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THIS IS A FEDERAL REQUIREMENT REGARDLESS OF THE SIZE OF THE EMPLOYER.

In preparation for the Medicare fall open enrollment period, employers sponsoring group health plans that include prescription drug coverage are required to notify all Medicare-eligible individuals whether such coverage is creditable (i.e., that the coverage is expected to pay, on average, as much as the standard Medicare prescription drug coverage).

Written Disclosure to Individuals

This written disclosure notice must be provided annually, prior to October 15, and at various other times as required under the law, to the following individuals:

  • Medicare-eligible active working individuals and their dependents;
  • Medicare-eligible COBRA individuals and their dependents;
  • Medicare-eligible disabled individuals covered under an employer's prescription drug plan; and
  • Any retirees and their dependents.

 The customizable creditable coverage notice, non-creditable coverage notice and instructions for completing the notices are available by clicking the appropriate hyperlink.  To determine if your prescription drug rider(s) is creditable or non-creditable, you contact your carrier or agent.

If you have multiple prescription drugs options, and one or more are creditable and the other, or others are non-creditable, then you send the appropriate letter for the plan the employee or retiree is covered.

Online Disclosure to CMS Also Required

Additionally, after sending out the appropriate Medical notices employers are required to complete an online disclosure to CMS to report the creditable coverage status of their prescription drug plans. This disclosure is also required annually, no later than 60 days from the beginning of a plan year, which would be 03/31/2019 for a plan beginning 01/01/2019.

If you are a Salus Group client and participate in our COPE compliance services, these notices to employees/retirees and the CMS disclosure have already been completed for you.

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