South Dakota Information for Alternative Method of Counting Creditable Coverage

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US-334EM
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This form is used by an entity to request additional information to determine an individual's coverage with respect to a category of benefits.

South Dakota Information for Alternative Method of Counting Creditable Coverage South Dakota offers alternative methods of counting creditable coverage for individuals who may not have traditional health insurance but still have coverage that can be considered creditable. The alternative methods provide flexibility in meeting the requirement of having continuous creditable coverage, which is necessary to avoid any pre-existing conditions exclusions when transitioning between health insurance plans. One type of alternative method available in South Dakota is the Health Care Sharing Ministry (CCSM) program. HCS Ms are faith-based organizations that facilitate the sharing of medical expenses among members who have common ethical or religious beliefs. While not considered traditional health insurance, HCS Ms can be creditable coverage and allow individuals to maintain continuous coverage without any gaps. Another alternative method in South Dakota is the Qualified Health Plan (HP) Enrollment Pathway. This pathway allows individuals who are eligible for financial assistance through the Health Insurance Marketplace to select an HP but make a "3×30" payment directly to the health insurance carrier. This payment represents the monthly premium payment for the previous three months, ensuring continuous coverage. South Dakota also offers the option of using a student health plan as an alternative method of counting creditable coverage. Full-time students who are enrolled in a qualified student health insurance plan can use this coverage to satisfy the continuous creditable coverage requirement. It is important for individuals to understand the specific guidelines and requirements for each alternative method in South Dakota. They should consult with the South Dakota Department of Labor and Regulation or a licensed insurance professional for further information and to determine whether their chosen alternative method qualifies as creditable coverage. In summary, South Dakota provides various alternative methods of counting creditable coverage, such as Health Care Sharing Ministry programs, Qualified Health Plan Enrollment Pathway, and student health plans. These alternative methods allow individuals to maintain continuous coverage and avoid pre-existing condition exclusions when transitioning between health insurance plans. It is advisable to seek guidance from official sources to ensure compliance with South Dakota regulations.

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A certificate of Creditable Coverage (COCC) is a document provided by your previous insurance carrier that proves that your insurance has ended. This includes the name of the member to whom it applies as well as the coverage effective date and cancelation date.

Non-creditable coverage: A health plan's prescription drug coverage is non-creditable when the amount the plan expects to pay, on average, for prescription drugs for individuals covered by the plan in the coming year is less than that which standard Medicare prescription drug coverage would be expected to pay.

Creditable coverage is a health insurance, prescription drug, or other health benefit plan that meets a minimum set of qualifications. Types of creditable coverage plans include group and individual health plans, and student health plans, as well as a variety of government-sponsored or government-provided plans.

Typically, COBRA is not creditable drug coverage for Part D. However, if your plan is an exception, you'll have a Special Enrollment Period to join a Part D plan without a penalty. Refer to your plan administrator to confirm the creditability of your current drug coverage.

Medicare Advantage plans must offer benefits that are at least as comprehensive as Medicare Parts A and B. Therefore, all Medicare Advantage plans have creditable coverage.

Acceptable documentation includes: pay stubs that reflect a premium deduction, explanation of benefit forms (EOBs), a benefit termination notice from Medicare or Medicaid, and verification by a doctor or a former health care benefits provider of the individual's prior health coverage.

Group health plan sponsors are required to disclose to CMS whether their prescription drug coverage is creditable or non-creditable. This disclosure is required regardless of whether the health plan's coverage is primary or secondary to Medicare.

Evidence of Coverage (EOC) is a notice you receive from your Medicare Advantage or Part D plan in late September. It lists the plan's costs and benefits that will take effect on January 1 of the upcoming year. Review the EOC to see if the plan will meet your health care needs in the next year.

The Notice of Creditable Coverage works as proof of your coverage when you first become eligible for Medicare. Those who have creditable coverage through an employer or union receive a Notice of Creditable Coverage in the mail each year. This notice informs you that your current coverage is creditable.

The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription

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South Dakota Information for Alternative Method of Counting Creditable Coverage