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Updated Guidance February 15, 2007, OMB 09380990 DISCLOSURE OF CREDITABLE COVERAGE TO MEDICARE PART D ELIGIBLE INDIVIDUALS GUIDANCE I. INTRODUCTION CMS issued General Creditable Coverage guidance

How to fill out disclosure of creditable coverage

How to fill out disclosure of creditable coverage:

1. Obtain the disclosure form: Begin by obtaining the disclosure of creditable coverage form from your health insurance provider. This form is typically provided annually and may also be available online.
2. Fill in personal information: Start by filling in your personal information on the form, including your name, date of birth, and contact details. Ensure that all information is accurate and up to date.
3. Indicate coverage details: In the form, you will need to indicate the details of your creditable coverage. This includes the start and end dates of your coverage, the type of coverage (such as individual or family), and the name of your health insurance plan.
4. Provide additional details: If there are any additional details required, such as the policy number or group number, make sure to fill them in accurately. These details can usually be found on your health insurance card or policy documents.
5. Sign and date the form: Once you have completed all the required information, sign and date the form. This confirms that the information provided is accurate to the best of your knowledge.
6. Submit the form: After filling out the form, submit it to the designated recipient, which is typically your employer's human resources department or the relevant health insurance authority. Make sure to keep a copy of the form for your records.

Who needs disclosure of creditable coverage?

1. Employees with health insurance: The disclosure of creditable coverage is primarily needed by employees who have health insurance through their employer. This form is used to provide information about the type and duration of their health insurance coverage.
2. Individuals with Medicare: Individuals who are eligible for and enrolled in Medicare, the federal health insurance program for seniors and certain individuals with disabilities, also require a disclosure of creditable coverage. This form helps Medicare determine whether the individual's existing health insurance coverage is comparable to Medicare's coverage.
3. Employers and health insurance providers: Employers and health insurance providers also play a role in requiring and requesting disclosure of creditable coverage. Employers need this information to comply with certain regulations and provide accurate reporting to the government, while health insurance providers use the information to assess an individual's eligibility and coverage options.

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What is disclosure of creditable coverage?

Disclosure of creditable coverage is the requirement for group health plans to report if their coverage is expected to pay, on average, as much as the standard Medicare prescription drug coverage.

Who is required to file disclosure of creditable coverage?

Employers and plan sponsors providing prescription drug coverage are required to file disclosure of creditable coverage.

How to fill out disclosure of creditable coverage?

Disclosure of creditable coverage can be filled out online through the CMS website using the required form.

What is the purpose of disclosure of creditable coverage?

The purpose of disclosure of creditable coverage is to inform Medicare-eligible individuals if their current prescription drug coverage is creditable or not.

What information must be reported on disclosure of creditable coverage?

The disclosure must include information on the plan sponsor, types of coverage, the expected benefit amounts, and other specific details.