CMS Unveils 12-Step Reconciliation Process For Retiree Drug Subsidy (RDS)
|
|
- Marsha Conley
- 5 years ago
- Views:
Transcription
1 CMS Unveils 12-Step Reconciliation Process For Retiree Drug Subsidy (RDS) The Centers for Medicare and Medicaid Services (CMS) has announced a 12-step final reconciliation process for plan sponsors receiving drug subsidies through the Medicare Part D Retiree Drug Subsidy Program. CMS has provided over 200 pages of detailed instructions on its website. Background Under the retiree drug subsidy program established by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (RDS program), employers providing prescription drug coverage to qualified retirees may receive a 28% tax-free subsidy from the government for allowable prescription drug costs incurred by those retirees. Plan sponsors that seek reimbursement from Medicare under RDS and receive at least one interim payment must go through a mandatory reconciliation process, under which they match their enrollment and member eligibility with CMS records, validate their coverage of drug claims, and true-up their costs with Medicare s allowable costs and compare the results with interim payments received. The reconciliation process must be completed no later than 15 months following the last day of the plan year. For 2006 calendar year plans, that deadline is March 31, Failure to timely file a final reconciliation will result in a denial of all payments to the plan sponsor, and will trigger recovery by CMS of interim payments, possible interest penalties, and fines. CMS 12-Step Reconciliation Process The final reconciliation is the process a plan sponsor will follow to submit the total gross covered prescription drug costs and actual cost adjustments (e.g., discounts, chargebacks, rebates and other price concessions) to CMS for the final payment under RDS. The reconciliation process must be completed for each application submitted by the plan sponsor, and all 12 steps summarized below must be completed for each application. If the final reconciliation is not completed with respect to an application for which the plan sponsor has received interim payments, then all interim payments will need to be returned to CMS. If the plan sponsor has not submitted any interim payment requests, the reconciliation is the final payment request. Except for steps 11 and 12, all of the steps can be completed by the Account Manager, or by a designee with appropriate authority. Steps 11 and 12 can only be completed by the Authorized Representative. In what follows, we highlight the 12 steps. The table on page 5 summarizes each step and sets out who has the authority to complete that step.
2 Step 1: Initiate Reconciliation The first step serves as notice to CMS that the plan sponsor is ready to submit the final reconciliation. The reconciliation can only be started after the plan year is completed thus for calendar year 2006 plans, the reconciliation can be started now. However, once the reconciliation is started no additional interim payments can be requested. CMS recommends that the reconciliation not be started until the plan sponsor understands the entire process and has collected and reviewed all necessary elements, including any changes in the Account Manager, Authorized Representative or designees the accuracy of retiree eligibility data whether cost data has been completed whether rebates have been finalized whether interim payment activities have been completed. BUCK COMMENT. In addition to the Account Manager and Authorized Representative, there are a number of other parties that could be involved in completing the final reconciliation including Cost Reporters, eligibility vendors, and other designees of the plan sponsor. Before the reconciliation process is started, the roles and responsibilities of each party must be clearly defined by the plan sponsor. Step 2: Review Payment Setup The second step involves review of the current payment setup and identification of who is allowed to report final costs, retiree eligibility and prepare the reconciliation payment request. Step 3: Request List of Covered Retirees The plan sponsor must request a list of all covered retirees from CMS and review it. Payment requests can be made only for retirees included in this list, and for the benefit options and coverage periods in the list. Step 4: Finalize Covered Retirees Once the plan sponsor finalizes the list of covered retirees, the list is verified with CMS. BUCK COMMENT. Because CMS continuously updates eligibility and enrollment under RDS, and because all RDS claim submissions must be limited to eligible RDS covered members, the finalization of the covered retiree list is a critical step. Plan sponsors should already be requesting eligibility lists from CMS, reviewing them for accuracy and rectifying any eligibility discrepancies before starting the final reconciliation process. Step 5: Start Preparation of Reconciliation Payment Request This step involves notification to CMS that the plan sponsor is ready to start submitting its final cost reports. [ 2 ]
3 Step 6: Manage Submission of Final Cost Reports The plan sponsor can now manage and verify the submission of the final cost reports from all cost reporting sources (e.g., the pharmacy benefit manager or carrier). This step must be carefully coordinated if there are multiple cost reporters. Step 7: Review Final Costs The plan sponsor must review and confirm all final cost reports for each UBOI (unique benefit option ID) included in the application. BUCK COMMENT. Plan sponsors should accurately identify and exclude prescription drugs that are not covered by Medicare Part D in particular drugs covered under Medicare Part B. The plan sponsor calculations must also apply the threshold and cost limit to each member, and this data must be reported separately by UBOI. Step 8: Enter Revisions to Final Costs The plan sponsor can enter any final adjustments, if necessary. BUCK COMMENT. Adjustment factors, such as rebates, are complex and may be financially material to large plan sponsors. All plan sponsors must exclude actual rebates from the final reconciliation. CMS has stated that this step cannot be undertaken until fall of Step 9: Finalize Reconciliation Payment Request The Account Manager (or designee) agrees that the reconciliation payment request is ready for the Authorized Representative. Step 10: Review Electronic Funds Transfer (EFT) Information The original RDS application included EFT information. In this step, the plan sponsor can modify that information, if necessary. Step 11: Approve EFT Information If the EFT information is modified in Step 10, then the Authorized Representative must approve the revised information. Step 12: Review and Submit Reconciliation Payment Request The Authorized Representative reviews the payment request and can either submit or reject the application. If the request is rejected, Steps 9 through 12 must be completed again with any necessary revisions. BUCK COMMENT. While the Account Manager or designee can complete the first ten steps, only the Authorized Representative can complete steps 11 and 12 and submit the final reconciliation payment request. [ 3 ]
4 Timing Final reconciliation must be completed no later than 15 months after the end of the plan year. For 2006 calendar year plans, that deadline is March 31, However, if the final reconciliation would have been due before November 30, 2007, the reconciliation deadline for that application will be November 30, Thus, for example, the final reconciliation for a plan sponsor with a plan year starting July 1, 2005 would be November 30, 2007, rather than 15 months after the end of the plan year. Failure to complete the reconciliation by the deadline will be treated as a denial of all payments to the plan sponsor and will trigger recovery of interim payments, with possible interest penalties and fines. BUCK COMMENT. Plan sponsors with non-calendar year plans should determine as soon as possible whether they will need to complete the final reconciliation by November 30, After CMS has processed the reconciliation payment request, one of the following will occur If the payment request is greater than zero, a payment will be made to the plan sponsor. If the payment request is less than zero, CMS will demand repayment of excess payments. If the payment request is zero, the plan sponsor will receive confirmation that the request has been finalized. Documentation CMS has also advised plan sponsors that they will be responsible for keeping records on a wide assortment of matters, including the work papers supporting the actuarial attestation, documentation of rebate arrangements, and other documentation required for the final reconciliation. Conclusion The reconciliation process requires the collection and verification of extensive retiree eligibility and claims data, and coordination between the plan sponsor and cost and eligibility data reporters. Buck has developed a service that can assist employers with the RDS reconciliation process, while also maximizing the RDS subsidy. This service is known as CARDS - Compliance, Audit validation, Reconciliation and Data Storage solution. Buck s consultants would be pleased to assist you in satisfying the RDS reconciliation process and in helping you understand and implement other aspects of the RDS program. [ 4 ]
5 The RDS Reconciliation Process The twelve steps are outlined in the following table along with who is allowed to complete each step. Authorized Representative Account Manager Designee with Payment Request Privilege Step 1 Initiate Reconciliation Yes Yes View Only Step 2 Review Payment Setup Yes Yes View Only Step 3 Request Covered Retiree List Yes Yes Yes* Step 4 Finalize Covered Retirees Yes Yes Yes* Step 5 Step 6 Start Preparation of Reconciliation Payment Request Manage Submission of Final Cost Reports Step 7 Review Final Costs Step 8 Enter Revisions to Final Costs Step 9 Finalize Reconciliation Payment Request Step 10 Review EFT Information Yes Yes Yes** Step 11 Approve EFT Information Yes View Only View Only*** Step 12 Review and Submit Reconciliation Payment Request Yes View Only View Only * Both payment request and retiree data privileges required to access download ** Designee with both payment request and EFT privileges may complete step *** View only for designee with both payment request and EFT privileges This FYI is intended to provide general information. It does not offer legal advice or purport to treat all the issues surrounding any one topic. [ 5 ]
Planning Survey Questionnaire (PSQ)
Planning Survey Questionnaire (PSQ) Plan Sponsor: LOCAL UNION Welfare Fund Benefit Plan Plan Sponsor ID#: XXXX Application ID#: XXXXX Complete this Survey for the applicable plan type and return it to
More informationNew Federal Early Retiree. Reinsurance Program
New Federal Early Retiree April 2010 Reinsurance Program An important provision of the Healthcare Reform legislation includes a temporary program providing reinsurance for health plans that cover early
More informationMEDICARE PLAN PAYMENT GROUP
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEDICARE PLAN PAYMENT GROUP Date: May 30, 2018 To: From: All Part D
More informationRetiree Drug Subsidy Update and RDS Program Oversight
Retiree Drug Subsidy Update and RDS Program Oversight Center for Beneficiary Choices (October 2005) Introduction Today s discussion Refresher on Employer Options Update on RDS Program Retiree Drug Subsidy
More informationMEDICARE PLAN PAYMENT GROUP
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEDICARE PLAN PAYMENT GROUP Date: June 23, 2017 To: From: All Part
More informationThe Second National Medicare Prescription Drug Congress
The Second National Medicare Prescription Drug Congress MMA Implementation: Employer Response to the MMA Mark Hamelburg, Director Employer Policy & Operations Group (EPOG) Centers for Medicare & Medicaid
More informationMedicare Part D Amounts Will Increase in 2015
April 24, 2014 Medicare Part D Amounts Will Increase in 2015 The Medicare Modernization Act (MMA) requires the Centers for Medicare & Medicaid Services (CMS) to announce each year the Medicare Part D standard
More informationContinuation of the Prescription Drug Event (PDE) Reports and PDE Analysis Reporting Initiatives for the 2014 Benefit Year
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Medicare 7500 Security Boulevard Baltimore, Maryland 21244-1850 Center for Medicare Medicare Plan Payment Group
More informationFrequently asked questions and answers for pharmacy providers
Frequently asked questions and answers for pharmacy providers The purpose of Medicare s Limited Income Newly Eligible Transition (NET) Program is to ensure individuals with Medicare s low-income subsidy
More informationMedicare Plan Payment Group. Date: August 8, All Part D Plan Sponsors, including PACE Organizations
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Medicare 7500 Security Boulevard, Mail Stop C1-13-07 Baltimore, Maryland 21244-1850 Medicare Plan Payment Group
More informationThe Limited Income NET Program Questions and Answers for Pharmacy Providers
The Limited Income NET Program Questions and Answers for Pharmacy Providers Introduction On January 1, 2012, Medicare s Limited Income Newly Eligible Transition (LI NET) Program successfully began its
More informationGASB 45 and Medicare Part D: Understanding Your Liability and Potential Cash Subsidy
VIRGINIA CHAPTER OF IPMA GASB 45 and Medicare Part D: Understanding Your Liability and Potential Cash Subsidy August 16, 2005 Agenda» Government Accounting Standards Board Statement No. 45 (GASB 45)» Medicare
More informationTexas Vendor Drug Program. Pharmacy Provider Procedure Manual Coordination of Benefits. Effective Date. February 2018
Texas Vendor Drug Program Pharmacy Provider Procedure Manual Coordination of Benefits Effective Date February 2018 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual.
More informationMassachusetts Provides Guidance on Section 125 Plan and Minimum Creditable Coverage Requirements
Massachusetts Provides Guidance on Section 125 Plan and Minimum Creditable Coverage Requirements A new Massachusetts health care law requires employers with employees working in Massachusetts to establish
More informationAMERICAN BAR ASSOCIATION. Technical Session Between the Centers for Medicare and Medicaid Services and the Joint Committee on Employee Benefits
AMERICAN BAR ASSOCIATION Technical Session Between the Centers for Medicare and Medicaid Services and the Joint Committee on Employee Benefits May 16, 2005 The following notes are based upon the personal
More informationQUESTIONS AND ANSWERS
QUESTIONS AND ANSWERS Understanding Medicare Part D Q1: What is Medicare Part D? A1: Beginning January 1, 2006, Medicare Part D was introduced as an entirely voluntary prescription drug benefit offered
More informationPREMIUM IMPACT OF REMOVING MANUFACTURER REBATES FROM THE MEDICARE PART D PROGRAM
PREMIUM IMPACT OF REMOVING MANUFACTURER REBATES FROM THE MEDICARE PART D PROGRAM July 6, 2018 RANDALL FITZPATRICK FSA, MAAA CHRIS CARLSON FSA, MAAA CONTENTS Executive Summary... 2 Data and Methodology...
More informationUnderstanding the Bidding Process
Medicare Prescription Drug, Modernization and Improvement Act ( MMA ) Understanding the Bidding Process Presented by William E. Gramlich, Esquire One Logan Square Philadelphia, PA 19103 215-569 569-57395739
More informationTRS-Care 2 and 3 Medicare Part D plans Express Scripts Medicare prescription plan FAQs
TRS-Care 2 and 3 Medicare Part D plans Express Scripts Medicare prescription plan FAQs General Questions What is Medicare Part D? Express Scripts Medicare for TRS-Care is a Medicare Part D plan. Medicare
More informationREQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM
REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM On May 5, 2010, the Department of Health and Human Services published in the Federal Register (75 FR 24450) an interim final rule on the Early Retiree
More informationMedicare and Prescription Drug Benefits. ABA Annual Meeting Section of Labor and Employment Law
Medicare and Prescription Drug Benefits ABA Annual Meeting Section of Labor and Employment Law August 9, 2005 Kathryn Bakich Phyllis Borzi Chip Kerby The Segal Company O Donoghue & O Donoghue McDermott,
More informationMedicare Part D: Retiree Drug Subsidy
A D V I S O R Y S E R V I C E S Medicare Part D: Retiree Drug Subsidy Programs to Control Fraud, Waste, and Abuse September, 2006 K P M G L L P Overview Summary Medicare Part D Prescription Drug Program
More informationMEDICARE PRESCRIPTION DRUG LEGISLATION: Part D Benefits and Employer Subsidies. December 2003
MEDICARE PRESCRIPTION DRUG LEGISLATION: Part D Benefits and Employer Subsidies December 2003 Medicare Prescription Drug, Improvement, and Modernization Act of 2003 #167572v2>Medicare Rx Program>KLB 1 Creates
More informationCENTERS FOR MEDICARE & MEDICAID SERVICES Creditable Coverage Disclosure to CMS Form Instructions and Screen Shots
CENTERS FOR MEDICARE & MEDICAID SERVICES Creditable Coverage Disclosure to CMS Form Instructions and Screen Shots INTRODUCTION The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
More informationAnnual Compliance Deadlines for Health Plans
Provided by Clark & Associates of Nevada, Inc. Annual Compliance Deadlines for Health Plans Employers that provide group health plan coverage to their employees are subject to numerous compliance requirements
More informationExpress Scripts Medicare Prescription Drug Plan (PDP) for EIA
Medicare Prescription Drug Plan (PDP) for EIA SUPERIOR COURT OF SANTA BARBARA COUNTY Introducing Medicare (PDP) for EIA Beginning January 1, 2015, the Santa Barbara County Superior Court will be offering
More informationHardship Plan Questions & Answers Insurance Trust for Delta Retirees ( the Trust )
Hardship Plan Questions & Answers Insurance Trust for Delta Retirees ( the Trust ) Assistance with paying Medical and Prescription Drug insurance premiums may be available to you as a Delta retiree, spouse,
More informationFAQ Results. Date: 2/24/2010. Send To Printer. Question #8663: Are service fees included in the Average Sale Price (ASP) calculation?
FAQ Results Please be advised that these FAQs were generated from a database that is updated frequently. For the most up-to-date information, please visit http://questions.cms.hhs.gov. Date: 2/24/2010
More informationEmployer Group Waiver Plan (EGWP) FAQs
EGWP: An opportunity for Alaska to maintain existing pharmacy benefits for Medicare-eligible retirees and achieve cost savings for years to come. An Employer Group Waiver Plan, known as an EGWP or Egg
More informationImplement a definition of negotiated price to include all pharmacy price concessions.
NCPA Analysis of Medicare Part D Pharmacy DIR Fee Reform Policy Proposal and Other Policies Impacting Community Pharmacies in the CMS Proposed Rule, Modernizing Part D and Medicare Advantage to Lower Drug
More informationHuman Resources Development Compensation and Benefits Retiree Medical Insurance Plan (RMIP) Update
Human Resources Development Compensation and Benefits Retiree Medical Insurance Plan (RMIP) Update October 16, 2014 Agenda Introductions Medicare Enrollment Overview Medicare Enrollment Requirement Reimbursement
More informationImpact of H.R. 1038/S. 413 on CMS Payments Under Part D
At the request of the (NCPA), Wakely Consulting Group, LLC (Wakely) has estimated the financial impact of companion House and Senate bills H.R. 1038/S. 413 ( Improving Transparency and Accuracy in Medicare
More informationSan Francisco Health Service System Health Service Board
San Francisco Health Service System Health Service Board HSS Rates & Benefits Committee Meeting City Plan (UHC) Employer Group Waiver Plan (EGWP) + Wrap Presentation April 12, 2012 Prepared by Aon Hewitt
More informationCity of Greenville and Greenville Utilities Commission Greenville, North Carolina. Request for Proposal For Employee Health Benefits Consultant
City of Greenville and Greenville Utilities Commission Greenville, North Carolina Request for Proposal For Employee Health Benefits Consultant Release Date: February 19, 2013 Submittal Deadline: March
More informationFederal Tax ID and Group Size Information Sheet
Federal Tax ID and Group Size Information Sheet Total Number of Employees Please review the Questions & Answers attached and respond to ALL of the following questions. This information is being collected
More informationPREFERRED PHARMACY NETWORKS AND THEIR IMPACT ON PART D PREMIUMS
PREFERRED PHARMACY NETWORKS AND THEIR IMPACT ON PART D PREMIUMS March 13, 2018 RANDALL FITZPATRICK FSA, MAAA GLENN GIESE FSA, MAAA ZACH HANSON ASA, MAAA CONTENTS Executive Summary... 2 Introduction...
More informationEGWP Frequently Asked Questions For SSC & USG Benefits Administrators
EGWP Frequently Asked Questions For SSC & USG Benefits Administrators Q. Why is the USG utilizing a Medicare part D plan as part of their pharmacy coverage? A. Due to Health Care Reform, Pharmaceuticals
More informationAmerican Bar Association. Technical Session Between the Centers for Medicare and Medicaid Services and the Joint Committee on Employee Benefits
American Bar Association Technical Session Between the Centers for Medicare and Medicaid Services and the Joint Committee on Employee Benefits May 5, 2008 The following notes are based upon the personal
More informationgood to know health and welfare benefits when you leave chevron excerpts
good to know health and welfare benefits when you leave chevron excerpts human energy. yours. TM This overview is provided to help you understand how your health and welfare benefits may change and the
More informationProgram Overview 2335ALL0216
Program Overview 1 Medicare s Limited Income Newly Eligible Transition Program (LI NET) Program overview LI NET is a demonstration program created by the Centers for Medicare & Medicaid Services (CMS)
More informationSpecial Report Arkansas Legislative Audit
Special Report Arkansas Legislative Audit Arkansas State and Public School Employees Health Benefits Employee Benefits Division - Department of Finance and Administration For the Fiscal Year Ended June
More informationVolume Nine, Issue Five May 2006
Volume Nine, Issue Five May 2006 In This Issue Medicare Part D Today In this fifth issue of the McGraw Wentworth Benefit Advisor for 2006, we discuss Medicare Part D. Medicare Part D launched effective
More informationSILVERSCRIPT S MEDICARE PART D PRESCRIPTION DRUG PLAN (PDP) FOR 2018
SILVERSCRIPT S MEDICARE PART D PRESCRIPTION DRUG PLAN (PDP) FOR 2018 Effective January 1, 2018, Medicare eligible PGCPS retirees, and/or their Medicare eligible dependents who have prescription drug coverage
More informationThe Impact of the Medicare Prescription Drug Legislation on Pharmaceutical Revenues
The Impact of the Medicare Prescription Drug Legislation on Pharmaceutical Revenues Presented By: Jack Rodgers PricewaterhouseCoopers February 27, 2004 P w C Overview of Recent Medicare Act On December
More informationAudience What If Answer 1. Medicare & Medicaid FBDE. A FBDE goes to a pharmacy and presents their Medicaid card
Full Benefit Dual Eligible (FBDE) (People who had full Medicaid benefits including drug coverage through their State Medicaid program through 12/31/05) Audience What If Answer 1. Medicare & Medicaid FBDE
More informationDUTCHESS EDUCATIONAL HEALTH INSURANCE CONSORTIUM
DUTCHESS EDUCATIONAL HEALTH INSURANCE CONSORTIUM A Year in Review, 9/2014 6/2015 This document provides summary highlights of the projects or major initiatives undertaken by the DEHIC Board of Trustees
More informationE-Commerce Enrollment
Electronic Claims Submission HCIQ will electronically submit your primary carrier, professional claims. Please refer to our payer list to view the insurance companies that we currently submit to. Electronic
More informationSan Francisco Health Service System
San Francisco Health Service System Health Service Board Rates & Benefits Kaiser Permanente Senior Advantage HMO Plan Renewal for Medicare Retirees June 11, 2015 Prepared by: Aon Hewitt Health & Benefits
More informationSAVINGS GENERATED BY PHARMACY BENEFIT MANAGERS IN THE MEDICARE PART D PROGRAM
February 6, 2014 GLENN GIESE KELLY BACKES SAVINGS GENERATED BY PHARMACY BENEFIT MANAGERS IN THE MEDICARE PART D PROGRAM June 26, 2017 GLENN GIESE RANDALL FITZPATRICK KEVIN MEYER CONTENTS Findings... 1
More informationTITLE 42 - THE PUBLIC HEALTH AND WELFARE CHAPTER 7 - SOCIAL SECURITY SUBCHAPTER XVIII - HEALTH INSURANCE FOR AGED AND DISABLED
TITLE 42 - THE PUBLIC HEALTH AND WELFARE CHAPTER 7 - SOCIAL SECURITY SUBCHAPTER XVIII - HEALTH INSURANCE FOR AGED AND DISABLED Part D - Voluntary Prescription Drug Benefit Program subpart 2 - prescription
More informationTexas Vendor Drug Program. Drug Addition Process. Effective Date. December 2017
Texas Vendor Drug Program Drug Addition Process Effective Date December 2017 This is a working document to provide a resource to interested internal and external stakeholders. Questions or comments regarding
More informationGroup Insurance Regulations Administrative Supplement No. 22
Group Insurance Regulations Administrative Supplement No. 22 Retiree Medical Insurance and Medicare A. Background This Administrative Supplement summarizes UC s procedures and describes rules applicable
More informationKEYSTONE 65 HMO POINT OF SERVICE ( POS ) GROUP MEDICARE ADVANTAGE CONTRACT. effective as of EFF. DATE. by and between. GROUP NAME (Called the Group)
KEYSTONE 65 HMO POINT OF SERVICE ( POS ) GROUP MEDICARE ADVANTAGE CONTRACT effective as of EFF. DATE by and between GROUP NAME (Called the Group) Group Number: GROUP# and KEYSTONE HEALTH PLAN EAST (Called
More informationBudgeting Drug Expenses Under the Medicare Drug Discount Card and the New Medicare Drug Program (Part D) on and after January 1, 2006
August 26, 2005 SUBJECT: TO: Budgeting Drug Expenses Under the Medicare Drug Discount Card and the New Medicare Drug Program (Part D) on and after January 1, 2006 All Regional Directors Food Stamp Program
More informationMedicare Part D. William J. Hogan American National Insurance Company
Medicare Part D William J. Hogan American National Insurance Company Introduction The 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA) Title I includes Prescription Drug Plans Title
More informationBenefit Designs for Simplified Determination of Creditable Coverage Status
Updated September 18, 2009 Creditable Coverage Simplified Determination This document is an update of the Simplified Determination of Creditable Coverage Status which was released on September 18, 2009
More information01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 1 of 7
01/07/2014 Medicare Part D Coverage Gap Discount Program Program Dates Page 1 of 7 and A. COVERAGE GAP DISCOUNT PROGRAM - BY CALENDAR YEAR 2011 through 2017 PDE Reporting Period Paid By After Receipt After
More information2012 Checklist for Community Pharmacy. Medicare Part D-Related Information
NATIONAL COMMUNITY PHARMACISTS ASSOCIATION 2012 Checklist for Community Pharmacy Medicare Part D-Related Information Medicare Part D Valid Prescriber Identifiers For 2012, CMS will continue to permit the
More informationConditional Cash In Lieu of County Sponsored Health Insurance
Conditional Cash In Lieu of County Sponsored Health Insurance Human Resources Use Only Effective Date: Date of Hire: Amount: Certified by: Medi-Cal Tricare Schools Employer Plan CHIP Medicare Part A Full-Time
More informationMedicare Part D Prescription Benefits Employer Requirements for Creditable Coverage
Medicare Part D Prescription Benefits Employer Requirements for Creditable Coverage PLEASE CAREFULLY READ THIS IMPORTANT NOTICE FROM ANTHEM BLUE CROSS ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE.
More informationOUT-OF-POCKET ASSISTANCE PROGRAM
OUT-OF-POCKET ASSISTANCE PROGRAM Helping Provide Patients with Affordable Access to RADICAVA (edaravone) IV infusion Please see accompanying full Prescribing Information, including Patient Information,
More informationMagellan Complete Care of Virginia (MCC of VA) Provider Training. July 2017
Magellan Complete Care of Virginia (MCC of VA) Provider Training July 2017 A Managed Long Term Services and Supports Program On August 1, 2017, Magellan Complete Care of Virginia (MCC of VA) part of the
More informationReporting and Disclosure Checklist for Welfare Benefit Plans
Reporting and Disclosure Checklist for Welfare Benefit Plans Plan Documents Certain documents including copies of plan and trust agreements, most recent SPD, annual report, any collectively bargained agreements,
More informationYour Health Savings Account Reference Guide. Your Guide to Understanding a Health Savings Account
Your Health Savings Account Reference Guide Your Guide to Understanding a Health Savings Account The Fidelity HSA A tax-advantaged way to pay for health care expenses.* A health savings account (HSA),
More informationIRS/SSA/CMS Data Match Guide on Instructions from CMS
IRS/SSA/CMS Data Match Guide on Instructions from CMS Data Match is a program coordinated by the Internal Revenue Service (IRS), Centers for Medicare & Medicaid Services (CMS), and the Social Security
More informationExperience Choice : OPERS HRA Edition OneExchange Newsletter for Medicare-eligible Retirees
Experience Choice : OPERS HRA Edition OneExchange Newsletter for Medicare-eligible Retirees In This Issue Direct Deposit We Heard You! Step 1: Reimbursement Types & Considerations Step 2: Tips for Submitting
More informationThe Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act June 4, 2013 Lisa Curry, CPA Amber Moore, CPA 2013 KSM Business Services, Inc. PPACA What Is It? Signed into law on March 23, 2010 Most significant regulatory
More informationAon Retiree Health Exchange What your Pre-Medicare retirees need to know
Aon Retiree Health Exchange What your Pre-Medicare retirees need to know Q. Why is OP&F changing our current health care coverage? A. Funding for the retiree health care plan at OP&F is limited, making
More informationPfizer encompass Co-Pay Assistance Program for INFLECTRA :
Pfizer encompass Co-Pay Assistance Program for INFLECTRA : Guide to Claim Submission and Payment INFLECTRA is a trademark of Hospira UK, a Pfizer company. Pfizer encompass is a trademark of Pfizer. Table
More informationAgent Mailing Address City State Zip Code. Agent Address
Application Medicare-Eligible Basic Plan Questions? Call 1-800-877-5187 Please type or PRINT in black ink All sections must be filled out completely Your premium and required documents should be included
More informationNational Conference of State Legislatures Impact of Medicare Modernization and New Accounting Rules on States as Employers and Plan Sponsors
December 8, 2004 National Conference of State Legislatures Impact of Medicare Modernization and New Accounting Rules on States as Employers and Plan Sponsors Derek N. Guyton, FSA, MAAA Chicago, Illinois
More informationPRESCRIPTION DRUG COVERAGE AND MEDICARE. December Dear Prudential Employee and/or Covered Dependent:
This is an important notice from Prudential about your prescription drug coverage and Medicare. If you are not eligible for Medicare benefits, this notice does not apply to you and you do not need to take
More informationNew Group Checklist. 30 days prior to the effective date, the following Group information is required:
New Group Checklist 30 days prior to the effective date, the following Group information is required: Group Policy Application completed and signed. Enrollment forms; be sure to complete any applicable
More information2018 Medicare Part D Transition Policy
Regulation/ Requirements Purpose Scope Policy 2018 Medicare Part D Transition Policy 42 CFR 423.120(b)(3) 42 CFR 423.154(a)(1)(i) 42 CFR 423.578(b) Medicare Prescription Drug Benefit Manual, Chapter 6,
More informationWellCare Medicare Prescription Drug Plan 2019 Individual Enrollment Form. How to Enroll with WellCare PDP
WellCare Medicare Prescription Drug Plan 2019 Individual Enrollment Form How to Enroll with WellCare PDP 1. Please read this entire enrollment form to make sure you understand the information. An incorrect
More informationYour Retirement Guide
Your Retirement Guide How to get started Just call 888.465.1300 and ask to speak with a retirement specialist. A retirement specialist will be your point of contact to assist with your pension and retiree
More informationHealthy Indiana Plan 2.0 Special Populations
Healthy Indiana Plan 2.0 Special Populations Objectives After reviewing this presentation you will understand: HIP 2.0 features, options, benefits, and cost sharing Different options, enrollment, benefits,
More information2018 NEW GROUP APPLICATION
2018 NEW GROUP APPLICATION Client Information Name: Employer New Group Application DBA (if applicable): Company address: City: State: ZIP Code: Federal Tax ID: Date Incorporated: Organization is operating
More informationKathryn A. Coleman, Director Medicare Drug and Health Plan Contract Administration Group
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE DATE: May 8, 2015 TO: FROM: All Current and Prospective
More informationDETERMINATION OF MEDICARE ISSUES IN WORKERS COMPENSATION CASES 2008
DETERMINATION OF MEDICARE ISSUES IN WORKERS COMPENSATION CASES 2008 Michael E. Rusin Rusin, Maciorowski & Friedman, Ltd 10 S. Riverside Plaza Chicago, IL 60606 312-454-5110 merusin@rusinlaw.com OUTLINE
More informationPharmacy/Prescriber Medicaid Managed Care Network & Medicaid Provider Enrollment. February 14, 2018
Pharmacy/Prescriber Medicaid Managed Care Network & Medicaid Provider Enrollment February 14, 2018 2 Pharmacy/ Prescriber Enrollment Enrollment Effective Date Pharmacy/Prescriber FAQ s Contract Amendment
More informationMy Rewards Benefits Enrollment Guide. Newly Eligible U.S. Team Members. My Pay/Recognition My Benefits My Work/Life My Career Growth
My Rewards Newly Eligible U.S. Team Members My Pay/Recognition My Benefits My Work/Life My Career Growth 2016 Benefits Enrollment Guide 2 2016 Benefits Enrollment Guide - Newly Eligible U.S. Team Members
More information2019 Transition Policy
2019 Number: 5.8 Prescription Drug Replaces: 5.8 v.2018 Cross 5.1.2 Transition Fill Monitoring Procedure References: Purpose: To provide guidance on the transition process for new or current Plan members
More informationOverview of Plans for Medicare Eligible Members
Overview of Plans for Medicare Eligible Members The following pages offer general descriptions of the types of plans offered to CTPF retirees who are eligible for and maintain active enrollment in Medicare
More information1 INSURANCE SECTION Instructions: This section contains information about the cardholder and their plan identification.
1 INSURANCE SECTION : This section contains information about the cardholder and their plan identification. 1 ID of Cardholder Required. Enter the recipient s 13 digit Medicaid ID. 2 Group ID Not Required.
More informationUnderstanding Private- Sector Medicare
Understanding Private- Sector Medicare A primer for investors Updated June 27, 2013 This presentation is intended for informational purposes only to give the reader a basic understanding of the Medicare
More informationWellCare Medicare Prescription Drug Plan 2018 Individual Enrollment Form
WellCare Medicare Prescription Drug Plan 2018 Individual Enrollment Form How to Enroll with WellCare (PDP) 1 Please read this entire enrollment form to make sure you understand the information. 2 When
More informationLegacy MedigapSM Outline of Medigap insurance coverage and enrollment application for Plan A and Plan C
Medicare Supplement Coverage offered by Blue Cross Blue Shield of Michigan Legacy Medigap SM Outline of Medigap insurance coverage and enrollment application for Plan A and Plan C Legacy Medigap plan
More informationLow Income Program Certification and Verification
Low Income Program Certification and Verification Overview Consumer Certification Consumers certify eligibility Company Certification Companies certify they are following state and FCC rules Verification
More informationToday s webinar will begin shortly. We are waiting for attendees to log on.
Today s webinar will begin shortly. We are waiting for attendees to log on. Presented by: Tabatha George Phone: (504) 529-3845 Email: tgeorge@ Please remember, employment and benefits law compliance depends
More informationHuman Resource Executive Online
Human Resource Executive Online March 23, 2009 Avoiding COBRA's Bite Because the federal stimulus bill offers a subsidy of COBRA benefits, employers should expect increased selection of the coverage. The
More informationAon Retiree Health Exchange What your retirees need to know
Aon Retiree Health Exchange What your retirees need to know Q. Why is OP&F changing our current health care coverage? A. Funding for the retiree health care plan at OP&F is limited, making the group health
More informationKey Elements of Health Care Reform for Employers
Key Elements of Health Care Reform for Employers Change in tax treatment for over-age 2010 dependent coverage Early retiree medical reinsurance Accounting impact of change in Medicare retiree drug subsidy
More informationFederal Spending on Brand Pharmaceuticals. April 2011
Federal Spending on Brand Pharmaceuticals April 2011 Summary Avalere Health estimates that manufacturers of brand-name prescription drugs will receive about $777 billion in revenues from the sales of outpatient
More informationHEALTH CARE REFORM. Meeting the Needs of Retirees and the Requirements of the New Law
HEALTH CARE REFORM Meeting the Needs of Retirees and the Requirements of the New Law Thomas M. Morrison, Jr. Senior Vice President Robert D. Mitchell Consultant Copyright 2010 by The Segal Group, Inc.,
More informationReinsurance Fees Examples of Counting Methods
Brought to you by Sullivan Benefits Reinsurance Fees Examples of Counting Methods The Affordable Care Act (ACA) created a transitional reinsurance program to help stabilize premiums in the individual market
More informationRETIREMENT PLANNING GUIDE
RETIREMENT PLANNING GUIDE For U.S. Salaried and Non-Union Hourly Positions What s inside: Pension and 401(k) Benefits...2 Retiree Health Care Benefits...3 Benefits in Retirement Before Age 65...5 Benefits
More informationHealth Care Reform at-a-glance
Health Care Reform at-a-glance August 2015 Table of Contents Employer mandate...3 Individual mandate...3 Health plan provisions applying to both grandfathered and non-grandfathered employer plans...4 Health
More informationUPMC for Life Medicare Advantage Plan. West Virginia
UPMC for Life Medicare Advantage Plan Individual PPO Application West Virginia For assistance completing this application, call UPMC for Life toll-free 1-877-381-3765 TTY users call 1-800-361-2629 Return
More informationU.S. Benefits Summary Plan Descriptions (2016 edition) Section 12 Retiree medical benefits
U.S. Benefits Summary Plan Descriptions (2016 edition) Section 12 Table of contents Section 12: 12-3 Overview 12-3 Eligibility 12-3 If you decline Hewlett Packard Enterprise retiree medical coverage 12-4
More information