According to updated CMS guidelines, the employer or union group must send out a notice informing the enrollees of the intent to enroll them in a Part D plan so that the notice is in members' hands no less than 21 days before the effective date. This is a modification to the prior guideline, which stated that the notice has to be sent out 30 days in advance. While it is the employer's responsibility to mail out the notice to the members, it is the Account Executive/Service Representative's responsibility to inform the account of this required communication. Following is a list of required communication that must be sent to the members. All of these requirements, except the Summary of Benefits are satisfied by sending the letter:
- Intent by employer to enroll the member in a PDP for a prospective date
- Member may affirmatively opt out of the enrollment; how to accomplish that; and any consequences to employer/union benefits that the opting out would cause
- An explanation on how to get more information about the PDP
- An explanation on how to contact Medicare for information on other Part D plans that might be available
- An explanation on how joining the PDP plan will affect the member's current health coverage through the employer Summary of Benefits (this has to be sent with the letter)
In addition, employers should be aware that, in the event of a decision to disenroll from Blue MedicareRxSM, they are required to send out a disenrollment notice to the enrollees 21 days in advance of the disenrollment effective date. Once a disenrollment request is received by Blue MedicareRx, the plan generates two standard communications to the members notifying them of the upcoming disenrollment. However, it is also the responsibility of the employer to directly notify their enrollees. See attached letter template.
