Rx Coverage Mailing to Employer Groups and Retirees
Beginning in late April, group administrators and members of group sponsored Medicare Advantage Plans that include Part D drug coverage will receive a Certificate of Coverage. This document outlines the prescription drug coverage included in their plan. It is a new New York State requirement to send this certificate to all members one time and to any new member when he or she first enrolls.
This New York state regulation affects all EGWP (Employer Group Waiver Plans) in 2014. This means that prescription drug benefits are provided through the combination of a Medicare Part D prescription drug plan and a supplemental drug plan. This certificate outlines the supplemental plan benefits.
We also wanted to take this opportunity to let you know that in addition to the current monthly Medicare Part D Explanation of Benefits (EOB) for paid claims that members currently receive, beginning in March 2014 members of employer group sponsored Medicare Advantage plans, began receiving a monthly statement of denied prescription drug claims. This new additional monthly EOB will provide members an opportunity to review any prescription drug claim denials and it will outline the New York State appeal and grievance rights that they are entitled to as part of the commercial portion of their prescription drug benefit.
If you have any questions or require further information regarding these documents, please contact your Account Consultant.
View sample employer letter (PDF) | View sample member letter (PDF) | View sample certificate (PDF)