All group health plans that provide prescription drug coverage to Medicare Part D eligible individuals (whether actively working, retired, or disabled) are required to notify CMS whether or not the coverage provided is creditable. This disclosure is required whether the coverage is primary or secondary to Medicare.

NOTE: If you are offering an actual Part D Plan, you are exempt from this filing requirement. Employers who have applied for a retiree drug subsidy are NOT required to complete this form.

You will need the following information to complete the Disclosure Notice (please note the form has been simplified from prior years):

  • Employer’s name, address and phone number;
  • Employer’s Federal Tax Identification Number (EIN);
  • Type of coverage (most will be Group Health Plan: Employer Sponsored Plan or Local Government);
  • Whether or not the prescription drug plans are creditable;
  • Name, title, and email address of individual authorized to file the Disclosure Notice;
  • Date of disclosure to CMS.

     In addition to the annual notice, employers are required to file a disclosure within 30 days after termination of any drug plan and within 30 days after the change in creditable coverage status of any drug plan. 

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