Customizing Medicare Disclosure Materials and Election Forms

50.2 – Customizing Medicare Disclosure Materials and Election Forms (Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13) In order to meet the requirements of 42 CFR 422.111(a)(2), which require an MA plan to disclose information about the plan in a clear, accurate and standardized form, MAOs should provide customized disclosure materials to “800 series” and Direct Contract MA plan enrollees to reflect the modified/supplemental benefits being provided to that particular employer/union group health plan enrollees, if any. More specifically, CMS has waived any rules that would otherwise prohibit these entities from offering customized disclosure materials to the extent those customized materials will more clearly and accurately describe the benefits available to employer/union group Medicare beneficiaries (for example, when the supplemental coverage is taken into account). This waiver also allows customization of disclosure materials for employer- sponsored enrollments in individual MA plans (e.g., where an employer/union group health plan sponsors coverage to its members using an individual MA plan and a non-Medicare supplemental plan designed to “wrap around” or enhance the individual MA plan. Premium amounts are required to be accurately reflected on any customized beneficiary disclosure material. MAOs should ensure these materials accurately reflect the actual premium amount the beneficiary pays when the supplemental coverage, if any, and any corresponding employer/union premium subsidization (or subsidization by CMS in the case of low-income premium subsidy eligible beneficiaries) is taken into account. Alternatively, if accurate premium information concerning the amount the beneficiary actually pays is not available to the MAO, the MAO may substitute language in lieu of providing actual premium amounts. Such language may include, for example, “For information concerning the actual premiums you will pay, please contact [insert employer/union group health plan sponsor name] or your employer group benefits plan administrator.”