TN 7 (07-95)

NL 00722.014 Form CMS-L1900-TR (Notice of Part A State Buy-in/Part A Group Payer Enrollment and Part A State Buy-In/Part A Group Payer Deletion)

A. POLICY

The Office of Systems prints and releases this notice to a beneficiary when the State paid the Part A Medicare premiums for a limited period of time.

This notice provides the inclusive dates for which the State was responsible for the Part A premiums.

B. EXHIBIT — FORM CMS-L1900-TR

 

G-HCFA-L1900-TR

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To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900722014
NL 00722.014 - Form CMS-L1900-TR (Notice of Part A State Buy-in/Part A Group Payer Enrollment and Part A State Buy-In/Part A Group Payer Deletion) - 05/08/2008
Batch run: 01/27/2009
Rev:05/08/2008