Prior to enrolling in the COSE MEWA, all employers must read and agree to the administration and compliance guidelines. Employers are also required to provide a Summary of Benefits and Coverage (SBC). Please see the below links for detailed information on employer requirements, plan SBCs, Underwriting Guidelines and more.
- Administration and Compliance Guide
- Medical Summary of Benefits and Coverage
- Medicare Exception Process and Forms
Because this is a MEWA, if at least one Participating Employer has at least 20 full and/or part time employees, Medicare is deemed to be secondary even for Participating Employers having fewer than 20 employees. However, there is an exception process for certain individuals entitled to Medicare on the basis of age for a Participating Employer with fewer than 20 employees.
In order to apply for this exception (and avoid the associated costs for the employee and your business), if you have a Participant and/or Participants spouse that become eligible for Medicare, you must provide a notice in writing for whom the Participating Employer is requesting Medicare be the primary payer. Written notice must be provided to those employees prior to them turning 65. Each Participating Employer must also send to Medical Mutual any required census data or application form requested by Medical Mutual. For more information, please contact your broker or sales representative.
- Underwriting Guidelines
- Employer Requirements
- Employee Newsletter
- CHIPRA Form
- Medicare Part D
A prescription drug plan is considered “creditable” if its benefits are at least as good as government-defined Medicare Part D prescription drug plans. To help Medicare-eligible participants decide whether or not to sign up for Part D coverage, group health plan sponsors are required by the federal government to send Medicare Part D (prescription drug) “creditable coverage” notices to their Medicare-eligible employees and dependents at various times during each year.
As a courtesy, Medical Mutual will send your Medicare-eligible plan participants (employees and dependents) their annual notice by the CMS deadline in October of each year. Medicare eligibility of your plan participants is based on information in Medical Mutual’s system – participants who either will be age 65 or older at any time during the year, or who are under age 65 but otherwise qualify for Medicare due to disability. If you know of other individuals covered by your plan who are eligible for Medicare but you have not communicated this information to Medical Mutual, it is your responsibility to notify those participants.
The COSE MEWA offers 16 plans to participating employers and their employees. 15 of those 16 plans are creditable regardless if the participant is Medicare Primary or Medicare Secondary.
For the HSA 4000 MMRx plan:
- If Medicare pays Primary to group coverage, then this plan is NOT creditable.
- If Medicare pays Secondary to group coverage, then this plan IS creditable.
If you have any questions about the creditable coverage notice or your responsibility to provide it to your Medicare-eligible participants and dependents, please contact your Medical Mutual representative or broker.