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Creditable Coverage

HMSA Employer-Sponsored Prescription Drug Plans – Notification of Creditable Coverage

HMSA has tested all of its group-sponsored prescription drug plans and has concluded that each meets or exceeds the requirements necessary to be considered Creditable Coverage under the Medicare Modernization Act (MMA).

Important: As an organization offering a group-sponsored drug plan to Medicare-eligible individuals, you are required under the MMA to provide a similar notice to all your Medicare-eligible beneficiaries. To assist you, HMSA has provided a model notice Creditable Coverage Notice Sample Letter (updated February 2007), which can be completed and distributed to all applicable individuals.

Most entities (groups) 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 Notice). A disclosure is required whether the entities’ coverage is primary or secondary to Medicare. Entities that must comply with these provisions are listed at the CMS web site.

Entities are required to provide the Disclosure Notice through completion of the disclosure form on the CMS Creditable Coverage Disclosure Web Page. As you answer the questions on the electronic Disclosure to CMS form, an additional box will appear where you should enter the required disclosure information. This method of transmission is convenient and will take minimal time to complete, and is the sole method for compliance with this annual requirement.

Visit the CMS web site for information and required forms for creditable coverage.

As a reminder, within the year there are creditable coverage "trigger events," which will require employers to provide the creditability notice. The trigger events are:

• Before the Medicare Part D annual coordinated election period (Nov. 15 - Dec. 31) each year.
• Within the 12 months before an individual’s Initial Enrollment Period for Medicare.
• Before the effective date of coverage for a Medicare eligible individual beginning participation in the employer sponsored group health plan.
• When the plan’s prescription drug coverage ends or is no longer creditable.
• Upon a beneficiary’s request.

If you have any questions regarding creditable coverage and the required notifications, please contact your HMSA representative.