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Medicare Part D Reminder & Vaccine Network Update

Prescription blankEmployers that sponsor a group health plan that includes a prescription drug plan are required to notify all Medicare-eligible individuals of whether their drug plan is Creditable. A creditable drug plan is one that is expected to pay, on average, the same as a standard Medicare prescription drug plan.

The written disclosure notice must be provided annually by October 14th to the following individuals:

  • Medicare-eligible active working individuals and their dependents (including a Medicare-eligible individual when he or she joins the plan)
  • Medicare-eligible COBRA participants and their dependents
  • Medicare-eligible disabled individuals covered under an employer’s prescription drug plan
  • And any retirees and their dependents

Model Notices can be found by visiting the Center for Medicare and Medicaid Services (CMS)

In addition, employers are required to submit an online disclosure to CMS to report creditable coverage status of their prescription drug plan(s). This disclosure is required annually, no later than 60 days from the beginning of their plan year.

Vaccine Network Change

All BlueEssentialsSM individual and Business BlueEssentials Affordable Care Act (ACA) plan members must receive vaccinations at a CVS/pharmacy for them to come at no cost to the member. This network change is effective immediately. Exclusive pharmacy networks are a necessary step toward regulating vaccination costs.

When a vaccine is administered, there are two costs: the actual cost of the vaccine and the administration fee. When a member receives a vaccine from a CVS/pharmacy, their BlueEssentials health plan will cover both the cost of the vaccine and the administration fee.  If a member goes to a non-network pharmacy or a provider’s office, the member will receive the vaccine at no cost, but will be responsible for paying any administration fees charged by the pharmacy.

Notification letters will be mailed to members next week.

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