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.