Entities that are required to provide a disclosure of creditable coverage status to CMS must complete the following online Disclosure to CMS Form. Refer to the links on the left side of this webpage to the Disclosure to CMS Guidance and Commonly Asked Questions and Helpful Hints documents to assist you when completing this form.
The disclosure submission process is composed of the following steps to complete the online Creditable Coverage Disclosure Form:
Step 1 -Enter the Disclosure Information
Step 2 -Verify and Submit Disclosure Information, and
Step 3 -Receive Submission Confirmation
Note: All fields are required unless otherwise indicated.
Step 1 - Enter Disclosure Information
Please complete the following information for each Type of Coverage offered by the Entity/Plan Sponsor.
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