Disclosure Requirements to Employees

Entities that provide prescription drug coverage to Medicare Part D eligible individuals must disclose to the Centers for Medicare & Medicaid Services (CMS) whether the coverage is “creditable prescription drug coverage”.  This disclosure is required whether the entity’s coverage is primary or secondary to Medicare.

Employers are required to disclose the creditable status of their pharmacy plans to Medicare-eligible employees and retirees by October 15 each year.

Since all medical plans include pharmacy coverage, you must distribute notices to employees and retirees enrolled in a medical plan, indicating whether the plan they have is “creditable” or “noncreditable.”

Plan Sponsor Disclosure Requirements to Employees

By law, plan sponsors must determine and communicate the creditable coverage status for each pharmacy benefit plan offered to members who are eligible to participate in a Medicare Part D benefit plan.  CMS requires the distribution of a Creditable Coverage notice annually, no later than October 15.

We recommend employers distribute a copy of the Creditable Coverage Notice to all employees and retirees enrolled in the medical plan. You may use the sample notices provided below or create your own version.  CMS template notices are available here.

For more information, visit the CMS website.

Creditable Coverage Determination & Notices

Ventegra has reviewed the pharmacy plans offered under the CBIA Health Connections medical program (see details by plan below).  View the creditable coverage status for 2024 and 2025 plans based on your group’s plan year (the later of your group’s effective or renewal date).

To create your Creditable Coverage Notice(s), use the templates provided on the CMS website or refer to the CBIA Health Connections sample notices below.

2025 Plans

CBIA Health Connections SAMPLE Notices:

• Creditable Coverage Status – for all 2025 plans
• 2025 CBIA Health Connections Sample Medical Creditable Coverage Notice
• 2025 CBIA Health Connections Sample Medical Non-Creditable Coverage Notice

2024 Plans

CBIA Health Connections SAMPLE Notices:

• Creditable Coverage Status – for all 2024 plans
• 2024 CBIA Health Connections Sample Medical Creditable Coverage Notice

Ventegra Determinations – 2025 Plans

• CBIA HSA $3500 30%
• CBIA HSA $4750 30%
• CBIA HSA $5500 30%
• CBIA PPO $30 $45 $3000 10%
• CBIA PPO $35 $50 $4000 30%
• CBIA PPO $30 $45 $1500

Ventegra Determinations – 2024 Plans

• CBIA HSA $3500 30%
• CBIA HSA $4750 30%
• CBIA HSA $5500 30%
• CBIA PPO $30 $45 $3000 10%
• CBIA PPO $35 $50 $4000 30%
• CBIA PPO $30 $45 $1500