This notice refers to your recent letter regarding the amount of your medical insurance
The Social Security Act requires that medical insurance premiums be paid l month in
advance. The initial billing covers premiums for months beginning with the first month
of coverage up to and including the third month of billing; subsequent billings are
for periods of 3 months.
Our records indicate you received a bill for $ (1) covering payment (2) through (3) . Since your first month of coverage was (4) , the bill is correct.
You should submit your premium payment immediately if you have not already done so
to avoid loss of coverage.
If You Have Any Questions