CMS Pub. 100-18, ch. 12, § 20.3.2.2

CMS has waived the specific dissemination requirements of 42 CFR 423.128 for

employer/union group health plan beneficiaries when the employer/union sponsor is subject to

alternative dissemination 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 dissemination 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 PDP or the PDP

sponsor offering the “800 series” plan or employer-sponsored individual PDP to beneficiaries

on a timely basis.

Similarly, for an employer/union sponsor plan eligible for the alternative dissemination

standards waiver referenced above in section 20.3.2.1.2, a PDP sponsor that offers “800

series” plans to these employer/union sponsors must retain copies of these alternative

dissemination materials or, alternatively, the information that would be necessary to satisfy its

reporting and disclosure obligations under 42 CFR 423.514(d). 42 CFR 423.514(d) provides

that entities must furnish, upon request, the information that any employees’ health benefits

plan needs to fulfill its reporting and disclosure obligations under ERISA.

However, 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. PDP

sponsors also will be required to retain these dissemination materials and provide access to

these written materials to CMS (or its designees) in accordance with 42 CFR 423.504(d) and

423.505(d) and (e).