Non‑creditable when pharmacy benefit absent or unevaluated

If there is no prescription pharmacy benefit, the product is NOT CREDITABLE. If a prescription pharmacy benefit/form is not on this list it was not evaluated; providers should reach out for assistance.

• No prescription pharmacy benefit = NOT CREDITABLE
• Unevaluated pharmacy benefit/forms require contacting the issuer for assistance

Informational: plan creditable coverage listings (Pass)

This section lists plan-level creditable coverage determinations (Creditable Coverage Determination = Pass) and associated attributes; the excerpt does not specify any prior authorization, denial risk, or step therapy actions.

• Creditable Coverage Determination = Pass for listed plans
• Pharmacy Benefit Rider values (e.g., In Base) and Deductible Rider (Optional) noted

Creditable coverage plan listings (Pass) — no authorization rules

Plan identifiers are listed with Creditable Coverage Determination = Pass; the excerpt does not include prior authorization, denial risk, documentation, or billing rules related to these entries.

• Each listed plan row shows Creditable Coverage Determination = Pass
• No authorization, denial, documentation, or billing rules stated in these chunks

NY plan-level creditable coverage status: Pass

For each listed New York (NY) plan in this segment, the Creditable Coverage Determination is documented as Pass and plan-level attributes (e.g., Pharmacy Benefit Rider = In Base, Deductible Rider (Optional) = No) are recorded.

• Creditable Coverage Determination = Pass for each NY plan listed
• Pharmacy Benefit Rider commonly recorded as In Base; Deductible Rider (Optional) commonly No
• Minimum integrated HRA contribution fields are present but blank in these entries

Plan-level creditable coverage summary (NY) — Pass

This section summarizes NY plan IDs and attributes; most listed NY products show Creditable Coverage Determination = Pass and pharmacy benefit rider details (In Base or In Base + Optional Rider).

• Many NY plan entries: Creditable Coverage Determination = Pass
• Pharmacy Benefit Rider entries indicate whether pharmacy benefits are In Base or In Base + Optional Rider
• Minimum integrated HRA contribution values are shown but often left blank

Creditable coverage pass status and attributes for NY products

Multiple NY product entries list Creditable Coverage Determination = Pass and include plan attributes such as Pharmacy Benefit Rider, Deductible Rider (Optional), Rider Changes Integrated Prescription Benefit codes when applicable; no clinical authorization or billing actions are specified here.

• Creditable Coverage Determination = Pass for listed NY products
• Pharmacy Benefit Rider and Deductible Rider (Optional) recorded per product
• Rider change codes (e.g., RXNY7EPO616XL) appear where applicable

Plan listing: creditable coverage = Pass (NY)

This plan listing enumerates NY plan identifiers with attributes and records their Medicare Creditable Coverage Determination as Pass; the excerpts do not specify provider-level prior authorization, denial, or step therapy requirements.

• Each listed plan: State = NY, High Level Product Line = EPO/PPO, Size often = Large, Creditable Coverage Determination = Pass
• Minimum integrated HRA contribution fields included but frequently blank

Creditable coverage summary for listed NY plans (Pass)

Multiple NY individual and small‑group plan IDs are listed with Creditable Coverage Determination = Pass; Pharmacy Benefit Rider is commonly In Base and Deductible Rider (Optional) is noted as No for these entries.

• Creditable Coverage Determination = Pass for each listed NY plan
• Pharmacy Benefit Rider typically = In Base; Deductible Rider (Optional) = No
• Minimum integrated HRA contribution to meet creditable coverage is shown but blank in many entries

Plan-level creditable coverage attributes — provider reference

Plan entries include identifiers, marketing names, pharmacy benefit rider status, deductible rider optional status, integrated prescription benefit change indicators, state, product line, market size, and Creditable Coverage Determination (Pass or Fail); providers should reference these attributes when confirming plan creditable status.

• Creditable Coverage Determination recorded per plan (Predominantly 'Pass')
• Fields captured: Pharmacy Benefit Rider, Deductible Rider (Optional), Rider Changes Integrated Prescription Benefit, State, High Level Product Line, Size, Marketing Name
• Minimum integrated HRA contribution fields included but often blank

Creditable coverage listing for VT products — Pass

For Vermont (VT) product codes listed, the document designates Creditable Coverage Determination = Pass and records Pharmacy Benefit Rider = In Base and Deductible Rider (Optional) = No for many entries; no authorization, denial risk, or step‑therapy actions are specified in this section.

• VT product entries: Creditable Coverage Determination = Pass
• Pharmacy Benefit Rider = In Base for many VT products
• Deductible Rider (Optional) = No in many VT entries
• Minimum integrated HRA contribution fields present but blank