§ 1395w–132.
(a)
Subsidy payment
(2)
Qualified retiree prescription drug plan defined
For purposes of this subsection, the term “qualified retiree prescription drug plan” means employment-based retiree health coverage (as defined in subsection (c)(1)) if, with respect to a part D eligible individual who is a participant or beneficiary under such coverage, the following requirements are met:
(A)
Attestation of actuarial equivalence to standard coverage
The sponsor of the plan provides the Secretary, annually or at such other time as the Secretary may require, with an attestation that the actuarial value of prescription drug coverage under the plan (as determined using the processes and methods described in
section 1395w–111(c) of this title) is at least equal to the actuarial value of standard prescription drug coverage, not taking into account the value of—
(C)
Provision of disclosure regarding prescription drug coverage
(3)
Employer and union special subsidy amounts
(B)
Cost threshold and cost limit applicable
(i)
In general
Subject to clause (ii)—
(I)
the cost threshold under this subparagraph is equal to $250 for plan years that end in 2006; and
(II)
the cost limit under this subparagraph is equal to $5,000 for plan years that end in 2006.
(C)
Definitions
For purposes of this paragraph:
(i)
Allowable retiree costs
(ii)
Gross covered retiree plan-related prescription drug costs
(4)
Qualifying covered retiree defined
(5)
Payment methods, including provision of necessary information
(6)
Construction
Nothing in this subsection shall be construed as—
(A)
precluding a part D eligible individual who is covered under employment-based retiree health coverage from enrolling in a prescription drug plan or in an MA–PD plan;
(B)
precluding such employment-based retiree health coverage or an employer or other person from paying all or any portion of any premium required for coverage under a prescription drug plan or MA–PD plan on behalf of such an individual;
(C)
preventing such employment-based retiree health coverage from providing coverage—
(i)
that is better than standard prescription drug coverage to retirees who are covered under a qualified retiree prescription drug plan; or
(ii)
that is supplemental to the benefits provided under a prescription drug plan or an MA–PD plan, including benefits to retirees who are not covered under a qualified retiree prescription drug plan but who are enrolled in such a prescription drug plan or MA–PD plan; or
(D)
preventing employers to provide for flexibility in benefit design and pharmacy access provisions, without regard to the requirements for basic prescription drug coverage, so long as the actuarial equivalence requirement of paragraph (2)(A) is met.
(b)
Application of MA waiver authority
The provisions of
section 1395w–27(i) of this title shall apply with respect to prescription drug plans in relation to employment-based retiree health coverage in a manner similar to the manner in which they apply to an MA plan in relation to employers, including authorizing the establishment of separate premium amounts for enrollees in a prescription drug plan by reason of such coverage and limitations on enrollment to part D eligible individuals enrolled under such coverage, and shall be applied in a manner to facilitate the offering of prescription drug benefits under a Program plan under
section 8903c of title 5, as required under subsection (h)(2) of such section, through employment-based retiree health coverage through—
(1)
a prescription drug plan; or
(2)
contracts between such a Program plan and the PDP sponsor of such a prescription drug plan..
([Aug. 14, 1935, ch. 531], title XVIII, § 1860D–22, as added [Pub. L. 108–173, title I, § 101(a)(2)], Dec. 8, 2003, [117 Stat. 2125]; amended [Pub. L. 111–152, title I, § 1101(b)(4)], Mar. 30, 2010, [124 Stat. 1039]; [Pub. L. 117–108, title I, § 101(b)(4)], Apr. 6, 2022, [136 Stat. 1137]; [Pub. L. 117–169, title I, § 11201(e)(5)], Aug. 16, 2022, [136 Stat. 1891].)