Your claim to establish eligibility for health insurance coverage under title XVIII
of the Social Security Act as a disabled individual has been approved. Your health
insurance coverage begins in (1) . A health insurance identification card will be mailed to you in or before that
Although you have been found entitled to a disability-based benefit, it is for the
purposes of health insurance coverage only. It has no effect on the benefit to which
you are now entitled.
The enclosed booklet lists the events you must report to the Social Security Administration
as a disabled individual.
If you believe that this determination is not correct, you may request that your claim
be reexamined. If you want this reconsideration, you must request it not later than
60 days from the date you receive this notice. You may make any such request through
any Social Security office. If additional evidence is available, you should submit
it with your request. Keep this notice as a permanent record with the Social Security
Award Certificate you received previously.
If You Have Any Questions
SSA Pub. No. 73-10153