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Click ‘Get Form’ to open the Creditable Coverage Disclosure Notice in the editor.
Begin by entering the required disclosure information in Box A, including the entity's name, Federal Tax Identification Number, and contact details.
Select whether all options offered are creditable, non-creditable, or a mix. Complete the corresponding boxes (B, C, or D) based on your selection.
Fill in the plan year dates and provide estimates for Medicare Part D eligible individuals covered under each option.
Review all entered data for accuracy and click ‘Continue’ to proceed to verification.
Submit your completed form. You will receive a confirmation message upon successful submission.

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What is a letter of creditable coverage for insurance?

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.

What is an example of creditable coverage?

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.

How do you get a certificate of creditable coverage?

A Certificate of Creditable Coverage may be obtained from your former health insurance carrier. Please contact your previous health carrier and request them to provide you with a certificate. This certificate may partially or fully apply to your new coverage and alleviate pre-existing situations.

Who gets Medicare Part D notices?

This annual disclosure must be provided to CMS within 60 days of the start of the plan year, which is typically March 1 (or February 29 for leap years). For employers with calendar year group health plans, the upcoming deadline to complete this disclosure reporting to CMS is March 1, 2025.