Model Notice Letters
Creditable Coverage Model Notice Letters
Entities that provide prescription drug coverage to Medicare Part D eligible individuals must notify these individuals whether the drug coverage they have is creditable or non-creditable.
Entities may modify the Model Disclosure Notices provided on this page under "Downloads" to notify affected individuals whether their drug coverage is creditable or non-creditable.
Downloads
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Model Non-Creditable Coverage Disclosure Notice (Spanish) (PDF) -
Model Creditable Coverage Disclosure Notice (Spanish) (PDF) -
Model Creditable Coverage Disclosure Notice (PDF) -
Model Non-Creditable Coverage Disclosure Notice (PDF)