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MODEL INDIVIDUAL NON-CREDITABLE COVERAGE DISCLOSURE NOTICE LANGUAGE FOR USE ON OR AFTER JANUARY 1, 2009, OMB 0938-0990 Important Notice From Insert Name of Entity About Your Prescription Drug Coverage

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What is non-creditable coverage notice?

A non-creditable coverage notice is a notification sent to individuals or groups who have health insurance coverage that does not meet the minimum creditable coverage standards set by the government.

Who is required to file non-creditable coverage notice?

Health insurance providers or employers offering health insurance coverage are required to file non-creditable coverage notices to inform their members or employees about the status of their coverage.

How to fill out non-creditable coverage notice?

Non-creditable coverage notices can be filled out by providing the necessary information about the insurance policy, including its limitations and coverage gaps, and sending the notice to the intended recipients via mail or electronically.

What is the purpose of non-creditable coverage notice?

The purpose of a non-creditable coverage notice is to inform individuals or employees about the limitations of their health insurance coverage, particularly if the coverage does not meet the minimum requirements for creditable coverage set by the government.

What information must be reported on non-creditable coverage notice?

Non-creditable coverage notices should contain information such as the name of the health insurance provider or employer, a description of the coverage, the effective dates, any specific limitations or exclusions, and contact information for further inquiries.

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