Group Health Plans Creditable/Non-Creditable Coverage Notices Due by 10/14/2022

Employee Benefits

Group Health Plans Creditable/Non-Creditable Coverage Notices Due by 10/14/2022

Sponsors of group health plans that provide prescription drug benefits are responsible for determining and notifying Medicare-eligible beneficiaries of whether the plan provides creditable* or non-creditable drug coverage before October 15 of each year.

When is the Notice of Creditable or NonCreditable Coverage (aka “Part D Notice”) due?

The Notice must be provided at each of the following times:

  1. Before the start of the Medicare Part D annual coordinated enrollment period (ACEP). The 2022 ACEP begins October 15 and runs through December 7 for Medicare prescription drug coverage (Part D) and Medicare Advantage plans (Part C) effective January 1, 2023. Therefore, generally, the notice deadline is October 14, 2022;
  2. Before the individual’s initial Medicare enrollment period;
  3. Prior to enrollment in the employer’s health plan;
  4. Upon request; and
  5. Whenever creditable status for the prescription drug coverage provided by the health plan changes.

Because employers may not know which employees’ family members are Medicare-eligible due to age or disability status, many employers will distribute the Notice to all employees covered by the group health plan.

Note that plan sponsors who distribute the Part D notice at least once per year to all plan participants in advance of the October 14 deadline (i.e., within the 12 consecutive months preceding October 14) generally are considered to have satisfied the notice requirements under one (1) and two (2) above. In other words, if a plan sponsor delivered the Notice anytime within the 12 months preceding October 14, they would not need to redistribute the Notice before a covered individual’s annual or initial Medicare enrollment period.

For what time period am I providing the Notice?

Generally, the Part D Notice applies to the plan year in which the Notice is issued. If there are subsequent changes in creditable coverage status, a new Notice must be distributed to affected participants and beneficiaries.

To whom must the Notice be provided?

The appropriate Part D Notices must be provided to affected participants and beneficiaries (who are Medicare-eligible due to age or disability) covered by the Group Health Plan, including active employees, retirees and their spouses and dependents who are Medicare-eligible.

How is the creditable or non-creditable status of the prescription drug benefits provided by a Group Health Plan determined?

A simplified (safe harbor) method for determining creditable coverage status may be applied if the plan fits within specific parameters. See Creditable Coverage Simplified Determination. If employers are receiving a Retiree Drug Subsidy, or the plan does not fit within the simplified determination parameters, and the plan sponsor would like to show creditable status, an actuarial determination is required.

Regulatory and Legislative Strategy Group