Αποτελέσματα Αναζήτησης
The purpose of this form is to provide documentation to Social Security that proves that you have been continuously covered by a group health plan based on current employment, with no more than 8 consecutive months of not having coverage.
10 Ιαν 2024 · You can apply online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) to your local Social Security office. You’ll also need to send CMS L564 - Request for Employment Information, and a required proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP) coverage ...
You lost job-based health coverage within the last 8 months. To sign up for Part B in one of these situations, you’ll also need to fill out and submit an Application for Enrollment in Part B (CMS-40B) form at the same time. Sign up for Part A & Part B using a Special Enrollment Period.
12 Δεκ 2023 · To use this SEP you should call the Social Security Administration at 1-800-772-1213 and request two forms: the Part B enrollment request form (CMS 40B) and the request for employment information form (CMS L564).
29 Νοε 2023 · The purpose of this form is to provide documentation to Social Security that proves that you have been continuously covered by a group health plan based on current employment, with no more than 8 consecutive months of not having coverage.
Contact the Social Security Administration (SSA) at 800-772-1213 and request forms. Beneficiary will need the following forms from SSA CMS 40B (Application for enrollment in Medicare)
Fill out and sign form CMS 40B and have your employer (or your spouse or family member’s employer) fill out form CMS L564. Once complete, bring both forms with an accompanying cover letter to your local Social Security office. (See the attached Part B SEP cover letter for assistance.)
