US · guidance
CMS Pub. 100-18, ch. 12, § 20.16.3
Financial Solvency
The financial solvency requirements for employer/union Direct Contract EGWPs are set forth
in Appendix I of the 2009 Solicitation for Applications for New Employer/Union Direct
Contract Prescription Drug Plans (PDP) Sponsors, dated January 24, 2008. CMS requires that
the entity demonstrate that its fiscal soundness is commensurate with its financial risk and that
through other means, the entity can assure that claims for benefits paid for by CMS and
beneficiaries will be covered. In all cases, CMS will require that the employer/union
sponsor’s contracts and sub-contracts contain beneficiary hold harmless provisions as
described in Appendix I and in other CMS guidance. The employer/union may request
waivers/modifications of the requirements in Appendix I by completing Appendix III
(“HPMS Technical Plan Bidding Instructions for Organizations Offering Part D
Employer/Union-Only Group Waiver Plans in Contract Year 2009). CMS may, at its
discretion, approve requests for such waivers/modifications on a case-by-case basis.
History
(Rev.6, Issued: 11-07-08, Effective/Implementation: 11-07-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
260c52c4cc496e0d3221f26f2a98f86a458ca75a36ec451c12ba4fc5521a38cf
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