CMS Pub. 100-16, ch. 9, § 50.2

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.”