Subscriber Contributions for Medicare Part D Coverage Sample Clauses

Subscriber Contributions for Medicare Part D Coverage. This section applies xxxx xo Group’s Kaiser Permanente Senior Advantage coverage that includes Medicare Part D prescription drug coverage. Group’s Senior Advantage Monthly Premiums include the Medicare Part D premium. Group may determine how much it will require Subscribers to contribute toward the Medicare Part D premium for each Senior Advantage Member in the Subscriber’s Family Unit, subject to the following restrictions: (a) If Group requires different contribution amounts for different classes of Senior Advantage Members for the Medicare Part D premium, then Group agrees to the following: (i) any such differences in classes of Members are reasonable and based on objective business criteria, such as years of service, business location, and job category, and are not based on eligibility for the Part D Low Income Subsidy (the subsidies described in 42 C.F.R. Section 423 Subpart P, which are offered by the Medicare program to certain low-income Medicare beneficiaries enrolled in Medicare Part D, and which reduce the Medicare beneficiaries' Medicare Part D premiums and/or Medicare Part D cost- sharing amounts); and (ii) Group will not require different Subscriber contributions toward the Medicare Part D premium for Members within the same class. (b) Group will not require Subscribers to pay a contribution for prescription drug coverage for a Senior Advantage Member that exceeds the Monthly Premiums for prescription drug coverage (including the Medicare Part D premium). (c) Health Plan will credit Group with any Low Income Subsidy amounts that Health Plan receives from CMS for Group’s Members, and Health Plan will identify those Members for Group as required by CMS. For those Members, Group will first credit the Low Income Subsidy amount toward the Subscriber’s contribution for that Member’s Senior Advantage premium for the same month, and will then apply any remaining portion of the Member’s Low Income Subsidy toward the portion of the Senior Advantage premium that Group pays on behalf of that Member for that month. If Group is unable to reduce the Subscriber’s contribution before the Subscriber makes the contribution, Group shall, consistent with CMS guidance, refund the Low Income Subsidy amount to the Subscriber (up to the amount of the Subscriber Premium contribution for the Member for that month) within 45 days after the date Health Plan receives the Low Income Subsidy amount from CMS. Health Plan reserves the right to periodically require Group to ce...
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