Only beneficiaries who receive the general enrollment period (GEP) mailing from CMS
can use Form CMS-L40D to enroll in SMI during the GEP. CMS mails Form CMS-L40D to
individuals that refused, withdrew, or terminated SMI during the prior year. The beneficiary completes the Form CMS-L40D and sends it to CMS. At the end of the
GEP, CMS sends the received forms to the Wilkes-Barre Data Operations Center for processing.
For information on GEP enrollment processing, see WB 00601.001.
Field offices do not process the Form CMS-L40D.