The Medicare Part D Reporting Disclosure is an annual form completed by the group health plan administrator. This submission is due to CMS 60 days from the plan year start date for all clients regardless of employee count or group health plan funding. For clients that renewed their group health plans effective January 1, 2025, your disclosure should be completed by February 28, 2025.  

Follow our step-by-step guide to submit your disclosure:

Visit CMS.gov and then select the “Disclosure to CMS Form”. You will be presented with a form to complete the required information online. 

Page one:  

  • Entity Name 
  • FEIN 
  • Street address, city, state, country, zip code 
  • Phone number 
  • Coverage type: Most plans will choose the “Group Health Plan: Employer Sponsored Plan” at the top of the list. If your plan is one of the other group health plan options, please select accordingly. If you do not know, please reach out to your account manager and choose the creditable/non-creditable offer that applies to your plans.  

Page two:  

  • Plan year begin date, plan year end date 
  • Number of creditable/non-creditable options 
  • Total Medicare Part D eligible employees expected to be covered 
  • How many are covered through a union retiree group health plan 
  • Date the notice was provided to employees 
  • Has the creditable coverage status changed since last renewal 

Page three: Effective date of creditable coverage status change and the date the status change was disclosed. You will need to attest by providing your name, title, email, and date of disclosure completion. 

Page four: This takes you to the review page where you can verify your information is accurate. This is also the page you will need to download the PDF of your form submission. Once you hit the blue arrow you will not be able to go back in and access the submission for your compliance manual. If you hit next, you can redo the entire submission to print the PDF, this will not cause any issues.  

If you have not yet informed your employees of any creditable changes to your plans, please see the CMS Model Notices in English and Spanish. You will need to complete the sections of the form and provide the notice to all employees regardless of age.