NOTICE: CMS Part D Notice of Creditable or Non- Creditable Coverage When you or a family member becomes eligible for Part D (Medicare’s prescription drug benefit), it is important to understand when to enroll in Part D. You can wait as long as you maintain “creditable” coverage (i.e., coverage which on average expects to pay at least as well as Part D expects to pay on average). But if you do not have creditable coverage, you need to enroll in Part D at the earliest opportunity to avoid future penalties. Below are highlights to note: • A continuous break in creditable coverage of 63 or more days will trigger a late enrollment penalty payable for life. • The longer you go without creditable coverage, the higher the penalty. For the rest of your life, you would be charged an additional 1% of Part D base premium for each month you are late. • When creditable coverage ends, a special enrollment period of two (2) months may be provided to enroll in Part D (but note that this is only available when normal coverage ends, not when retiree or COBRA coverage ends). • The Part D annual open enrollment occurs each year from October 15th through December 7th for coverage to begin January 1st. The information below indicates whether prescription drug coverage under our plan is creditable.
Creditable Coverage
Non-Creditable Coverage
Cigna Plans: (HMO 500 & HMO) 1500) Kaiser Plans: (DHMO 500 & DHMO Plus 1500)
None (all plans are creditable)
Anyone needing to learn more about Medicare should contact a Medicare-approved counselor in their state at https://www.shiphelp.org . REMEMBER: If you have creditable coverage through our plan, keep this Notice as proof. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this Notice when you join to show you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date:
11/01/2024
Name of Entity/Sender:
Jefferson Center for Mental Health
Contact:
Human Resources | Colorado
43 A special enrollment right also arises for employees and their dependents who lose coverage under a state Children's Health Insurance Program (CHIP) or Medicaid or who are eligible to receive premium assistance under those programs. The employee or dependent must request enrollment within 60 days of the loss of coverage or the determination of eligibility for premium assistance. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, see the contact information at the end of these notices. NOTICE: WOMEN’S HEALTH AND CANCER RIGHTS ACT (WHCRA) Did you know that your plan, as required by the Women's Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymphedema)? For more information, see the contact information at the end of these notices. NOTICE: SPECIAL ENROLLMENT RIGHTS If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stopped contributing towards the other coverage). However, you must request enrollment within 30 days after you or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).
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