This page provides Creditable Coverage Guidance and Model Disclosure Notices for use after June 15, 2008 under the "Downloads" below.

To download the PDF Model Disclosure Notices below, you will need Adobe® Acrobat®.  Adobe® Reader ® is available for free at http://www.adobe.com/.

To download the Word Model Disclosure Notices below, open the zipped files.

The other links on the left hand side of this page will direct you to general guidance and overview documents relating to Creditable Coverage, Medigap Coverage and the Disclosure to CMS Form.

Note:  The model notices have been updated as of June 15, 2008.  The guidance document was last updated as of February 15, 2007.

Downloads
Guidance - Disclosure of Creditable Coverage to Medicare Part D Eligible Individuals Guidance (PDF, 113KB) Model Individual Creditable Coverage Disclosure Notice (PDF, 86KB) Model Individual Creditable Coverage Disclosure Notice-Spanish (PDF, 86KB) Model Individual Non-Creditable Coverage Disclosure Notice (PDF, 82KB) Model Individual Non-Creditable Coverage Disclosure Notice-Spanish (PDF, 82KB) Model Personalized Individual Disclosure Notice (PDF, 54KB) Model Personalized Individual Disclosure Notice-Spanish (PDF, 54KB) Model Individual Creditable Coverage Disclosure Notice (Zipped Word, 15KB) Model Individual Creditable Coverage Disclosure Notice-Spanish (Zipped Word, 15KB) Model Individual Non-Creditable Coverage Disclosure Notice (Zipped Word, 15KB) Model Individual Non-Creditable Coverage Disclosure Notice-Spanish (Zipped Word, 15KB) Model Personalized Individual Disclosure Notice (Zipped Word, 13KB) Model Personalized Individual Disclosure Notice-Spanish (Zipped Word, 13KB)
Related Links Inside CMS
Employer & Union Retiree Drug Subsidy Overview Page Employer Group Waiver Plans Overview Page
Related Links Outside CMS
There are no Related Links Outside CMS

Page Last Modified: 07/16/2008 1:43:55 PM
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