Upcoming Due Date for Disclosure to CMS for Medicare Part D, Form W-2 Aggregate Cost Reporting

Deadline Coming Up for Calendar Year Plans to Submit Medicare Part D Notice to CMS

Group health plans offering prescription drug coverage are required to disclose to all Part D-eligible individuals who are enrolled in or were seeking to enroll in the group health plan coverage whether such coverage was “actuarially equivalent,” i.e., creditable. (Coverage is creditable if its actuarial value equals or exceeds the actuarial value of standard prescription drug coverage under Part D.) This notice is required to be provided to all Part D eligible persons, including active employees, retirees, spouses, dependents and COBRA qualified beneficiaries.

The regulations also require group health plan sponsors with Part D eligible individuals to submit a similar notice to the Centers for Medicare and Medicaid Services (“CMS”).  Specifically, employers must electronically file these notices each year through the form supplied on the CMS website. 

The filing deadline is 60 days following the first day of the plan year.  If you operate a calendar year plan, the deadline is the end of February.  If you operate a non-calendar year plan, please be sure to keep track of your deadline.

At a minimum, the Disclosure to CMS Form must be provided to CMS annually and upon the occurrence of certain other events including:

1) Within 60 days after the beginning date of the plan year for which disclosure is provided;
2) Within 30 days after termination of the prescription drug plan; and
3) Within 30 days after any change in creditable status of the prescription drug plan.

The Disclosure to CMS Form must be completed online at the CMS Creditable Coverage Disclosure to CMS Form web page.

The online process is composed of the following three step process: (1) Enter the Disclosure Information; (2) Verify and Submit Disclosure Information; and (3) Receive Submission Confirmation.

The Disclosure to CMS Form requires employers to provide detailed information to CMS including but not limited to, the name of the entity offering coverage, whether the entity has any subsidiaries, the number of benefit options offered, the creditable coverage status of the options offered, the period covered by the Disclosure to CMS Form, the number of Part D eligible individuals, the date of the notice of creditable coverage, and any change in creditable coverage status.

For more information about this disclosure requirement (instructions for submitting the notice), please see the CMS website for updated guidance.

As with the Part D Notices to Part D Medicare-eligible individuals, while nothing in the regulations prevents a third-party from submitting the notices (such as a TPA or insurer), ultimate responsibility falls on the plan sponsor.

Reminder:  Form W-2 Reporting on Aggregate Cost of Employer Sponsored Coverage

Unless subject to an exemption, employers must report the aggregate cost of employer-sponsored coverage provided in 2013 on their employees’ Form W-2 (Code DD in Box 12) issued in January 2014. Please see IRS Notice 2012-9.  See also our previous e-mail alerts dated September 22, 2011 as updated on April 13, 2012 for more information. If you did not receive or cannot locate these alerts or memoranda, please advise.

Moreover, pursuant to new proposed rules, certain dental and vision plans may be deemed HIPAA excepted benefits and not be subject to Form W-2 reporting.  Certain requirements must be met.  See 78 Fed. Reg. 77632 (Dec. 24, 2013).  The proposed rules also address employee assistance plans (EAPs).


If you have a question as to whether your dental, vision or EAP benefits are deemed HIPAA excepted, or for more information on this issue, please contact Elizabeth H. Latchana at 517.377.0826 or elatchana@fraserlawfirm.com.