BASIC (07-81)

NL 00722.033 Form CMS-2687 Notice of Medicare Enrollment

A. Sample Form

G-NL 00722.033A

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B. General

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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900722033
NL 00722.033 - Form CMS-2687 Notice of Medicare Enrollment - 05/12/2008
Batch run: 01/27/2009
Rev:05/12/2008