A two-part Form CMS-2687 (CMS-2687A) (Notice of Medicare Enrollment) will be generated
for insured beneficiaries in conditional pay status and uninsured cases when a premium
HI or SMI election has been processed. The Form CMS-2687 will be sent to the beneficiary
and Form CMS-2687A (not shown) will be filed on the left side of the folder for documentation.