Group health plan sponsors must provide Medicare Part D “creditable coverage” notices prior to October 15th, the start date of the Medicare annual enrollment period for Part D, Prescription Drug coverage. (The enrollment period is October 15–December 7.) Most plan sponsors use the Model Medicare Part D Notices provided by the Centers for Medicare and Medicaid Services (CMS) to notify affected plan participants. Links to all the model letters (in English and Spanish) are available here.  These notices are in .pdf format.  Cornerstone has provided versions of the notice in Word Document format for your convenience. The carriers plan listings and/or links to their creditable coverage site are available below (refer to 2019 listing for Anthem KY and MMO, as 2021 document will be released December 2020). You will find the 2020 listings in the Document Search on the Cornerstone Resource Center:

Aetna

(plans below non-creditable, all others creditable)

• AFA OAAS Value 8150 100% CY VP
• AFA OAAS Value 8150 100% CY ACF
• AFA OAAS Essentials 6900 HSA 100% E CY ACF
• AFA OAAS 6250 HSA 100% E CY ACF
• AFA CPOSII 6250 HSA 100/50 E CY ACF

Anthem IN

• Small Group Legacy
• Small Group ACA
• Chamber Care Health Alliance

Anthem OH

• Small Group MEWA
• Small Group Legacy
• Small Group ACA

Anthem KY

• Small Group ACA
• Small Group Chamber Advantage

Humana

• ASO Creditable Coverage List
• LFP Creditable Coverage List
• Large Group Creditable Coverage List
• Small Group Creditable Coverage List

Medical Mutual

• MMO Creditable Coverage List

UHC

• 2021 Plan Lookup
• 2021 SB Lookup

The October 15th deadline applies for all group health plan sponsors, regardless of plan year, plan size, employer size, grandfather status, or whether the plan is insured or self-funded. Employers who send out Open Enrollment packets prior to October 15th often include the Medicare Part D notices in the Open Enrollment packets, to avoid the extra cost and administrative burden of sending them separately. Employers are also required to notify CMS online annually that they have sent out these Part D notices. The notice to CMS is due within 60 days after the start of the plan year. See the last paragraph of this article for details.

When Is the Medicare Part D Notice Required?

Medicare Part D notices must be provided at least once annually, prior to October 15th, which is the beginning of the Part D annual enrollment period. Additional notices must be provided if the employer-provided coverage changes (from creditable to non-creditable, or vice-versa), if the individual requests a copy of the notice, and when an individual first enrolls in the employer plan.

Why is the Part D Notice Required?

The reason plan sponsors are required to provide Part D Notices is because a penalty will be imposed on an individual if he/she, after becoming eligible for Medicare Part D coverage, has a lapse of “creditable” prescription drug coverage for a period of at least 63 days. Additionally, such individuals may have to wait until the following October to join. An individual can elect either Medicare prescription drug coverage or other “creditable coverage” to avoid having a lapse in coverage. Thus, Medicare-eligible participants in employer group health plans must know whether or not the employer group coverage is “creditable” so they do not unwittingly incur a late enrollment penalty.

Additional Details on the Disclosure Requirements

• Group health plan sponsors to whom this disclosure requirement applies include employers and Unions; multiple employer welfare arrangements (MEWAs); federal, state and local government employers; and churches.
• The Part D Notice must be provided not only to Medicare-eligible active working employees and their dependents, but also to participants who are retired, on COBRA, or disabled and covered under the employer’s prescription drug plan.
• Although the requirement is only that “Medicare-eligible” individuals be provided this notice, employers often provide it to all plan participants and dependents, because of the practical difficulty of knowing who is Medicare-eligible.

Annual Notice to CMS Also required, though not by October 15th

Additionally, plan sponsors are required to notify CMS annually, via the CMS website (Online Disclosure to CMS form). This notice must be made within 60 days after the beginning of the plan year (or contract renewal date, for small plans that do not file Form 5500s so do not specify a plan year), and it pertains to the creditable coverage status for the prior plan year. For calendar year plans, this notice must be provided to CMS no later than March 1.  Sponsors of non-calendar year plans should mark their calendars to make sure the disclosure to CMS is made within 60 days after the beginning of the plan year. (E.g., for an April 1 plan year, the CMS online disclosure should be made no later than May 30.) Additionally, if applicable, plan sponsors must complete the Online Disclosure to CMS Form within 30 days after termination of a prescription drug plan or within 30 days after any change in creditable coverage status. For additional information, click here for the main CMS webpage that provides guidance on “creditable coverage.” Or you can visit the webpage  at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/

The IRS has updated penalties and forms for the upcoming year as follows:

• 2021 ACA A and B annual penalties for Applicable Large Employers who fail to offer minimum essential coverage that is either unaffordable or doesn’t provide minimum value: $2,700 A penalty and $4,060 B penalty.
• 2021 Affordability percentage is 9.83%
• New 2020 Forms 1094C and 1095C introduced to address ICHRAs and adding the employee age and zip code

Contact your Cornerstone representative with any questions.

Fees to fund the Patient-Centered Outcomes Research Institute (PCORI) are due to the IRS no later than July 31, 2020, from employers who sponsor certain self-insured health plans such as level-funded and health reimbursement arrangements (HRA) that are not treated as excepted benefits.

How to Pay PCORI Fees

Employers that sponsor certain self-insured health plans (level-funded) must report and pay the required PCORI fees via IRS Form 720 along with HRA plans, Quarterly Federal Excise Tax Return. Complete Part II, line 133. Employers should note “2nd Quarter” on the 720 form (click here for instructions for Form 720).

The fee applies to each plan year that ends after October 1, 2012, and before October 1, 2020. “Plan year” refers to the plan year for your level-funded medical plans or an HRA plan. Generally, the plan year and the coverage period are the same. As an example, if your HRA benefit resets each January 1, your HRA plan year and your coverage period are generally a calendar year and end December 31.

Plan Year Ending Date	Fee
October 1, 2018 to September 30, 2019	$2.45
October 1, 2019 to September 30, 2020	$2.54

There are three methods that can be used to determine the average number of lives covered under a plan for the policy year. For an HRA plan, it is acceptable to use the number of subscribers only. The most commonly used method for determining the fee for your level-funded plan is the “Snapshot Method.”

1. Actual Count Method: A plan sponsor may determine the average number of lives covered under a plan for a plan year by adding the totals of lives covered for each day of the plan year and dividing that total by the total number of days in the plan year.
2. Snapshot Method: A plan sponsor may determine the average number of lives covered under an applicable self-insured health plan for a plan year based on the total number of lives covered on one date (or more dates if an equal number of dates is used in each quarter) during the first, second, or third month of each quarter, and dividing that total by the number of dates on which a count was made.
3. Form 5500 Method: An eligible plan sponsor may determine the average number of lives covered under a plan for a plan year based on the number of participants reported on the Form 5500, Annual Return/Report of Employee Benefit Plan, or the Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit Plan.

Payments should be made payable to the U.S. Treasury and sent by July 31, 2020 to the address below:

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0009

The Form 720 and Form 720 instructions for this year’s filing are not yet available. Once released, you will be able to retrieve these documents from the Cornerstone website on the Resource Center.

The Patient-Centered Outreach Research Institute Filing Due Dates and Applicable Rates flier can be downloaded here.

Tools to Assist you by Carrier:

All Savers®

All Savers posts the employer group’s membership information to the employer website. The employer group is required to complete and file the IRS Form 720. For general questions please contact All Savers Broker Services at 1-866-405-7174.

Humana Level Funded

Humana provides a snapshot report that shows the monthly membership employers will need when filing the PCORI. It is an employer report (instructions below). As a broker, the employer may grant you access if they want you to pull it for them.

Click here to learn how to generate a Humana member report.

Aetna Funding Advantage

This link takes you to the Aetna Funding Advantage PCORI Fee Estimator Tool. This tool gives you guidance on calculating the PCORI fees for this group.

**Anthem OH SOCA MEWA, Anthem KY Chamber Advantage, Anthem IN Chamber Health Alliance, MMO COSE MEWA, and UHC MEWA have built the PCORI fees into the premiums, therefore, you will not need to file and pay any additional fees.