This section provides an overview of the following topics related to Step 3: Request List of Covered Retirees:
The purpose of Step 3: Request List of Covered Retirees is to allow the Plan Sponsor to request a Covered Retiree List. The Covered Retiree List includes records for each Qualifying Covered Retiree (QCR), each Benefit Option, and each Subsidy Period approved by CMS' RDS Center. This list is finalized by the Authorized Representative or Account Manager. The Plan Sponsor assigns appropriate staff to review and validate the Covered Retiree List, since costs cannot be reported for the QCRs, Benefit Options, and Subsidy Periods not included in the Covered Retiree List.
Step 3: Request List of Covered Retirees is completed after Step 2 is complete. Step 3 is marked "Complete" on the Reconciliation Checklist after a Covered Retiree List is requested. A Covered Retiree List can be requested once per day, until Step 4: Finalize Covered Retirees is marked "Complete."
Step 3 must be marked "Complete" on the Reconciliation Checklist to proceed to the remaining steps.
Note: The Covered Retiree List is created by CMS' RDS Center and is available for download within approximately 15 minutes after the request. Because Step 3 requires an overnight batch process that is only performed during weekdays, if this step is initiated on a weekend or observed Federal holiday, the request is generated the next business day.
Step 3: Request List of Covered Retirees is completed by the Authorized Representative, the Account Manager, or Designee with Request Payment privilege.
There are two methods to download the Covered Retiree List.
The Account Manager, Authorized Representative, or Designee with View/Send/Receive Retiree Data privilege can download the Covered Retiree List from the Manage Retirees page on the RDS Secure Website.
The Account Manager, Authorized Representative, or Designee with both Request Payment privilege and View/Send/Receive Retiree Data privilege can download the Covered Retiree List using the Download Covered Retirees link on either the Step 3: Request Covered Retiree List page or Step 4: Finalize Retiree List page, which navigates to the Download Covered Retiree List page. If a Designee is not assigned both privileges, the download link for the Covered Retiree List is not active for that Designee.
For more information on downloading the Covered Retiree List, refer to Request a Covered Retiree List.
The Covered Retiree List includes all Qualifying Covered Retirees having at least one Benefit Option where at least one Subsidy Period exists. A separate record is created for each beneficiary, Benefit Option, and Subsidy Period combination. Only beneficiaries approved for at least one day of subsidy are included in the Covered Retiree List.
For more information on the format of the Covered Retiree List, refer to Covered Retiree List File Layout and Format.
Federal law requires that cost data be submitted only for the individual beneficiaries, Benefit Options, and Subsidy Periods listed in the Covered Retiree List.
If a retiree record that was expected to be on the Covered Retiree List is absent, or if any of the Subsidy Periods do not match the Plan Sponsor's internal records, the Plan Sponsor should verify that all Retiree Response Files and Weekly Notification Files for this application have been processed. After all files have been processed, the Plan Sponsor requests a new Covered Retiree List and compares the updated internal records to it.
If there are discrepancies in the Covered Retiree List, the Plan Sponsor submits an ADD/UPD/DEL Retiree File containing records for the beneficiaries in question when any of the following occurs:
If discrepancies cannot be resolved, the Plan Sponsor works with the beneficiary to validate all identifying information (for example, Date of Birth, HICN, or SSN) and Medicare coverage. The beneficiary may contact 1-800-Medicare to discuss any identifying information or coverage issues. If the Plan Sponsor is still unable to resolve the discrepancy, contact CMS' RDS Center for assistance.
After Step 3 is complete, the status of Step 3: Request List of Covered Retirees changes to "Complete" and the "Last Updated Date" and "Last Updated By" fields are updated accordingly. Step 3 is marked with a green check mark to indicate the step is complete and Step 4: Finalize Covered Retirees is marked with a blue arrow to indicate that it is the next step. The status of the application remains "Reconciliation Initiated."
This section provides step-by-step instructions to complete Step 3: Request List of Covered Retirees.
To access the RDS Secure Website, and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.
On the Reconciliation Checklist page:
Select Step 3: Request List of Covered Retirees.
On Step 3: Request List of Covered Retirees page:
Select Request Covered Retiree List to proceed or select Cancel to return to Step 3: Request List of Covered Retirees page without completing this step.