CMS Creditable Coverage Notice

What is Creditable Coverage?

The Medicare Modernization Act requires employers who offer prescription coverage to notify their employees whether their coverage is creditable. Who is required to provide disclosure?

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Most of Prevea360 Health Plan's Large and Small Group products meet the CMS requirements for creditable coverage. However, some HSA-eligible High Deductible Health Plan (HDHP) options may not meet the CMS creditable coverage requirements due to the higher single/family deductible levels.

In general, these are HDHP options with a deductible/coinsurance combination above $3,000/0% coinsurance. See the table below for more information.

HDHP Creditable Coverage Example Table

Plan Year HDHP Deductible Coinsurance Provides Creditable Rx Coverage?
2019 $2,000/$4,000 0% Yes
2019 $2,000/$4,000 20% Yes
2019 $3,000/$6,000 0% Yes
2019 $3,000/$6,000 20% Yes
2019 $4,000/$8,000 0% Yes
2019 $4,000/$8,000 20% Yes
2019 $5,000/$10,000 0% Yes
2019 $5,000/$10,000 20% No
2019 $6,000/$12,000 0% No
2019 $6,000/$12,000 20% No
2019 $6,500/$13,000 0% No
2019 $6,500/$13,000 20% No
 
Plan Year HDHP Deductible Coinsurance Provides Creditable Rx Coverage?
2018 $2,000/$4,000 0% Yes
2018 $2,000/$4,000 20% Yes
2018 $3,000/$6,000 0% Yes
2018 $3,000/$6,000 20% Yes
2018 $4,000/$8,000 0% Yes
2018 $4,000/$8,000 20% Yes
2018 $5,000/$10,000 0% Yes
2018 $5,000/$10,000 20% No
2018 $6,000/$12,000 0% No
2018 $6,000/$12,000 20% No
2018 $6,500/$13,000 0% No
2018 $6,500/$13,000 20% No

For more information on creditable coverage, please contact your Account Manager or visit the Centers for Medicare and Medicaid Services (CMS) Creditable Coverage website.