Plan sponsors must notify participants of a plan’s creditable prescription drug coverage status at least once a year by November 15. The notice must be provided to all Part D-eligible individuals who are covered under, or who apply for, the plan sponsor’s prescription drug coverage.
These individuals include Medicare beneficiaries who are active employees, disabled, on COBRA/State Continuation, as well as Medicare beneficiaries who are covered as spouses or dependents (including those spouses or dependents who may be disabled or on COBRA/State Continuation) under active employee coverage.
Typically it may be hard for a group administrator to discern who meets this criteria especially when it comes to spouses and/or dependents, so it is our recommendation that you send the notices to all employees and their families. This is especially important if a plan is not creditable, because participants in a non-creditable plan will pay a penalty if they later enroll in Medicare Part D.
In addition, plan sponsors must provide notice of creditable coverage annually, when a beneficiary first becomes eligible for Part D, when plan changes are made, or when a beneficiary requests it. Failure to properly inform plan participants of creditable coverage status could cost participants significantly if they later elect to enroll in Medicare Part D instead of the plan sponsor offering.
Finally, you also are required to disclose the creditable coverage status of your plan to CMS via the Disclosure to CMS form on the CMS website. The disclosure must be made to CMS on an annual basis, and upon any change that affects whether the coverage is creditable. The link to the CMS website is below.
You should be receiving a letter from your health plan that will notify you if your current drug plan meets the criteria of a Creditable or Non-Creditable plan. If you need assistance in making that determination you may also contact our office.
UPDATE on 1% Premium Tax—Rate Calculation change
On September 18th, 2009 the Oregon insurance division issued another bulletin that replaced the original bill that was signed in August to assess the 1% premium tax. The new bulletin changes the way that the premium tax is calculated and implemented. We are hearing that all the insurance companies (except for Regence), have calculated this incorrectly and they will be correcting it on your November 1st billing. Please call our office if you have any questions regarding this change.
Health Care Reform
It seems that we can’t open a newspaper, watch the news or have a conversation with friends without discussing the current Health Care Reform efforts. There is a lot of press and talk about what the government is proposing and it can all be very confusing. There is talk of mandated coverage, fines, coverage for everyone, a public option, affordability, increasing taxes to pay for the reform….and the list goes on and on. We encourage you to read as much as you can and stay informed, as the proposals and issues change daily. We will be sure to update you with any changes that will affect your coverage as they occur.
Group Profile Forms
Every year, your carrier sends you a Oregon Standardized Group Profile Form that they are required by the State of Oregon to mail out to mainly verify your employer size and they also ask for some additional items. The carriers will NOT release the renewal without this information and will in some instances, either terminate your plan or inflate the rate increase unnecessarily. Please contact your agent here in the office, if you need assistance in filling this form out. It is very important that it is completed timely and correctly and we are more than happy to assist you!
Flu Shot Season
We are right in the middle of flu season….so we would like to remind you and your employees to go get a flu shot. This is an important preventive action that we all can take to prevent the spread of this virus. Please access your carrier website, or call customer service to find out your coverage for flu shots. Most of the carriers will cover the flu shot for your doctor visit copay, and some are free. The H1N1 vaccine is also coming in and being available and most carriers are covering the vaccine for the at risk (young children, pregnant women, elderly) for the same benefit as the regular flu shot. You can also call our office and we can help you determine your coverage.
Helpful Information from the Department of Consumer & Business Services
In July 2009 the DCBS issued a NEWS RELEASE that lists resources from each of the major carriers here in Oregon to help health care consumers find out in advance what the cost of their care will be.
If you would like a copy, please contact a member of our team.
Employee Benefits Department Contacts:
Suzie Moll, Employee Benefits Manager 503-655-6344 ext 33
Stephanie Bartrug, Employee Benefits Specialist 503-655-6344 ext 29
Robert Rivenburgh, Employee Benefits Specialist 503-655-6344 ext 32
Lisa Ewers, Office Support, Individual/Medicare 503-655-6344 ext 31