The Departments of Health and Human Services (HHS), Labor, and the Treasury issued new regulations requiring new health plans
to cover evidence-based preventive services and eliminate cost sharing requirements for such services. The new rules will allow
for patients to have easier access to services such as blood pressure, diabetes, and cholesterol tests; many cancer screenings;
routine vaccinations; pre-natal care; and regular wellness visits for infants and children. SBPA is currently analyzing the attached
regulation and will be providing more details.
Medicare Part D
Model Notices. CMS recently revised its guidance on Medicare Part D by issuing new model notices. They must
also be sent to Part D-eligible spouses/dependents under active or retiree coverage (including spouses/dependents
who are disabled or receiving COBRA benefits). The good news is that according to CMS, plans are permitted to send
a single Notice to the employee/participant and his or her Part D-eligible spouse/dependents. However, the plan
must send a separate Notice if the plan knows that a Part D-eligible spouse/dependent resides at a different address.
Timing of the Notices. Plans must send the Notices at the following times:
(1) Prior to the Medicare Part D annual election period beginning every year on November 15.
(2) Prior to an individual's initial opportunity to enroll in Medicare Part D;
(3) Prior to the effective date of coverage for any Medicare eligible individuals who joins the plan;
(4) When the plan's prescription drug coverage is no longer creditable or becomes creditable;
(5) Upon request by the participant or beneficiary.
CMS has also said that they will consider 1 and 2 above to be met if the plan provides the Notice to all plan
participants annually, i.e. in an SPD.
The Disclosure Notice must be provided through completion of the disclosure form on the CMS Creditable Coverage
Disclosure Web Page. Get disclosure form... This method of transmission is the sole method
for compliance with the requirement. For a simplified method of Creditable Service determination,