BASIC (07-81)

NL 00722.025 Form CMS-1585 Notice of Medical Insurance Enrollment and Premium Deduction

A. Sample Form

G-HCFA-1585

Printer Friendly Version

B. General

A two-part Form CMS-1585 (CMS-1585A) (Notice of Medical Insurance Enrollment and Premium Deduction) will be produced for processed “YES” election cases for the purpose of documenting the folder and providing a notice to the beneficiary regarding action taken as a result of a “YES” election. This form will be generated for current pay insured cases. The Form CMS-1585 is sent to the beneficiary and Form CMS-L1585A (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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900722025
NL 00722.025 - Form CMS-1585 Notice of Medical Insurance Enrollment and Premium Deduction - 05/08/2008
Batch run: 01/27/2009
Rev:05/08/2008