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MODEL INDIVIDUAL CREDITABLE COVERAGE DISCLOSURE NOTICE
Important Notice from Your EmployerSponsored Health Plan
About Your Prescription Drug Coverage and Medicare
Please read this notice carefully
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What is model beneficiary creditable coverage?
Model Beneficiary Creditable Coverage refers to the coverage of prescription drug benefits that is at least as good as the standard Medicare prescription drug benefit.
Who is required to file model beneficiary creditable coverage?
Employers and entities that provide prescription drug coverage to Medicare-eligible individuals are required to file model beneficiary creditable coverage.
How to fill out model beneficiary creditable coverage?
Model beneficiary creditable coverage can be filled out by completing the online disclosure form available on the CMS website.
What is the purpose of model beneficiary creditable coverage?
The purpose of model beneficiary creditable coverage is to inform Medicare-eligible individuals whether their prescription drug coverage is creditable or not.
What information must be reported on model beneficiary creditable coverage?
The information that must be reported on model beneficiary creditable coverage includes the plan sponsor's name, contact information, and medication coverage details.
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