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Medicare Part D Notices Revised

As we reported in our July 2005 issue of Benefits in Brief, the Medicare Part D regulations issued by the Centers for Medicare and Medicaid Services (“CMS”) require group health plans providing prescription drug coverage to Part D-eligible individuals to disclose to participants whether that coverage is “creditable” – that is, at least as good as Medicare Part D coverage. Most plans sent these notices to participants last fall, prior to the beginning of the initial enrollment period for Medicare Part D coverage. CMS has now issued new guidance, along with revised model notices for use on or after May 15, 2006. The revised model notice has been up-dated to eliminate references to the Part D initial enrollment period, which ended on May 15. Plan sponsors do not need to redistribute this notice immediately; however, future disclosure will be required under any of the following circumstances:

1. Prior to each Medicare Part D annual coordinated election period – beginning November          15 and extending through December 31 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 who joins the plan;

4. Whenever prescription drug coverage ends or changes so that it is no longer creditable or            becomes creditable; and

5. Upon a plan participant’s request.

The regulators consider items 1 and 2 to have been met if the disclosure notice is provided to all participants annually. For these purposes, “prior to” means that the Medicare beneficiary must have been provided the notice within the past 12 months.

CMS has also created a new “personalized” notice. This is designed to provide participant-specific information, including the individual’s specific periods of Part D creditable coverage under the plan. According to CMS, a plan may provide the personalized notice in lieu of the more generalized notice, and it should provide the personalized notice when a Medicare beneficiary requests a copy of his or her creditable coverage notice.

The new model notices and model personalized notice are posted on the CMS website.