drug coverage to Medicare Part D eligible individuals must notify these individuals whether the drug coverage they have is creditable or non-creditable prior to Oct 15 of each year. Templates in English and Spanish are available under the "Employer Templates" section of this page.

CREDITABLE COVERAGE DISCLOSURE TO CMS GUIDANCE
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added a new prescription drug program to Medicare. Regulations to implement Medicare prescription drug coverage were published January 28, 2005. 

Under those provisions, most entities that currently provide prescription drug coverage to Medicare Part D eligible individuals must disclose to the Centers for Medicare & Medicaid Services (CMS) whether the coverage is "creditable prescription drug coverage". Disclosure to CMS is required whether the entity’s coverage is primary or secondary to Medicare. Entities that must comply with these provisions are listed on the creditable coverage homepage at http://www.cms.hhs.gov/CreditableCoverage. However, entities that contract with Medicare directly as a Part D plan or that contract with a Part D plan to provide qualified prescription drug coverage are exempt from the disclosure to CMS requirement.

For more information, you should visit the CMS website link related to creditable coverage issues at: http://www.cms.hhs.gov/CreditableCoverage

Click here for more guidance information.
Click here
to complete your CMS Notification electronically.
Click here to see if your 2015 BEN-E-LECT Plan is considered creditable coverage.