| DECLINATION |
SMI - Processed Declination of Coverage -Beneficiary in Current Pay Status - Refund
Due
|
NL 00703.616 |
E3616 |
| |
SMI - Processed Declination of Coverage - Beneficiary in Suspense Status - Discard
Any Bill For Premiums
|
NL 00703.617 |
E3617 |
| |
Beneficiary's Refusal of SMI Coverage Not Acceptable - State is Paying Premiums |
NL 00703.618 |
E3618 |
| ENROLLMENT |
SMI - Reenrollment During the GEP After Prior Enrollment Terminated |
NL 00703.602 |
E3602 |
| |
Enrollment Beyond the Initial Enrollment Period |
NL 00703.603 |
E3603 |
| |
Applied Prior to Beginning of Initial Enrollment Period |
NL 00703.604 |
E3604 |
| |
SMI Denial - Not in GEP or SEP |
NL 00703.605 |
E3605 |
| ENTITLEMENT |
HI/SMI - Reduced HI Premium |
NL 00703.600 |
E3600 |
| |
SMI Only - Eligible for Reduced Premium |
NL 00703.601 |
NONE |
| |
HI/SMI - Entitled to Mother's or Widow's Benefits - Coverage Based on Disability -
Coverage Begins Within 2 Months After COM
|
NL 00703.619 |
E3619 |
| |
HI/SMI - Entitled to Mother's or Widow's Benefit - Coverage Based On Disability -
Coverage Begins More Than 2 Months After COM
|
NL 00703.620 |
E3620 |
| |
HI/SMI - Based on Chronic Renal Provisions |
NL 00703.621 |
E3621 |
| INELIGIBLE |
Ineligible For HI/SMI Coverage Due to DIB Termination |
NL 00703.622 |
E3622 |
| |
Ineligible For HI/SMI Coverage Because DIB Ceased |
NL 00703.623 |
E3623 |
| WITHDRAWAL |
SMI Reversal Request Treated as GEP Enrollment |
NL 00703.606 |
E3606 |
| |
Withdrawal From SMI - Entitlement to CHAMPUS or CHAMPVA |
NL 00703.625 |
E3625 |
| PREMIUM COLLECTIONS
|
Initial LESSDO Notice (MBA Less than SMI Premium) |
NL 00703.631 |
E4030 |
| |
MBA Less than SMI Premium (LESSDO) - No Prior Year Premium Balance |
NL 00703.632 |
E4031 |
| |
MBA Less than SMI Premium (LESSDO) - Prior Year Premium Balance Less than 3 Months |
NL 00703.633 |
E4032 |
| |
MBA Less than SMI Premium (LESSDO) - Prior Year Premium Balance Equals 3 (or more)
Months
|
NL 00703.634 |
E4033 |
| |
MBA Less than SMI Premium (LESSDO) - Failure to Bill - More than 6 Months Past Due
Premiums
|
NL 00703.635 |
E4034 |
| |
MBA Less than SMI Premium (LESSDO) - Failure to Bill - Equitable Relief Period Ends |
NL 00703.636 |
E4035 |
| MISCELLANEOUS |
New Health Insurance Card - As a Result of Requested Changes |
NL 00703.609 |
E3609 |
| |
Address Change - Returning HI Card |
NL 00703.610 |
E3610 |
| |
DIB to RIB Conversion - Full retirement age PAC Reduction |
NL 00703.624 |
E3624 |
| |
Notice When Claimant Protests Amount of Premium |
NL 00703.626 |
E3626 |
| |
Notice When Claimant's Correspondence Contains an Incorrect Claim Number |
NL 00703.627 |
E3627 |
| |
Notice When Claimant Protests Termination |
NL 00703.628 |
E3628 |
| |
General “Check Box” Notice |
NL 00703.629 |
E3629 |
| |
Government Medicare - Coverage Based on Disability - Coverage Begins More Than 2 Months
After COM
|
NL 00703.630 |
E3630 |