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Creditable Coverage Notice Reminder

September 23, 2019

Applies to: All markets

Health plan sponsors (employer groups) that offer prescription drug coverage to Medicare-eligible employees and their dependents are required to notify those employees and dependents whether their coverage is creditable or non-creditable. Notifications must be sent before the 2020 Medicare Annual Election Period, which begins on October 15, 2019. This requirement is part of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA).

As defined by the Centers for Medicare & Medicaid Services (CMS), prescription drug coverage is creditable if the actuarial value of the coverage is equivalent to, or better than, the actuarial value of standard Medicare Part D prescription drug coverage. A non-creditable prescription drug plan has an actuarial value that is less than the standard Medicare Part D coverage.

Horizon Blue Cross Blue Shield of New Jersey will inform your employer group clients who have Medicare-eligible members of their prescription plans’ status in late September. Members in the Consumer market who are at or approaching the Medicare eligibility age (age 65) will receive a letter.

View samples of the notices that will be sent to your clients informing them of their prescription drug plans’ status and their obligations for this year.

Once your clients receive this information, they must disclose to their employees whether their prescription plan is creditable or non-creditable. CMS-approved models for creditable and non-creditable disclosure notices are available at cms.hhs.gov/creditablecoverage.

Your clients are also required to disclose, directly to CMS, whether or not the coverage that is offered to Medicare-eligible employees and their dependents is creditable prescription drug coverage.

This disclosure must be made to CMS annually and upon any change in the creditable coverage status of the prescription drug plan. The Disclosure to CMS form can also be found on the CMS website at cms.hhs.gov/creditablecoverage.

If your clients do not have Medicare-eligible employees, they will not be notified and no disclosure is required.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

Published on: September 23, 2019, 06:52 a.m. ET
Last updated on: October 29, 2019, 07:02 a.m. ET