Who Is Responsible For Providing The Notice Of Creditable Prescription Drug Coverage?

Gary

Member
Who is responsible for providing the notice of creditable prescription drug coverage to medicare-eligible employees, the employer or GHP insurance company?

And, what should an employee do if neither one of those will provide it?
 

JC

Well-Known Member
Its your responsibility to get that to medicare to avoid the Late Enrollment Penalty. If your HR department won't provide you with a letter showing the dates you had employer coverage's I would try and get that from the insurance company itself. If neither of those will provide it try filing a complaint with Medicare.
 

Gary

Member
Its your responsibility to get that to medicare to avoid the Late Enrollment Penalty. If your HR department won't provide you with a letter showing the dates you had employer coverage's I would try and get that from the insurance company itself. If neither of those will provide it try filing a complaint with Medicare.
Thanks!

I tried to get that from the insurer (New Mexico Health Connections), but unbelievably they have told me they don't even know what it is! They have already sent me a letter showing that I had insurance (no details about prescription drug coverage), but I explained that it was not what I needed. On the last of my 3 phone calls, they wanted to send me the same wrong letter, but I explained that was not what I needed, refused to let them hang up, and asked to speak to someone else. So, I got a supervisor who said she would research it and call me back. I'm still waiting.

But that was when I thought it was the legal requirement per the MMA was on the insurance company. Whoops!

In researching this I found out that it's the employer's responsibility (legally), but most insurance companies provide this to the employers as a service. Figuring out what is "creditable coverage" for a PDP can be a little beyond the expertise of a small company's HR person. Our office manager didn't have a clue. So, I worked with my office manager to get me the notice. This was actually a good thing because she didn't know that our company also had to provide a notice to CMS each year by March 1, so I helped her get that done for both 2016 and 2017. For 2016 it will be late, but we figured it's "better late than never".

If I can get my Part C started soon (that's the other thread) I guess I won't need this proof of coverage, but I'll have it if it's needed.
 

JC

Well-Known Member
Thanks!

I tried to get that from the insurer (New Mexico Health Connections), but unbelievably they have told me they don't even know what it is! They have already sent me a letter showing that I had insurance (no details about prescription drug coverage), but I explained that it was not what I needed. On the last of my 3 phone calls, they wanted to send me the same wrong letter, but I explained that was not what I needed, refused to let them hang up, and asked to speak to someone else. So, I got a supervisor who said she would research it and call me back. I'm still waiting.

But that was when I thought it was the legal requirement per the MMA was on the insurance company. Whoops!

In researching this I found out that it's the employer's responsibility (legally), but most insurance companies provide this to the employers as a service. Figuring out what is "creditable coverage" for a PDP can be a little beyond the expertise of a small company's HR person. Our office manager didn't have a clue. So, I worked with my office manager to get me the notice. This was actually a good thing because she didn't know that our company also had to provide a notice to CMS each year by March 1, so I helped her get that done for both 2016 and 2017. For 2016 it will be late, but we figured it's "better late than never".

If I can get my Part C started soon (that's the other thread) I guess I won't need this proof of coverage, but I'll have it if it's needed.
You may need that letter to avoid any Late enrollment penalties
 

Josh Carter

New Member
Also, if your former employer went through a health insurance brokerage firm, often times those firms are able to request documents.

Whenever I need those docs for one of my new clients, that is always the first thing I check.
 

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