Employers must notify the Centers for Medicare and Medicaid Services (CMS) each year if the medical plan will provide prescription drug coverage to individuals who are eligible for Medicare. If you do not expect to have any Medicare-eligible individuals covered by your medical/RX plan this year, you do not need to complete this form.

This disclosure is required within 60 days of the start of the plan year and only takes a few minutes to complete online. For medical plans renewing January 1, the disclosure must be submitted by March 1.

If you want a copy of the form, print a screen shot before you click “Review and Submit”. You should receive a message that the form was successfully submitted, but it will not contain a copy.