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If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, this Federal law gives you more choices about your prescription drug coverage. See below for
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How to fill out disclosure of creditable coverage
How to fill out disclosure of creditable coverage
01
Obtain the disclosure of creditable coverage form from your health insurance provider or employer.
02
Fill out the form with your personal information, including your name, address, and date of birth.
03
Provide details about your existing health insurance coverage, such as the name of the plan, policy number, and coverage dates.
04
Sign and date the form to certify the accuracy of the information provided.
05
Submit the completed form to the appropriate party, such as your new employer or health insurance carrier.
Who needs disclosure of creditable coverage?
01
Individuals who are enrolling in a new health insurance plan.
02
Employers who provide health insurance coverage to their employees.
03
Health insurance providers who need to verify a person's prior coverage.
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What is disclosure of creditable coverage?
Disclosure of creditable coverage is a notice that group health plans and insurers must provide to individuals who are eligible for Medicare.
Who is required to file disclosure of creditable coverage?
Group health plans and insurers are required to file disclosure of creditable coverage.
How to fill out disclosure of creditable coverage?
Disclosure of creditable coverage can be filled out online or submitted via mail.
What is the purpose of disclosure of creditable coverage?
The purpose of disclosure of creditable coverage is to inform individuals about whether their current health coverage is as good as or better than Medicare.
What information must be reported on disclosure of creditable coverage?
The disclosure must include information on the creditable coverage status of the plan.
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