Crosswalk CY 2022 EOB

Part D Model EOB Crosswalk
2022 (old version)

2023 (new version)

Throughout

Throughout: Updated contract year from 2022
to 2023.

Cover page

Reorganized how beneficiary information and
resources are presented.

Phone number for non-English speaking
beneficiaries located to left of page

Beneficiary name and address information
located on left margin

Phone number for non-English speaking
beneficiaries moved to bottom right of page

Centered beneficiary name and address
information.

Type of
Change
Rev

Reason for
change
Accuracy

Rev

Clarity

Rev

Clarity,
accessibility

Rev

Clarity,
visibility

Beneficiary Medicare Number and Date of
Claims Processed added into grey box

Helpline number for plan located on first
page

Added “If you have questions, please call….”
to footer from 2nd page of EOB on to the end of
the document.

Add

Clarity

Chart 1 Your prescriptions for covered
Part D drugs

Reformatted as:
Chart 1 Your MONTHLY prescriptions for
covered Part D drugs

Rev

Clarity

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.

Burden
Change
No

No

No

No

No

No

2022 (old version)

2023 (new version)

“What happens next?” located after
chart

Reformatted “What happens next?” as
separate box and placed on same page as
payment stage chart

CHART 2.
Your prescriptions for drugs
covered by our plan’s
Supplemental Drug Coverage

Reformatted to read as:
CHART 1A
Your prescriptions for drugs covered
by your plan’s
Supplemental Drug Coverage
Your Supplemental Drug Coverage pays
for some drugs not generally covered by
Medicare. Any prescriptions you filled
for these drugs this month are listed in
the chart below. The amounts paid for
these drugs do not count toward your
out-of-pocket costs* or total drug costs.

This chart shows your
prescriptions for drugs
that are not generally
covered by Medicare.
These drugs are covered for you
under our plan’s Supplemental
Drug Coverage.
•

Year-to-date totals

Moved location from after Chart 1 to
after Chart 1A and reformatted to read
as:
CHART 2
Your YEARLY spending totals for
covered Part D drugs

Type of
Change
Rev

Rev

Rev

Reason for change

Burden
Change

Clarity

No

Clarity, consistency

No

Clarity, consistency

No

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.

2022 (old version)

2023 (new version)

Definitions of Yearly Deductible
Initial Coverage
Coverage Gap
Catastrophic Coverage located
within drug payment stage chart

Moved definitions of Yearly Deductible
Initial Coverage
Coverage Gap
Catastrophic Coverage after Chart 3
and reformatted to read as bullet points

SECTION 4. Updates to the
plan’s Drug List that affect drugs
you take

Revised to read:
Chart 4
Changes to our Drug List that affect
drugs you take

Type of change: in bullet point
form.
“We are changing….” in bullet
form

Type of
Change
Rev

Reason for Change
Clarity

Burden
Change
No

Rev

Clarity, consistency

No

Reformatted Type of Change to text in
grey box

Rev

Consistency

No

Relocated as shorter bullet point after
Chart 4 with bold line separation

Rev

Clarity

No

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.

2022 (old version)
-

-

2023 (new version)

SECTION 5.
If you see
mistakes on this summary or
have questions, what should
you do?

If you have questions, call us

Type of
Change

Reason for Change

Burden
Change

Rev

Visibility

No

Revised language in help box

Rev

Visibility, clarity

No

Revised to read as:

Rev

Clarity

No

Moved to display before revised language
that reads in grey box as:

-

See mistakes or have questions?

located before:
-

Section 6. Important things to
know about your drug
coverage and your right

Help box language

Your “Evidence of Coverage” has the
details about your drug coverage and
costs

Reformatted and relocated to read as:

Important things to know about your drug
coverage and your rights

Get more details in the Evidence of
Coverage with dividing line. Condensed
information about evidence of coverage

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.

2022 (old version)

2023 (new version)

Language for extra help in Section 6:

Did you know there are programs to
help people pay for their drugs?

Reason for Change
Consistency

Burden
Change
No

Rev

Clarity

No

Removed bullet point from “Extra Help” and
revised to state:

Get help paying for your drug coverage

•

“Extra Help” from Medicare

“Extra Help” from Medicare.

•

Help from your state’s
pharmaceutical assistance
program

Removed bullet point from:

Section 6 subheading: What if you
have problems related to coverage or
payments for your drugs?

Type of
Change
Rev

Help from your State Pharmaceutical
Assistance Program

Revised to read as: Where to go for help
with coverage problems with dividing black
line to mark off section

What about possible fraud? : located
after: If you have questions, call us

Removed: What about possible fraud as
Del
Organization
No
separate section and included similar
language in See mistakes or have
questions?
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This pre-decisional, privileged, and confidential
information is for internal government use only, and must not be disseminated, distributed, or copied to persons not authorized to
receive the information. For Preliminary discussion only, pending review of all public comments. Unauthorized disclosure may result
in prosecution to the full extent of the law.

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.