If you are a sponsor of a group health plan that provides prescription drug coverage you must provide an annual disclosure to the Centers for Medicare & Medicaid Services (CMS) whether your health plan coverage is “creditable prescription drug coverage”. The deadline for this year’s annual disclosure is approaching. If you haven’t done so already, sponsors must provide an annual disclosure of creditable coverage status to CMS no later than 60 days after the beginning of each plan year–which is October 1st for August renewal plans.
A plan that has creditable coverage is one that is at least actuarially equivalent to the Medicare Part D coverage. That is why Medicare Part D eligible individuals and CMS need to know via the annual disclosure whether a group health plan is creditable or non-creditable. Creditable Coverage disclosures to CMS are made online using the “Disclosure to CMS Form” available on the CMS website.
The link to the “Disclosure Notice” is as follows:
Entities that must provide annual disclosure to CMS include sponsors of:
Group health plans (offered by employers; union/Taft-Hartley plans; church, State and local government, and other group-sponsored plans) including the Federal employees health benefits program; and qualified retiree prescription drug plans as defined in section 1860D-22(a)(2) of the Act;
Governmental sponsored plans, including Medicaid coverage under title XIX of the Act or under a waiver under section 1115 of the Act; State Pharmaceutical Assistance Programs (SPAPs) as defined at §423.454 and State High Risk Pools as defined under 42 CFR 146.113(a)(1)(vii);
Plans that provide coverage of prescription drugs for veterans, survivors and dependents under chapter 17 of title 38, U.S.C.;
Plans that provide Military Coverage under chapter 55 of title 10, U.S.C., including TRICARE;
Plans that provide individual health insurance coverage (as defined in section 2791(b)(5) of the Public Health Service Act) that includes coverage for outpatient prescription drugs and that does not meet the definition of an excepted benefit (as defined in section 2791(c) of the Public Health Service Act);
Coverage provided by the medical care program of the Indian Health Service, Tribe or other Tribal Organization, or Urban Indian Organization (I/T/U);
Plans that provide coverage under a Medicare supplemental policy (Medigap policy), as defined at 403.205, including standardized plans H, I or J; pre-standardized plans; waiver State plans; and plans with innovative benefits; and
Plans that provide other coverage as the Secretary may determine appropriate.
If an entity does not offer outpatient prescription drug benefits to any Medicare Part D eligible individuals on the beginning date of their plan year (renewal year, contract year, etc.), the entity is not required to complete the Disclosure to CMS on-line form for that plan year.
Note: This article for informational purposes only. Not to be relied upon for legal or tax advise.