TN 8 (08-12)

NL 00715.210 Medicare Paragraphs, Parts B, C & D

HIBC01

Information About Medicare

HIB010

Because (1) monthly benefits are stopped, we will bill (2) every 3 months for the premiums.

Fill-Ins

  1. your/(beneficiary's first name)' (apostrophe only)/(beneficiary's first name)'s (apostrophe “s”)

  2. you/him/her/(beneficiary's first name) (non-possessive)

HIB034

We will continue to deduct the Medicare Part B (medical insurance) premium of (1) from (2) payments.

Fill-Ins

  1. Amount in format ($$$,$$.¢¢)

  2. your /(beneficiary's first and last name)' (apostrophe only)/ (beneficiary's first and last name)'s (apostrophe “s”)/his/her

HIB092

(1) State or local government retirement system will continue to pay (2) Medicare medical insurance late enrollment premium penalty. (3) must continue to pay the basic Medicare medical insurance premium.

Fill-Ins

  1. Your/(beneficiary's first name)' (apostrophe only)/(beneficiary's first name)'s (apostrophe “s”)

  2. your/his/her/the

  3. You/He/She/(beneficiary's first name) (non-possessive)

MHPC02

Information About (1) Health Plan Premiums

Fill-In

  1. Your/(beneficiary's first name)' (apostrophe only)/(beneficiary's first name)'s (apostrophe “s”)

MHP011

We deducted (1) from the check you will receive for (2) on or about (3).

Fill-Ins

  1. Total Part C/D premium amount ($$$$,$$$.¢¢)

  2. Month and Year of COM (format – “December 2005”)

  3. Month, Day and Year of CMA (format – “January 18, 2006”)

MHP012

This represents all health plan premiums due to date.

MHP015

Each month, we will continue to deduct (1) for (2) health plan premiums.

Fill-Ins

  1. Total Part C/D premium amount ($$$$,$$$.¢¢)

  2. your/his/her/(beneficiary's first name)' (apostrophe only)/(beneficiary's first name)'s (apostrophe “s”)

MHP017

We will no longer deduct money for (1) health plan premium(s) from

(2) monthly benefits.

Fill-Ins

  1. your/his/her/(beneficiary's first name)' (apostrophe only)/(beneficiary's first name)'s (apostrophe “s”)

  2. your/his/her/the

MHP018

If you have any questions about (1) health plan premiums, please contact (2)health plan(s).

Fill-Ins

  1. your/his/her/the

  2. your/his/her/the


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900715210
NL 00715.210 - Medicare P