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Medicare Part
D Creditable Coverage Notice
As required by the Prescription Drug, Improvement, and
Modernization Act (MMA) provisions, you must disclose to the Centers for Medicare
& Medicaid Services (CMS) whether your health plan coverage is “creditable prescription
drug coverage” regardless of whether the coverage is primary or secondary to Medicare.
The Disclosure Notice and policy guidance were posted on the Medicare website and
require that the Disclosure Notice must be made to CMS on an annual basis and upon
any change that affects whether the drug coverage is creditable. The initial Disclosure
Notice must be provided by March 31, 2006 for plan years that end in 2006. For plan
years that end in 2007 and beyond, disclosure of creditable coverage status must
be provided within 60 days after the beginning date of the plan year for which the
entity is providing the disclosure to CMS. Disclosure must also be made within 40
days after the termination of the prescription drug plan; and within 30 days after
any change in the creditable coverage status of the prescription drug plan.
Click on the Icon to view:
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Creditable Coverage Disclosure Guidance: |
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Creditable Coverage Disclosure Instructions: |
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Creditable Coverage Disclosure Technical Help/Policy Assistance: |
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Click here for more information about Creditable Coverage (This link will take you to
the CMS website)
Medicare
Part D Forms
Forms provided as a courtesy to
BPA clients:
The following model documents are for disclosure of
Creditable and Non-Creditable coverage under Medicare Part D.
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Important Notes About These Model
Documents: |
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Creditable Coverage Disclosure Notice: |
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Non-Creditable Coverage Disclosure Notice: |
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Personalized Disclosure Notice: |
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