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RDS Program Components

Additional Program Tasks

Quick Access Reports (QAR)

Supplemental Information

Step 4: Finalize Covered Retirees

User Roles:

AM

AR

D

Program Components:

Reconciliation

Overview

This section provides an overview of the following topics related to Step 4: Finalize Covered Retirees:

Introduction to Step 4: Finalize Covered Retirees

The purpose of Step 4: Finalize Covered Retirees is for the Plan Sponsor to agree to the Covered Retiree List provided by CMS' RDS Center. The Covered Retiree List includes all of the Qualifying Covered Retirees (QCRs), corresponding Subsidy Periods, and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled. The Plan Sponsor is able to view Annual and Monthly unique retiree counts for each plan month.

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Timing for Step 4: Finalize Covered Retirees

Step 4: Finalize Covered Retirees is completed after Step 3 is complete. To complete Step 4, a Covered Retiree List must be requested, created by CMS' RDS Center, and downloaded.

To complete Step 4, the following conditions must be met:

  • A Covered Retiree List must be requested since the last response file or notification file was created. If this has not occurred, the following warning appears in red at the top of the Step 4: Finalize Covered Retirees page: "A Retiree Response File or Weekly Notification File was created after the last Covered Retiree List was created. You must request another Covered Retiree List before you can finalize Reconciliation Step 4."

    Note: During Reconciliation, the Covered Retiree List must be requested in Step 3: Request List of Covered Retirees, not outside of Step 3.

  • The last requested Covered Retiree List must be created. If this has not occurred, the following warning appears in red at the top of the Step 4: Finalize Covered Retirees page: "A new Covered Retiree List was requested and will not be available for download until the next business day. Step 4 cannot be finalized when there is an outstanding Covered Retiree List request."

    Note: Covered Retiree Lists are now available for download within approximately 15 minutes from the time of the request. This warning message will be updated at a later date.

  • The last created Covered Retiree List has been downloaded. If this has not occurred, the following warning appears in red at the top of the Step 4: Finalize Covered Retirees page: "A new Covered Retiree List is available for download. Step 4 may not be completed until the Covered Retiree List has been downloaded."

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User Role Responsibilities for Step 4: Finalize Covered Retirees

Step 4: Finalize Covered Retirees may only be completed by the Authorized Representative or the Account Manager. Designees with Request Payment privilege may view this step but cannot complete it.

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Verifying the Covered Retiree List in Step 4

Federal law requires that the Plan Sponsor submit cost data only for the Qualifying Covered Retirees (QCRs), corresponding Subsidy Periods, and the Benefit Option in which the QCR is enrolled. By completing the Finalize Covered Retirees step, the Plan Sponsor is agreeing to the accuracy of the Covered Retiree List. When the Covered Retiree List is finalized, CMS' RDS Center stops all retiree processing for that application.

When Step 4: Finalize Covered Retirees is marked "Complete" on the Reconciliation Checklist or the Reconciliation Deadline has passed for that application, the following is true:

  • The Plan Sponsor is unable to upload retiree files using the RDS Secure Website.
  • Any retiree list submitted through the Mainframe, VDSA, or MIR will not be processed by CMS' RDS Center. Retiree files are rejected for the application and Response Files are sent with Reason Code 28 indicating the rejection.
  • CMS' RDS Center no longer creates or sends Weekly Notification Files.
  • Medicare Part D Enrollment Rejection Notifications are no longer posted to the RDS Secure Website.
  • An email is sent to the Authorized Representative, Account Manager, and Designee with View/Send/Receive Retiree Data privilege informing them that retiree processing has stopped.

Note: Retiree files should continue to be sent to CMS' RDS Center until the Covered Retiree List is validated and finalized during Reconciliation.

Validation of the Covered Retiree List in Step 4

The Covered Retiree List may be validated by the persons responsible for coordinating retiree eligibility for the Benefit Options within the application. The Plan Sponsor must work with all Cost Reporters to ensure that the cost data being reported is only for the Qualifying Covered Retirees and Subsidy Periods listed in this file.

Note: Be sure Cost Reporters are aware of the need to coordinate Cost Thresholds and Cost Limits within an application for each Qualifying Covered Retiree.

Discrepancies in the Covered Retiree List in Step 4

After Step 4: Finalize Covered Retirees is complete and despite a Plan Sponsor's best efforts to ensure that the retiree data reflected in the Covered Retiree List is accurate, there may be instances where a Plan Sponsor becomes aware of changes to its Qualifying Covered Retirees after it has completed Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retiree, but before it has completed Step 12.

Such changes include adding or deleting Qualifying Covered Retirees, changes to the approved Subsidy Periods, or changes in which Benefit Option a Qualifying Covered Retiree is enrolled. In such cases, the Plan Sponsor must contact CMS' RDS Center prior to the completion of Step 12, to request that Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees be changed to an "Incomplete" status.

When Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees are changed to an "Incomplete" status after they have been completed, ALL other Reconciliation steps completed, beginning with Step 3: Request List of Covered Retirees, are changed to an "Incomplete" status and must be completed again. However, the application's Reconciliation Deadline date does not change.

Please be aware that it can take CMS' RDS Center up to 5 business days to change Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees from "Complete" to "Incomplete" status.

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What Happens After Step 4: Finalize Covered Retirees Is Complete

After Step 4 is complete, the status of Step 4: Finalize Covered Retirees changes to "Complete" and the "Last Updated Date" and "Last Updated By" fields are updated accordingly. Step 4 is marked with a green check mark to indicate the step is complete and Step 5: Start Preparation of Reconciliation Payment Request is marked with a blue arrow to indicate that it is the next step. The status of the application remains "Reconciliation Initiated."

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Step-by-Step Instructions

This section provides step-by-step instructions to complete the following steps for Step 4: Finalize Covered Retirees:

Download the Covered Retiree List in Step 4: Finalize 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:

  1. Select Step 4: Finalize Covered Retirees.

     Select [Finalize Covered Retirees]

On the Step 4: Finalize Covered Retirees page:

  1. Select Download Covered Retirees to download the Covered Retiree List.

     Select [Download Covered Retirees]

On the Download Covered Retiree List page:

  1. Download the Covered Retiree List.
  2. Select Return to Finalize Covered Retirees to return to the Step 4: Finalize Covered Retirees page.

     Select [Covered Retiree List], Select [Return to Finalize Covered Retirees]

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View Monthly Retiree Counts in Step 4: Finalize 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:

  1. Select Step 4: Finalize Covered Retirees.

     Select [Finalize Covered Retirees]

On the Step 4: Finalize Covered Retirees:

  1. Select View Monthly Counts in the Actions column of the Plan Year Retiree Count By Benefit Option table.

     Select [View Monthly Counts]

On the Benefit Option Monthly Retiree Count page:

  1. Review the monthly retiree counts and select Continue to return to Step 4: Finalize Covered Retirees page.

     Select [Continue]

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Complete Step 4: Finalize 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:

  1. Select Step 4: Finalize Covered Retirees.

     Select [Finalize Covered Retirees]

On the Step 4: Finalize Covered Retirees page:

  1. Select the checkbox to indicate that the warnings and instructions have been read.
  2. Select Submit to finalize the Covered Retiree List or select Cancel to return to the Reconciliation Checklist page without completing this step.

     Select [Agreement Checkbox], Select [Submit]

On the Step 4: Finalize Covered Retirees Verification page:

  1. Select Confirm to finalize Covered Retirees or select Cancel to return to Step 4: Finalize Covered Retirees page without completing this step.

     Select [Confirm]

On the Step 4: Finalize Covered Retirees Confirmation page:

  1. Select Continue to return to the Reconciliation Checklist page.

     Select [Continue]

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