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This certificate provides evidence of your prior health coverage. You may need to furnish this certificate if you become eligible under a group health plan that excludes coverage for certain medical conditions that you have before you enroll.
Creditable coverage: A health plans prescription drug coverage is creditable when the amount the plan expects to pay for prescription drugs for individuals covered by the plan in the coming year is, on average, the same or more than what standard Medicare prescription drug coverage would be expected to pay.
Entities that provide prescription drug coverage to Medicare Part D eligible individuals must disclose to CMS whether the coverage is creditable prescription drug coverage. This disclosure is required whether the entitys coverage is primary or secondary to Medicare.
What is it? Youll get this notice each year if you have drug coverage from an employer/union or other group health plan. This notice will let you know whether or not your drug coverage is creditable.
This certificate provides evidence of your prior health coverage. You may need to furnish this certificate if you become eligible under a group health plan that excludes coverage for certain medical conditions that you have before you enroll.

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Entities that provide prescription drug coverage to Medicare Part D eligible individuals must disclose to CMS whether the coverage is creditable prescription drug coverage. This disclosure is required whether the entitys coverage is primary or secondary to Medicare.
This notice has information about your current prescription drug coverage with your employer and about your options under Medicares prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan.
Entities that provide prescription drug coverage to Medicare Part D eligible individuals must notify these individuals whether the drug coverage they have is creditable or non-creditable.

creditable coverage disclosure form