Disclosure Requirements

50.4 - Disclosure Requirements (Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13) CMS has waived the specific disclosure requirements at 42 CFR 422.111 for employer/union group health plan beneficiaries when the employer/union sponsor is subject to alternative disclosure requirements (e.g., those required by the Employee Retirement Income Security Act of 1974 (“ERISA”)), and the employer/union sponsor complies with such alternative requirements. However, these alternative disclosure materials (including summary plan descriptions and all other beneficiary communications that provide descriptions of the Medicare benefit offerings) must be provided by the Direct Contract MAO, or the MAO offering the “800 series” plan or employer-sponsored individual MA plan to beneficiaries on a timely basis. Similarly, for an employer/union sponsor plan eligible for the alternative disclosure standards waiver, an MAO that offers “800 series” plans to these employer/union sponsors may provide copies of the alternative disclosure materials or, alternatively, information that would be necessary to satisfy its reporting and disclosure obligations under 42 CFR 422.516(d). 42 CFR 422.516(d) states that entities must furnish, upon request, the information that any employees’ health benefits plan needs to fulfill its reporting and disclosure obligations under ERISA. As a condition of CMS providing these particular waivers or modifications, CMS reserves the right to request and review these materials in the event of beneficiary complaints, or for any other reason it determines to ensure the information accurately and adequately informs Medicare beneficiaries about their rights and obligations under the plan. MAOs are also required to retain these dissemination materials and provide access to these written materials to CMS (or its designees) in accordance with 42 CFR 422.503(d) and 422.504(d) and (e).