Who must provide the notice?

All group health plan sponsors offering prescription drug coverage (fully insured or self-insured) must provide the notice. There are no exceptions for government or church plans.

Who is entitled to receive the notice?

Plan sponsors are required to issue notices to all individuals who are eligible for Medicare Part D, including active employees (and their dependents), COBRA beneficiaries, and retirees. Employer-sponsors may provide the notice to all employees to simplify compliance.

When are the notices required to be issued?

Before an individual's initial enrollment period for Part D;
Before the effective date of coverage for any Medicare Part D-eligible individual who joins an employer plan; and
Annually before October 15th each year for all Medicare Part D-eligible individuals covered under the prescription drug plan.

Plan sponsors can satisfy these three requirements by regularly including the notice in its initial, special, and annual open enrollment materials that are provided to all plan participants.

Additionally, notices must be issued whenever prescription drug coverage ends or creditable coverage status changes, and upon request.

How can the notices be delivered?

The notices can be provided by paper delivery by hand or first-class mail, or electronically for participants who utilize a computer as an essential part of their work duties.

Plan sponsors may issue a standalone notice, or include the notice in open enrollment or other plan materials so long as the notice is prominent and conspicuous. CMS provides model language to use to satisfy this “prominent and conspicuous” requirement.

What information must be included in the notice?

CMS makes available model notices to use for disclosing whether coverage is creditable or non-creditable (Model Creditable Coverage Disclosure Notice or Model Non-Creditable Coverage Disclosure Notice).