1.02
1.03
1.04
1.05
1.06
1.07
1.08
1.09
2.01
“Einal Reconciliation” shall mean the last payment request filing made by a Plan Sponsor
with respect to a Subsidy Application, as required by 42 CFR §423.888(b)(4).
“Member” shall mean an individual enrolled for prescription drug coverage under the Plan,
including an individual continuing coverage in accordance with the Consolidated Omnibus
Budget Reconciliation Act of 1985, as amended (“COBRA”).
“Plan Document” shall mean generally the written description of the benefits provided by
the Plan, the terms and conditions under which the Plan is operated and the standards and
tules governing the payment of benefits under the Plan.
“Plan Year” shall mean the period of time specified on a Plan Sponsor’s Subsidy
Application with respect to which Medicare Subsidy Payments are calculated and paid to the
Plan Sponsor.
“Retired Medicare Eligible Individual” or “RMEI” shall mean a Medicare Eligible
Individual who has retired.
“Subsidy Application” shall mean a Plan Sponsor’s request for Medicare Drug Subsidy
payments with respect to the Plan for a Plan Year, as permitted by 42 CFR §423.884(c)(1).
“Reconciled Plan Year(s)” shall mean any Subsidy Application for which Final
Reconciliation is completed before or during the effective term of this Agreement.
“Reopening” shall have the meaning provided in 42 CFR 423.890(d) with respect to a
Subsidy Application for a Reconciled Plan Year.
SECTION 2
PDA SERVICES
Specific PDA Services — Drug Subsidy. During the term of this Agreement, PDA shall
provide any or all of the following services as may be necessary to assist Plan Sponsor with
respect to Reopening Reconciled Plan years:
(a) General consultation regarding the Part D Program and assist in determining the
magnitude of potential Medicare Drug Subsidies as may be available to Plan
Sponsor;
(b) Assist in the identification of Retired Medicare Eligible Individuals who have not
elected drug coverage under Medicare Part D;
(c) Assist in obtaining, compiling and documenting detailed drug expenditure
information (including, by way of illustration only, the types of information listed in
Exhibit B attached hereto) from pharmacy benefit managers and other sources;
(d) Appoint a Medicare Drug Subsidy Account Manager for Plan Sponsor and Plan to
assist in the preparation and filing of a Reopening Request and, if granted, a new
Final Reconciliation with CMS for the Reconciled Plan Year and assist with follow-
up tasks as may be required by CMS, including cost reporting and payment requests
to CMS and Final Reconciliation; and
City of Nashua 2 SA Revised March 2016
