Dear Colleagues,
While we can’t help out with your holiday shopping list, DDI would like to make your end- of –the- year benefits to-do list easier with this month’s DDI E-newsletter.
Did you notify your employees about the Creditable or non-creditable Coverage to Medicare Part D? It’s not too late…
By November 15th (beginning of the annual Medicare coordinated election period), groups that offer prescription drug coverage to employees should notify their members of the creditable coverage status of their plan and of possible penalties for late enrollment in Medicare Part D if their current coverage is not creditable. Your health plan should have sent your Plan Administrator a communication. If you don’t know if your plan is creditable or not, please contact DDI and we will find out for you.
As defined by the Centers for Medicare & Medicaid Services, coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of standard prescription drug coverage under the Medicare prescription drug benefit.
The Medicare Modernization Act imposes a late enrollment penalty on individuals who do not maintain creditable coverage for a period of 63 days or longer following their initial enrollment period.
1. How should I notify employees of the creditable coverage status of their prescription drug plan?
The Centers for Medicare & Medicaid Services provide sample notices for your convenience.
- Model beneficiary creditable coverage disclosure. (PDF)
- Model beneficiary noncreditable coverage disclosure. (PDF)
2. Medicare Open Enrollment Period is here!
Medicare’s Annual Open Enrollment is from Nov. 15 – Dec. 31
Each year plans change what they cost and what they cover. During the annual open enrollment, people with Medicare can add, drop or change their prescription drug coverage. They can also select a health plan for their 2011 coverage.
Medicare touches everyone. Medicare “eligibles” might be your employees, medicare-eligible disabled, your parents, grand-parents, neighbors, maybe the CEO or owner of your company, or your employees’ dependents. Wouldn’t it be nice to simply be able to call a trusted Medicare expert that could help you or someone you know make the best decision? You can! DDI partners with a private, locally-owned, licensed and appointed firm that focuses on assisting medicare eligibles. Contact us for more information to get the help you or someone you care about needs.
3. Women’s Health and Cancer Rights Act of 1998 – Who notifies who?
The following is a required annual notification under the Women’s Health and Cancer Rights Act of 1998. This federal law requires health plans that provide mastectomy benefits to inform their plan members of its availability. In most cases your health plan is routinely sending member notifications. However, the Department of Labor states that the named “Plan Administrator” is ultimately responsible for disclosures. We recommend that you check with your health plan or DDI to verify that your health plan is sending this notice. Below is the required language:
Benefits for women following a mastectomy should be determined in consultation between the attending personal physician/provider and the patient. Members are entitled to the following coverage:
- Reconstruction of the breast on which the mastectomy was performed
- Surgery and reconstruction of the other breast to produce a symmetrical (balanced) appearance
- Prostheses (artificial replacements) and treatment of physical complications of all stages of mastectomy, including lymphedemas
These reconstructive benefits may be subject to annual deductibles and co-insurance provisions, like other medical and surgical benefits covered under the plan.
4. Health Reform reminders for 2011:
Effective September 23rd and on your health plan renewal date many of the new provisions of the health reform law take effect:
- Flexible Spending Accounts effective 1/1/11: If you offer your employees an FSA, certain over the counter (OTC) drugs are no longer eligible for reimbursement with pre-tax healthcare reimbursement dollars. This link provides more details…
- Dependents allowed to remain on plan until age 26 (special open enrollment at plan renewal)
- Lifetime limits are removed (at plan renewal)
- Preventive care is covered at 100% (at plan renewal): Includes colonoscopies for people over 50!
- Some companies may be eligible to “grandfather” and keep the same plan without implementing some of the new provisions. DDI can help you review your plan status and options.
- Small employers under 25 full time equivalent employees may be eligible for a new health care premium tax credit. Contact DDI for more information to see if your company qualifies.
5. Worksite Wellness: It really works! Put it at the top of the TO DO list for 2011.
“Research shows that every $1 companies spend on prevention produces $3.50 in savings from reductions in absenteeism and health-care costs.” (Washington DC based Partnership for Prevention.)
FORTUNE magazine headlined worksite wellness in their September 28th issue stating, “Corporate America is hard at work trying to get their employees in shape. It’s a great way to boost productivity and rein in health-care costs.” DDI is helping employers do just that. Look for our January issue of our e-newsletter for great reasons and effective ways to start a worksite wellness program, no matter if you are 2 or 200 employees!
Call DDI today so we can help you with your Benefits To Do list!
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