Annual CMS Disclosure Information

According to the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), most entities that currently provide prescription drug coverage to Medicare Part D eligible individuals must disclose to the Centers for Medicare & Medicaid Services (CMS) whether the coverage is “creditable prescription drug coverage” (Disclosure to CMS). Disclosure to CMS is required whether the entity’s coverage is primary or secondary to Medicare. Entities that must comply with these provisions are listed at 42 CFR §423.56(b) and are also referenced on the creditable coverage homepage.

We strongly encourage you to review the information provided here and on the CMS Web site to assist you in meeting your obligation as a Plan Sponsor.

Remember that Medicare eligibility can be defined by age or disability. Be sure to check with all of your employees to inquire about any covered dependents (spouse or children) who are eligible for Medicare. If you do not have any Medicare eligible employees (or dependents) covered under your group health plan, you do not need to disclose any information to CMS at this time.

The disclosure form is available at https://www.cms.gov/CreditableCoverage/45_CCDisclosureForm.asp and is submitted to CMS electronically. There is no other option for submitting this form to CMS.

The CMS Web site has information available about the initial and annual disclosure requirement as well as the times when notices of creditable coverage must be given to your Medicare-eligible retirees, employees, and dependents. The following pages on the CMS Web site may help you understand whether you are obligated to complete a disclosure notice.

Creditable Coverage Disclosure to CMS Guidance

Disclosure to CMS Form

CMS Disclosure Form Instructions and Screen Shots

• When completing the section "Entity/Plan Sponsor Information" on the form, always use your company’s name, tax id number, address, etc. The reference to “Entity” means your company name, not “CBIA” or “CBIA Health Connections.”
• When choosing "Coverage Type" on the form, select the GROUP HEALTH PLAN that best describes your plan - i.e., Employer Sponsored Plan.
• When completing sections "How Many Prescription Drug Options Offered Under This Coverage" and "Creditable/Non-Creditable Offer:", refer to the following document to assist you with determining the number of unique pharmacy plans available and whether the plan(s) are creditable or non-creditable:
  • ConnectiCare Small Group ACA-Compliant Pharmacy Plans
  • Medicare Pharmacy Plans

Remember, you are required to notify your employees of the creditable or non-creditable status of their health plan each year, on or before the Oct. 15th deadline.

For specific inquiries about the CMS Disclosure Form, please contact CMS directly at 800-MEDICARE (800-633-4227).