TN 30 (03-96)
NL 00703.605 SMI Denial — Not in General Enrollment Period (GEP) or Special Enrollment Period (SEP)
Document Identifier for Word Processor: E3605
A. Exhibit letter
We are writing about your application for Medicare medical insurance. You cannot sign up for medical insurance at this time.
When you can sign up
You can sign up for medical insurance during January through March each year.
You may also have an 8-month special enrollment period if you are insured by a group health plan and;
your group health plan is through your current work or your spouse's current work, or
your plan is a large group health plan and you meet other rules.
For most people, the special enrollment period starts when the work ends or your coverage under the plan ends. It may also start if the type of plan you have changes.
If you need more information or help deciding what to do, please let us know. The employer who covers you under the group plan may also be able to help.
If you disagree with the decision
If you have any questions
3901D - Foreign
B. Requesting instructions
Use this notice when a disability beneficiary tries to enroll outside a GEP or SEP and he/she had SMI but it was terminated or has never been enrolled in SMI.
C. Typing instructions
Information for this letter will be shown on Form SSA-573. The name and address, if not given, can be taken from the latest Form SSA-3926-EP in file.