Creditable coverage disclosure notice 2026

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

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