Employer & Other Insurance

5. Employer and Other Insurance

5.1 Information Partners Can Use on: Comparison of Outpatient Prescription Drug Coverage: Medicare, VA, VA-CHAMVA, DOD-Tricare Pharmacy)

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/tricare.pdf

2/06

CMS

Partner

Fact Sheet

This fact sheet is explains Part D for people with TRICARE coverage.

Spanish

5.2 Information Partners Can Use on: Veteran's Administration Benefits

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/VA.pdf

8/05

CMS

Partner

Tip Sheet

This tip sheet is for partners to use when counseling a person about VA benefits and the Medicare drug coverage.

Spanish

5.3 Tip Sheet for Employer & Union Plan Sponsors: Beneficiaries who will be automatically enrolled in a Medicare drug plan and how their retiree coverage will be affected

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/eupautofe.pdf

11/05

CMS

Partner

Tip Sheet

This tip sheet contains Information for Employers and Unions about beneficiaries who will be Auto-Enrolled in a Medicare prescription drug plan.

5.4 Dual-Eligible Beneficiaries With Retiree Drug Coverage: What Retiree Plan Sponsors Should Know About the Risks and Choices Facing Retirees, Spouses & Dependents, and What They Can Do to Help

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/eupautoissue.pdf

11/05

CMS

Partner

Tip Sheet

This tip sheet contains information to help retiree plan sponsors and unions provide flexible benefit packages and offer creative solutions that integrate well with Medicare Rx and end up helping their dual eligible retirees.

5.5 Information Counselors Can Use On: Employer/Union Options for Working with Medicare Prescription Drug Coverage

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/counseloreu.pdf

11/05

CMS

Partner

Tip Sheet

This tip sheet contains Information about retiree plan options, Retiree Drug Subsidy (RDS), actuarially equivalent, coverage at least as good as Medicare's basic coverage, plan requirements about coverage, and creditable coverage disclosure requirements.

5.6 Information Partners Can Use on: FEHBP

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/FEHBP.pdf

2/06

CMS

Partner

11241-P

This tip sheet contains information on how to counsel people with Medicare and Federal Employee Health Benefit Program (FEHBP) coverage about the choices available to them through Medicare Rx. It addresses common questions people ask and touches on how the program works for people with Medicare Rx and limited income and resources.

5.7 Notification of Changes in Medicare Part D Payment for Calendar Year 2008 (Part D Payment Notification)

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/
Downloads/PartDannouncement2008.pdf

4/07

CMS

Partner

Notice

This memo describes changes in the payment methodologies applied under Part D of the Act for Calendar Year (CY) 2008. The key changes in Part D payment methodologies for 2008 include: updated benefit parameters for the defined standard benefit and the Retiree Drug Subsidy (RDS); calculations of the national average monthly bid amount and the regional low-income benchmark premium amounts; normalization of the Part D risk adjustment model; and statutory changes in the risk corridors. This information applies to all Prescription Drug Plan (PDP) Sponsors, Medicare Advantage Organizations and others offering prescription drugs under Part D. Any changes to employer/union-only group waiver plan payment for 2008 will be issued in separate guidance. This memo is a key element of the information that CMS is providing to help organizations bid for the upcoming contract year. NOTE: Same as section 4.109

5.8 Frequently Asked Questions About: Retiree Prescription Drug Coverage & the New Prescription Drug Coverage

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmplUnionPlanSponsorInfo/Downloads/
11162retireefactweb.pdf

11/05

CMS

Beneficiary

11162

FAQ tool. This fact sheet with Q&A, or QA explains options for prescription drug coverage for people with Medicare who also have a retirement sponsored plan. It includes things to consider before choosing and joining a plan, and how joining a Medicare plan may change coverage through the retiree plan.

Spanish

5.9 Information Partners Can Use On: TRICARE

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/tricaretip.pdf

2/06

CMS

Partner

11237-P

This tip sheet describes what people with TRICARE and Medicare should consider when deciding whether to enroll in a Medicare prescription drug plan. It contains a chart comparing TRICARE coverage of outpatient prescription drugs to the standard coverage of Medicare prescription drug coverage.

Spanish

5.10 Information Counselors Can Use on: Issues Facing People who Have Medicare, Medicaid and Retiree Drug Coverage

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/retireeauto.pdf

3/05

CMS

Partner

Tip Sheet

This tip sheet explains for counselors what people with Medicaid and a retiree health plan should consider before joining a Medicare prescription drug plan. NOTE: Same as section 8.27

Spanish

5.11 Employer Retiree Drug Subsidy Program Website

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://rds.cms.hhs.gov/

3/07

N/A

FirstGov

Partner

Link

Site, web page, or URL for employers. CMS' RDS Center is pleased to announce the addition of new functionality to the RDS Secure Web Site. Effective Saturday, July 1, 2006 Plan Sponsors may report costs and request payments for their qualified covered retirees. For specific information on how to perform the cost reporting and payment request steps, refer to the How To Submit Cost Data and How To Submit an Interim Payment Request documents on the RDS Program Web Site. RDS website contacts:

Call RDS Help Line. Call CMS' RDS Center's Help Line at (877) RDS-HELP, or (877) 737-4357. TTY for the hearing impaired: (877) RDS-TTY0, or (877) 737-8890.
E-mail RDS Help Line. E-mail CMS' RDS Center's Help Line at rds@cms.hhs.gov

5.12 Workers’ Compensation Medicare Set-aside Arrangements (WCMSAs) Questions and Answers

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/WorkersCompAgencyServices/Downloads/
123005PartDMemo.pdf

12/05

CMS

Partner

Tool

FAQ tool (Q&A, or QA) – a memo – addresses how Workers’ Compensation Medicare set-aside arrangements work with Part D. Memorandum provides clarification regarding prescription drug coverage for WC vs. Medicare. The prescription drugs in this document are limited to those prescription drugs that are for the treatment of Workers’ Compensation (WC) related injury/injuries and/or illnesses/diseases and those where Medicare provides coverage. Learn more about the Coordination of Benefits (COB) program to assist you with meeting responsibilities and obligations under the Medicare Secondary Payer (MSP) laws concerning Workers' Compensation (WC) issues.

5.13 Train-the-Trainer Module 5: Coordination of Benefits

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/NationalMedicareTrainingProgram/TL/list.asp

4/07

CMS

Partner

Classroom

Some Medicare-eligible beneficiaries also have other health insurance plans or are eligible to have their health care costs paid for by other means. This set of classroom training slides (PowerPoint with speaker’s notes) discusses when Medicare is the primary payer and when it is the secondary payer (MSP), and is being updated to include issues related to integration of Medicare Rx with other types of coverage, such as SPAP, PAP, or ADAP. Visit the Training Library for updates.

5.14 When Employees Become Caregivers - A Manager's Workbook

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/11035.pdf

12/04

CMS

Partner

11035

This booklet guides employers in how to make needed eldercare and Medicare information available to care-giving employees, at little or no cost.

5.15 Medicare and Other Health Benefits: Your Guide to Who Pays First

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/02179.pdf

9/05

CMS

Beneficiary

02179

This booklet provides an explanation of how Medicare pays with other types of insurance.

Braille

Audio (English)

Audio (Spanish)

5.16 Tip Sheet & Issue Paper about Retirees Automatically Enrolled In Medicare Part D

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmplUnionPlanSponsorInfo/Downloads/
EmpUnionTipSheetonAutoEnroll.zip

12/05

N/A

CMS

Partner

Tip Sheets

This zipped file contains two tip sheets: 1. Tip Sheet for Employer & Union Plan Sponsors: Beneficiaries Who Will Be Automatically Enrolled in a Medicare Drug Plan and How Their Retiree Coverage Will Be Affected, and 2. Dual Eligible Beneficiaries With Retiree Drug Coverage: What Retiree Plan Sponsors Should Know About the Risks and Choices Facing Retirees, Spouses & Dependents, and What They Can Do to Help.

5.17 The Retiree Drug Subsidy: Why Employers and Union Plan Sponsors Should Consider It. (RDS)

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmplUnionPlanSponsorInfo/Downloads/
RDS4Emp040605.pdf

12/05

CMS

Partner

Tip Sheet

This tip sheet explains to employers the Five Easy Steps to receiving the Retiree Drug Subsidy (RDS) and why they should consider applying.

5.18 Overview of Retiree Drug Subsidy Option

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmployerRetireeDrugSubsid/downloads/
OviewoftheRDSRev1.pdf

11/05

CMS

Partner

Tip Sheet

This tip sheet is a summary that provides employers an overview of provisions in the final regulation of interest to plan sponsors relating to the Medicare retiree drug subsidy (RDS) program.

5.19 Creditable Coverage Issues for Plan Sponsors

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmplUnionPlanSponsorInfo/Downloads/
OviewofCCIssueRev1.pdf

1/06

CMS

Partner

Tip Sheet

This tip sheet provides group health plan sponsors an overview of the MMA requirement that plan sponsors disclose to all Medicare eligible individuals with prescription drug coverage under the plan whether such coverage is creditable, or as good as the new Medicare prescription drug coverage. Sponsors are expected to provide this information and communicate effectively with retirees to ensure that retirees make informed and timely enrollment decisions.

5.20 Overview of Plan Sponsor Options Requiring Waivers

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmplUnionPlanSponsorInfo/Downloads/
OviewofPSOptsReqWaiversRev1.pdf

3/05

CMS

Partner

Tip Sheet

CMS has authority to waive or modify requirements that hinder the design of, the offering of, or the enrollment in, Part D arrangements sponsored by employers or unions for their retirees. This tip sheet on waiver authority can assist plans that provide coverage under the Medicare drug benefit (Part D plans) to design prescription drug benefits offered exclusively to their retiree populations, as well as make it easier for plan sponsors to contract with, or even become Prescription Drug Plans (PDPs) and Medicare Advantage plans that include prescription drugs (MA-PDs) in order to provide enhanced benefits to their retirees that supplement the Medicare standard prescription drug benefit.

5.21 Overview of Plan Sponsor Supplemental Coverage Options & TROOP

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmplUnionPlanSponsorInfo/Downloads/
OviewofPSSuppCvrgOptsandTrOOP.pdf

12/05

CMS

Partner

Tip Sheet

This tip sheet provides an overview to one of the options available to retiree health plan sponsors under the MMA is the ability to provide coverage that supplements a retirees’ Medicare prescription drug benefit.

5.22 Retiree Plan Sponsor Options: More Secure Coverage for Retirees

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmplUnionPlanSponsorInfo/Downloads/
issuepaper05RDS.pdf

1/05

CMS

Partner

Reference

This historical reference explains that sponsors of employer and union plans that offer a prescription drug benefit as good as, or better than, Medicare’s defined standard prescription drug benefit under Part D will be able to apply for the retiree drug subsidy (RDS), which is estimated to roughly average $668 per beneficiary in 2006.

5.23 Summary of Options for Employer & Union Plan Sponsors

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/EmplUnionPlanSponsorInfo/Downloads/
SumryofOptsforEmployerandUnionPSRev1.pdf

11/05

CMS

Partner

Tip Sheet

This tip sheet provides an overview of the options available to employer & union plan sponsors.

5.24 Medicare Secondary Payer Manual

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/Manuals/IOM/itemdetail.asp?
filterType=none&filterByDID=-
99&sortByDID=1&sortOrder=ascending&itemID=CMS019017

8/05

8 chapters

CMS

Partner

100-05

This reference provides detailed information on Medicare Secondary Payer (MSP) issues.

5.25 Prescription Drug Coverage Contracting:

Draft Coordination of Benefits Guidance – 2007

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovContra/
Downloads/NextYearCobGuidelines.pdf

6/06

CMS

Partner

Reference

This updated draft reference provides guidance to Part D sponsors regarding CMS requirements and procedures for the coordination of benefits (COB) between Part D plans, State Pharmaceutical Assistance Programs (SPAPs) and other providers of prescription drug coverage with respect to the payment of premiums and coverage, as well as payment for supplemental prescription drug benefits. Learn more.

5.26 Final Coordination of Benefits Guidance – 2006

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/
CobGuidance_07.01.05.pdf

7/05

CMS

Partner

Reference

This outdated reference provides guidance to Part D sponsors describing requirements and procedures for coordination of benefits (COB) between Part D plans and State Pharmaceutical Assistance Programs (SPAPs) and other providers of prescription drug coverage with respect to the payment of premiums and coverage, as well as coverage supplementing the benefits available under Part D.

5.27 Information Partners Can Use on: Coordination of Benefits

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/COB.pdf

1/06

CMS

Partner

Tip Sheet

This tip sheet provides information to Medicare partners about how Medicare prescription drug coverage will work with supplemental drug coverage including State Pharmacy Assistance Programs, Employer Group Health Plans, the Federal Employee Health Benefits Program, and Military coverage (including TRICARE).

Spanish

5.28 Updated Creditable Coverage Guidance and Model Notices Posted in Federal Register for an Additional 30 Day Public Comment Period

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/
edocket.access.gpo.gov/2006/pdf/E6-18006.pdf

9/06

N/A

CMS

Partner

Reference

Draft reference library (174KB zipped). It includes a sample or model letter, mailing, or notice. On September 22, 2006, CMS published in the Federal Register a request for Paperwork Reduction Act (PRA) comments on updated Creditable Coverage model notices that entities can use when disclosing creditable coverage status to beneficiaries. (The package also includes conforming changes to previously released Creditable Coverage guidance.) The proposed changes are in response to comments received on the model notices published in May 2006. Please note that plan sponsors can continue to provide creditable coverage disclosures using the May 2006 model disclosure notices and guidance, or they can use the updated notices and guidance until CMS finalize and release the materials. Learn more. NOTE: Same as section 4.39

5.29 Union Forum

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/Partnerships/17_union.asp

2/07

N/A

CMS

Partner

Link

CMS staff provides opportunity for the union representatives who participate in the Forum to identify issues and questions regarding the Medicare program that will then become agenda items for the Forum conference calls. The emphasis is on communicating and discussing Medicare issues and Medicare-related messages to the union member community for the benefit of their organizations, union members, and members' welfare. This site, web page, or URL provides information for the Union Forum composed of representatives of about 65 major unions.

Resource Guide for Partners