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RDS Program Components

Additional Program Tasks

Quick Access Reports (QAR)

Supplemental Information

Make Changes to an Application After Submission

User Roles:

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Program Components:

Annual Plan Application

This section explains what application information must be maintained after an application has been submitted and approved, how information should be maintained, and what application information cannot be changed.

Information That Must Be Maintained

Certain application information must be kept current throughout the Application Lifecycle, while some information may be modified at the Plan Sponsor's discretion.

Information regarding Qualifying Covered Retirees (QCRs) is critical to determining accurate subsidy payment and must be maintained by both the Plan Sponsor and CMS' RDS Center on a regular basis.

Verifiable banking information must be maintained on the application for CMS' RDS Center to render subsidy payments to the Plan Sponsor. If the Electronic Funds Transfer (EFT) information provided on the application fails to be verified by the Plan Sponsor's bank, the Plan Sponsor must correct the banking information and re-submit the application.

The role of Account Manager and Authorized Representative must always be active with a current valid user assigned.

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Who Can Change Application Information?

Application information is maintained by the Account Manager, Authorized Representative, or a Designee granted the appropriate privilege. Retiree data may also be supplied by a Vendor contracted by the Plan Sponsor or a Coordination of Benefits (COB) contractor.

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Information That May Not Be Changed

The following information may not be changed after submitting an application:

Plan Information (including Plan Year Start/End Date and Plan Description)

  • The Plan Description is not relevant to CMS' RDS Center and is not used for any reason other than to provide a reference to the Application ID that is generated by the Plan Name and Plan Start/End Dates as defined in the application. Consequently, a Plan Sponsor cannot change the Plan Name in its application once it is defined and submitted to CMS' RDS Center.
  • If the Plan Year Start/End Dates on the submitted application are incorrect, the Plan Sponsor must contact CMS' RDS Center.

Benefit Option - It is not possible to add, delete, rename, or change the Benefit Option once the application has been submitted to CMS' RDS Center, except for changing the Benefit Option Type.

  • To remove a Benefit Option from an approved application, it is necessary only to remove the retirees from that Benefit Option. For more information on removing retirees, refer to Managing Retiree Information.
  • When determining if it is necessary to ignore a Benefit Option previously defined in the application, remember to consider any impact to the Actuarial Attestation previously provided to CMS' RDS Center for that application. The application still needs to pass the Actuarial Equivalence Test. If a Benefit Option needs to be added to an approved application, contact CMS' RDS Center for assistance.

Assign Actuary - Once the Actuary completes and submits the online Actuarial Equivalence Test and the application is submitted, the Plan Sponsor may not change the Actuary assigned to the application.

Attestation Summary - Once the Actuary completes and submits the online Actuarial Equivalence Test and the application is submitted, the Actuarial Attestation may not be changed. However, if it is later determined that the plan and/or a Benefit Option do not pass the Actuarial Equivalence Test, the Plan Sponsor must contact CMS' RDS Center.

Payment Frequency - Once the application is submitted, the Payment Frequency cannot be changed. The chosen Payment Frequency applies to the application for the entire plan year, and the Plan Sponsor may select a different Payment Frequency when applying for the next plan year.

Plan Sponsor Agreement - Once the Authorized Representative signs and submits the Plan Sponsor Agreement, the Plan Sponsor Agreement may not be withdrawn.

If the Account Type, Account Number, or the Bank Routing Number is changed on the EFT Information page, the Authorized Representative must view, re-sign, and re-submit the Plan Sponsor Agreement to CMS' RDS Center. If a new Authorized Representative is assigned to the application, the Plan Sponsor Agreement does not need to be re-signed as the terms and conditions of the original Plan Sponsor Agreement remain unchanged.

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Notifying the Plan Sponsor When Changes Occur

In the case of critical data such as Qualifying Covered Retirees (QCRs), corresponding Subsidy Periods, and associated Benefit Options, CMS' RDS Center provides a Retiree Response File to the Plan Sponsor whenever a retiree file is received. CMS' RDS Center also provides a notification file to the Plan Sponsor whenever Medicare notifies CMS' RDS Center of an event that could impact a Plan Sponsor's ability to receive subsidy for a beneficiary.

If CMS' RDS Center is unable to verify the banking information provided on the application, CMS' RDS Center notifies the Plan Sponsor by email that the data must be updated. CMS' RDS Center also notifies the Plan Sponsor when role reassignments occur, Designee privileges are updated, and Electronic Funds Transfer (EFT) information is changed.

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Manage Retirees Through the Application Lifecycle

Retiree information must be continually managed throughout the Application Lifecycle so that the Plan Sponsor's records and CMS' RDS Center records accurately reflect QCRs, the corresponding Subsidy Periods, and the associated Benefit Options. The Retiree Electronic Data Interchange (EDI) Methods and Sources may be changed until Step 4 of Reconciliation is complete or the Reconciliation Deadline has passed. The Plan Sponsor can return to Step 7: Retiree Electronic Data Interchange (EDI) Methods and Sources and update or change the EDI information until Step 4 of Reconciliation is complete or the Reconciliation Deadline has passed.

Removing Retirees From a Benefit Option

A Benefit Option may not be changed or removed once the application has been submitted to CMS' RDS Center.

To remove a Benefit Option from an approved application, remove the retirees from that Benefit Option; the Benefit Option itself can stay within the application. To remove the retirees associated with the Benefit Option, the Plan Sponsor sends a Monthly Retiree List with delete transactions for only those associated retirees. If necessary, the Plan Sponsor should assign those retirees to other UBOIs as applicable. For more information on sending retiree files refer to Covered Retiree List.

Changing Retiree Electronic Data Interchange (EDI) Methods and Sources

The Retiree Electronic Data Interchange (EDI) Methods and Sources may be changed up until Step 4 of Reconciliation is complete or the Reconciliation Deadline has passed. The Plan Sponsor can return to Application Submission Process Step 7: Retiree Electronic Data Interchange (EDI) Methods and Sources and update or change the EDI information. However, if the Plan Sponsor is changing the Retiree List Submission Method to Mainframe, VDSA (Voluntary Data Sharing Agreement), or Mandatory Insurer Reporting (MIR), it is imperative that the Plan Sponsor does not change the Retiree List Submission Method until the appropriate connections to CMS' RDS Center are established and tested.

Changing the Retiree List Submission Method before the new connection is established jeopardizes the Weekly Notification File process. If the Plan Sponsor selects Mainframe, VDSA, or MIR as the Weekly Notification File Delivery Method before the connection is successfully established, CMS' RDS Center will be unable to send the Weekly Notification File until the connectivity is established.

The Plan Sponsor should consider the retirees that were submitted prior to the EDI Method or Source change and ensure that the Qualifying Covered Retirees' (QCRs') information matches the method or Plan Sponsor partner that is now assigned responsibility. The Plan Sponsor should then download the Covered Retiree List (CRL) for verification. Retirees that were submitted from a source that is no longer current should be removed using a Delete transaction and added using the new Retiree List Submission Method, or modified using an Update/Add transaction using the new Retiree List Submission Method, for the Plan Sponsor or Vendor to properly receive Notification Files.

For information about downloading the CRL, refer to Covered Retiree List.

The Retiree EDI Methods and Sources may be changed using the same process in which they were initially set. For information about how to change Retiree EDI Methods and Sources, refer to Complete Step 7: Retiree Electronic Data Interchange (EDI) Methods and Sources.

CMS Extranet Connection Setup Times:

  • For Plan Sponsors or Vendors with a CMS Extranet account and a connection to CMS' RDS Center, the setup takes 1 to 2 weeks.
  • For Plan Sponsors or Vendors with a CMS Extranet account but have no connection to CMS' RDS Center, the setup takes 1 to 2 months.
  • For Plan Sponsors or Vendors without a CMS Extranet account, the setup takes 2 to 3 months.
  • For Plan Sponsors using Coordination of Benefits (COB) with VDSA or MIR, the usual timeframe for completing the agreement and testing with the CMS COB contractor is 60 to 90 days for new agreements.

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Manage Electronic Funds Transfer (EFT) Information

Select a topic to learn how to manage Electronic Funds Transfer (EFT) information.

Introduction to Managing Electronic Funds Transfer (EFT) Information

EFT Information must be maintained on the application for CMS' RDS Center to send subsidy payments to the Plan Sponsor's bank. The Plan Sponsor may change EFT Information at their discretion or after CMS' RDS Center sends an email notification of payment or pre-note failure due to invalid or missing banking information. CMS' RDS Center validates certain information including Account Type, Account Number, and Bank Routing Number. If CMS' RDS Center is unable to validate this banking information, the application is marked "Application Error," the EFT section of the application is marked "Error - Needs Attention," and the Plan Sponsor is notified by email.

Notes:

  • If the Account Type, Account Number, or Bank Routing Number is changed, the Authorized Representative must re-sign the Plan Sponsor Agreement. Changing this information impacts CMS' RDS Center's ability to process the EFT Information and may cause the pre-note to fail.
  • If information other than the Account Type, Account Number, or Bank Routing Number is changed, the Plan Sponsor Agreement does not need to be re-signed and the terms and conditions of the original Plan Sponsor Agreement remain unchanged.

Some helpful hints when changing EFT Information are:

  • Verify with your internal finance department that the bank has not merged or been purchased by another bank. If so, the Bank Routing Number may have changed.
  • Verify with your internal finance department that the Bank Routing Number is for ACH (Automated Clearing House), not Wire Transfers.
  • Verify with your internal finance department that the account is active.

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Impact to the Application When EFT Information is Changed

EFT Information may be changed on submitted applications in any of the following statuses: "Approved," "Application Error," and "EFT Re-sign Application."

The following three scenarios outline how an application is processed after EFT Information on an application is changed and sent to CMS' RDS Center for processing:

Scenario 1: Plan Sponsor changes Account Type, Account Number, or Bank Routing Number

When the Account Type, Account Number, or the Bank Routing Number is changed, an email notification is sent to the Authorized Representative stating that changes have been made to EFT Information. The Authorized Representative must view, re-sign, and re-submit the application in order for the EFT validation to be performed. The application status changes to "EFT Re-sign Application" until the Authorized Representative validates this information by re-signing the Plan Sponsor Agreement. After the application is re-submitted with the new EFT Information, the application is placed back into the "Submitted" status until the revised EFT Information can be verified by CMS' RDS Center.

Scenario 2: Plan Sponsor changes EFT Information other than Account Type, Account Number, or Bank Routing Number OR does not change EFT Information while the application is currently in "Approved" status and the EFT section is in "Verified" status

If any information on the Edit Electronic Funds Transfer (EFT) Information page other than the Account Type, Account Number, or Bank Routing Number is changed, the information is submitted and does not require the Authorized Representative to re-sign the application. After the EFT Information Verification page is confirmed, the application section and EFT section statuses do not change. The information is re-saved and the application is then placed in an "Approved" status.

Scenario 3: Plans Sponsor changes EFT Information other than Account Type, Account Number, or Bank Routing Number OR does not change EFT Information while the application is currently in "Application Error" status and the EFT section is in "Error - Needs Attention" status

This scenario results after the pre-note fails because of a bank processing error. The Plan Sponsor re-enters the Account Number and re-enters the Bank Routing Number on the Edit EFT Information page. The application is then set to an "Approved" status if the application was previously "Approved" or set to "Submitted" if pending approval. The EFT section is set to "Verification Pending." The pre-note is generated and sent to the Plan Sponsor's bank. After the pre-note is successful, the EFT section is set to "Verified" status.

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Communication of EFT Information Changes to the Plan Sponsor

An email confirmation of application changes is sent to the Authorized Representative, Account Manager, and Designee with Complete Electronic Funds Transfer (EFT) Information privilege only when EFT Information including Account Type, Account Number, or Bank Routing Number is modified.

An email notification regarding EFT failures is sent to the Authorized Representative, Account Manager, and Designee with Complete Electronic Funds Transfer (EFT) Information privilege.

CMS' RDS Center recommends that the Plan Sponsor notify their bank prior to CMS' RDS Center sending a $0 pre-note for approval.

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Step-by-Step Instructions to Change EFT Information

This section provides step-by-step instructions to change Electronic Funds Transfer (EFT) information.

EFT Information may be changed on submitted applications in any of the following statuses: "Approved," "Application Error," and "EFT Re-sign Application."

On the Application Status page:

  1. Select Step 5: Electronic Funds Transfer (EFT) Information.

On the View Electronic Funds Transfer (EFT) Information page:

  1. Select Edit to make changes or select Cancel to return to the Application Status page.

     Select [Edit]

On the Edit Electronic Funds Transfer (EFT) Information page:

  1. Enter the updated information.
  2. Select Continue to proceed and return to the Application Status page. Select Clear Form to remove all data from this form. Select Cancel to return to the Application Status page.

     Select [Continue]

    Note: Plan Sponsors should verify with their internal finance department that the EFT banking information is correct before submitting the information to CMS' RDS Center. After confirming the EFT banking information internally, Plan Sponsors should exercise care when entering the information to ensure prompt verification of the EFT Information and avoid rework on the application.

On the Electronic Funds Transfer (EFT) Information Verification page:

  1. Review the information.
  2. Select the checkbox to confirm that you notified the Authorized Representative to re-sign the Plan Sponsor Agreement.

    Note: The checkbox is enabled only if the Account Type, Account Number, or Bank Routing Number is changed. If information other than the Account Type, Account Number, or Bank Routing Number is changed, the Plan Sponsor Agreement does not need to be re-signed and the terms and conditions of the original Plan Sponsor Agreement remain unchanged.

  3. Select Continue to proceed, select Edit to make changes or select Cancel to return to the Application Status page.

     Select [Continue]

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