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Why did I receive a notice from my new Part D (Rx) company requesting proof of prior prescription drug coverage?

If you are over 65 and are signing up for a Medicare Part D (Rx) plan for the first time, you will receive a letter from your Part D insurance carrier asking for proof of prior prescription drug coverage. This is completely normal and does not mean there are any problems.
Declaration Of Prior Prescription Drug Coverage.png
In the letter you will find an area to write down the name of the insurance company you had coverage with (most likely through your employer) as well as the dates you had coverage with them. All you need to do is simply fill in this information and return it by using the enclosed return envelope.

Failure to return this form can result in you being charged a late enrollment penalty on top of your Part D premium.
We do not have the option to submit your proof of prior coverage along with your enrollment application.

​You will receive this notice directly from your new Part D
company after you have enrolled.
See the example below for what the completed form would
look like for someone who is retired from UVA:
Example - Declaration Of Prior Prescription Drug Coverage.png
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