A two-part Form CMS-L325 (CMS-L325A) (Notice of Termination of Medical Insurance Benefits)
will be generated for insured beneficiaries in current pay status who have requested
termination of medical insurance coverage. The Form CMS-L325 will be sent to the beneficiary
and Form CMS-L325A (not shown) will be filed on the left side of the folder for documentation.
The form is printed and released from the program service centers.
NOTE: INTPSC see Form