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City of BurnetImportant Legal Notices you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription
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How to fill out disclosure of creditable coverage
How to fill out disclosure of creditable coverage
01
Step 1: Obtain the disclosure of creditable coverage form from your employer or insurance provider
02
Step 2: Fill in your personal information such as name, address, and date of birth
03
Step 3: Provide details about your current health insurance coverage including the type of plan, coverage dates, and any dependents covered
04
Step 4: Sign and date the form to certify the accuracy of the information provided
05
Step 5: Submit the completed form to the appropriate party as instructed
Who needs disclosure of creditable coverage?
01
Individuals who are transitioning between health insurance plans
02
Employers who offer health insurance benefits to their employees
03
Insurance providers who are required to provide information about coverage to their policyholders
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What is disclosure of creditable coverage?
Disclosure of creditable coverage is a notice that must be provided to individuals who are eligible for Medicare to inform them whether their current health plan's prescription drug coverage is at least as good as Medicare's.
Who is required to file disclosure of creditable coverage?
Employers or health plan sponsors that provide prescription drug coverage to individuals who are eligible for Medicare are required to file disclosure of creditable coverage.
How to fill out disclosure of creditable coverage?
Disclosure of creditable coverage can be filled out electronically through the CMS Medicare website or by using the paper form provided by CMS.
What is the purpose of disclosure of creditable coverage?
The purpose of disclosure of creditable coverage is to help individuals make informed decisions about whether to enroll in Medicare Part D based on the prescription drug coverage offered by their current health plan.
What information must be reported on disclosure of creditable coverage?
The disclosure must include information about the creditable coverage status, whether it is on an individual or aggregate basis, and the date on which the coverage ends.
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