BASIC (07-81)

NL 00722.027 Form CMS-1589 Medical Insurance Termination Notice

A. Sample Form

G-HCFA-1589

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B. General

A two-part Form CMS-1589 (CMS-1589A) (Medical Insurance Termination Notice) will be generated when SMI is terminated due to non-payment of premiums within the time limit set by the law. Form CMS-1589 will be sent to the beneficiary and Form CMS-1589A (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/0900722027
NL 00722.027 - Form CMS-1589 Medical Insurance Termination Notice - 05/08/2008
Batch run: 01/27/2009
Rev:05/08/2008