Under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), employers that offer prescription drug coverage on a group basis are required to provide annual notice to both employees/covered individuals and to the Centers for Medicare & Medicaid Services (CMS) regarding the “creditability” of the prescription coverage offered by the employer (whether or not the prescription coverage is equal to or exceeds the value of prescription coverage through Medicare Part D).
The employee/covered individual notice must be provided at least annually to those Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the group health plan. To simplify plan administration, plan sponsors often decide to provide the disclosure notice to all plan participants.
At a minimum, this notice must be provided at the following times:
1. Prior to the Medicare Part D Annual Coordinated Election Period – Oct. 15 through Dec. 7 of each year;
2. Prior to an individual’s Initial Enrollment Period for Part D;
3. Prior to the effective date of coverage for any Medicare eligible individual that joins the plan;
4. When prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable; and
5. Upon a beneficiary’s request.
If the employer provides the notice annually prior to 10/15, items 1 and 2 are considered to be met.
The CMS disclosure notice must be made to CMS on an annual basis, or upon any change that affects whether the coverage is creditable. At a minimum, the notice must be provided at the following times:
1. Within 60 days after the beginning date of the plan year for which the entity is providing the form;
2. Within 30 days after the termination of the prescription drug plan; and
3. Within 30 days after any change in the creditable coverage status of the prescription drug plan.
If you have questions regarding the creditability status of your plan, creating notices specific to your plan, or the notification process, please contact your NEEBCo representative.