Personalized Notices of Rx Coverage

[Linda]

I have a question about the proposal from the Centers of Medicare and Medicaid Services to require health plans to provide personalized notices of creditable prescription drug coverage upon request. Unless the Medicare Part D enrollment period gets pushed back, we’re supposed to be ready to provide these personalized notices on May 15. How are you planning to make that happen?

[Guest fritzreb]

It doesn't matter if the Part D enrollment period is extended; sponsors of prescription drug plans were required to provide notice to Medicare eligible employees, dependents and retirees in 2005 and upon request. The personalized notice is only a "model". CMS also provided a non personalized model notice that entities may choose to use and provided guidance on including the notice in the SPD. If notice is requested, the entity can use the personalized notice (using the CMS model), a generic notice (using the CMS model) or provide the person requesting the notice a copy of the SPD or enrollment materials used by the entity to orginially notify their Medicare eligible active employees, dependents and retirees if their drug coverage is creditable.

[Linda]

I interpreted CMS’ recent guidance as requiring a plan sponsor to provide a personalized notice if/when requested by an individual who both (a) has Rx coverage under the sponsor’s plan and (b) is Medicare-eligible. (From the guidance “The personalized disclosure notice should be provided upon request by the beneficiary.”) Fritzreb, did you interpret that guidance as saying the personalized notice will be an option for responding to the individual’s request but will not be mandatory?

[Guest fritzreb]

Yes, and I confirmed with the Employer Policy & Operations personnel at CMS. EBIA released notice of the CMS models for use by employers that provide prescription drug coverage to emploees in a recent weekly bulletin and EBIA also interpreted the new personalized model as only one of several different forms an employer may use to provide notice to employees upon request.