- On October 14, 2025
Medical Mutual, MHS, Paramount Sending Annual Creditable Coverage Letters
Topic: Broker Relations | Companies: Medical Mutual, Paramount, Mutual Health Services | Segment: Individual, Small Group (1-50), 51-99, 100+, MEWA
Employer groups are required by law to send an annual notification to members who are currently or will become eligible for Medicare during 2026 regarding their prescription drug plans’ creditable (at least as good as the base Medicare Part D plan design) status related to Medicare Part D coverage.
In October, Medical Mutual sent the required annual notifications to individual customers and, as a courtesy, to members of its small group customers (1-50), and Multiple Employer Welfare Arrangement (MEWA) groups with 1 to 50 eligible employees. Mutual Health Services (MHS) and Paramount also sent letters to their applicable customers.
In addition, letters were sent to the group official of each plan with a Medicare-eligible employee, dependent or retiree to whom we mail a creditable coverage notice. The letter reminds group officials of their responsibility to provide notices to eligible employees and dependents at all other times as required by law.
Creditable status for members is determined based on benefit designs as of Aug. 15, 2025, for Medical Mutual and MHS and Sept. 25, 2025, for Paramount. If a member’s plan has a benefit design change between those dates, and the date the letter is received, the prescription drug plan’s creditable status may change. We will not systematically send new letters to the members; it is the group’s responsibility
to do so.
It remains the responsibility of mid-size (51-99) and large (100+) groups to determine their own creditable or non-creditable status and to notify its members accordingly, both for the annual notice requirements and at all other times as required by law.
Disclosure to CMS
All employers, regardless of funding type or group size, are required to log into the Centers for Medicare and Medicaid Services (CMS) website and notify the government of their health plan’s creditable status by completing the disclosure process. Additional information is available in the Creditable Coverage section of CMS’ website.
Creditable Prescription Drug Plans Flyer
To help determine the credibility status of groups’ prescription drug coverage, a flyer has been created, which provides “creditable” examples of freestanding prescription drug plans (members have separate cost-sharing amounts for prescription drugs and medical coverage) and major medical drug plans (members have combined cost-sharing for prescription drugs and medical coverage).
When reviewing the charts, a comparison can be made between a group’s plan and the examples. A determination can be made as to whether a group’s benefits are the same as or richer (i.e., member cost-sharing is less) than the examples:
- If yes, the group’s plan is considered creditable.
- If no (i.e., a group’s benefits are less rich and, therefore, the member cost-sharing is more than the examples), the group should consult with its legal benefits and tax counsel to determine creditability.
- If a group’s plan does not follow any of the examples provided, the group should consult with its legal benefits and tax counsel to determine the plan’s creditability.
Introducing MedMutual Simple Life
Topic: Product News | Companies: MedMutual Life | Segment: Small Group (1-50), MEWA
To make life insurance more accessible for small groups, a new plan option called MedMutual Simple Life is now available from MedMutual Life.
MedMutual Simple Life combines Basic Life and Accidental Death & Dismemberment (AD&D) coverage into one affordable, straightforward plan. Employers can select from five coverage levels, with flat monthly rates starting at just $4 per employee for predictable budgeting and easy administration. MedMutual Simple Life is available to groups of 1-50 employees and requires 100% employer contribution.
For even more savings, MedMutual Simple Life plans of $25,000 or more are eligible for the MedMutual Multi-policy Bundling Credit, which offers groups of 1-50 up to $8,000 savings when bundling health, dental, life and indemnity plans from the Medical Mutual family of companies.
Gag Clause Reporting Responsibilities Reminder
Topic: Legal | Companies: Medical Mutual, Paramount, Mutual Health Services | Segment: Small Group (1-50), 51-99, 100+, MEWA
Gag Clause Prohibition Compliance Attestation (GCPCA) reporting must be submitted annually by Dec. 31. Please note that Medical Mutual will either submit the GCPCA reporting for groups, or we will alert select group partners that they must submit on behalf of their company.
Medical Mutual will submit the GCPCA reporting for the following groups and will alert them to the submission:
- Medical Mutual groups (Fully Insured 100+, Small Group (1-99), COSE Benefit Plan, GCADA, ODAWT and Balanced Solutions)
- Important: While Medical Mutual has historically directly notified Small Groups (1-99) that we will be filing and submitting GCPCA reporting for them, we will not this year. Brokers are encouraged to let their small Medical Mutual groups know that we will be submitting GCPCA reporting for them.
- All Paramount groups
The following groups must submit their own attestations; however, Medical Mutual and Mutual Health Services (MHS) teams will reach out with a reminder before the annual submission date:
- Medical Mutual Self-Funded groups besides those listed above
- Medical Mutual Groups with 12/2/25 or later effective dates
- MHS Self-Funded groups
Medical Mutual will only submit the attestation for the timeframe the group was effective with Medical Mutual. If your group was effective any part of the year with another carrier or TPA, the group must coordinate the attestation with that carrier.
At this time, there is no action needed from our broker partners unless they want to notify their small Medical Mutual groups, but please be aware that some groups will receive a communication from Medical Mutual.
Please contact your ExpressLink representative with any questions.