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MODEL INDIVIDUAL CREDITABLE COVERAGE DISCLOSURE NOTICE LANGUAGE OMB 09380990 FOR USE ON OR AFTER APRIL 1, 2011Important Notice From Insert Name of Entity About Your Prescription Drug Coverage and
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Model individual non-creditable coverage is a disclosure form that is used to inform individuals whether their prescription drug coverage is creditable or non-creditable.
Employers who offer 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 CMS website or by submitting a paper form to the CMS.
The purpose of model individual non-creditable coverage is to help individuals make informed decisions about their prescription drug coverage options.
Model individual non-creditable coverage must include information about the prescription drug coverage offered by the employer and whether it is creditable or non-creditable.
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