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MODEL INDIVIDUAL CREDITABLE COVERAGE DISCLOSURE NOTICE LANGUAGE OMB 09380990FOR USE ON OR AFTER APRIL 1, 2011Important Notice From Insert Name of Entity About Your Prescription Drug Coverage and MedicarePlease
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Model individual non-creditable coverage refers to a notice that must be provided to Medicare-eligible individuals regarding the creditability of their prescription drug coverage.
Entities that provide prescription drug coverage to Medicare-eligible individuals are required to file model individual non-creditable coverage.
Model individual non-creditable coverage can be filled out online through the Centers for Medicare & Medicaid Services (CMS) website or by submitting a paper form.
The purpose of model individual non-creditable coverage is to inform Medicare-eligible individuals whether their prescription drug coverage is creditable or non-creditable.
Model individual non-creditable coverage must include information about the coverage being offered, the creditability status, and the deadline for enrollment in Medicare Part D.
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