Identification Number:
HI 03094 TN 2
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Medicare Part D Exhibits Of Notices
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 030 – Eligibility for Subsidized Medicare Prescription Drug Coverage
Subchapter 94 – Medicare Part D Exhibits Of Notices
Transmittal No. 2, 08/10/2020

Audience

PSC: BA, CA, CS, DS, IES, ILPDS, IPDS, ISRA, NPR, PETE, RECONR, SCPS, TSA, TST, TYPIST;
OCO-OEIO: BET, CR, CTE, EIE, ERE, FCR, FDE, PETL, RECONE, RECONR;
Subsidy Appeals Unit (SAU): SDR, SDS, SDT;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, DES, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

08/10/2020

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

On July 18, 2020, the enhanced Leads and Appointment System (eLAS) will be replacing the 800# Appointment and Referral System. Updating system name displayed in POMS from "800 Number System" to "enhanced Leads and Appointment System (eLAS).

 

Summary of Changes

HI 03094.010 SSA-L824 - Protective Filing Closeout

Subsection A. - Update system name from "800 Number System" to "enhanced Leads and Appointment System (eLAS).

HI 03094.010 SSA-L824 - Protective Filing Closeout

A. Purpose/Use

The subsidy protective filing closeout notice (SSA-L824) is available in English on the enhanced Leads and Appointment System (eLAS). The protective filing closeout notice is available on DPS in both English and Spanish. See HI 03010.030 for completion instructions.

B. Sample Notice SSA-L824 – Subsidy Protective Filing Closeout

 

Social Security Administration

Medicare Prescription Drug Assistance

Important Information

 

Date: December 10, 2005

Social Security Number: 123-00-6789

 

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

 

 

 

On _______(1)_________, we talked with _________(2)_____ about ___3)_____ eligibility for extra help with Medicare prescription drug plan costs. Before we can decide if _________(4)______ eligible, you must file an application.

 

What To Do Next

 

You may complete an application right away on the Social Security Administration’s website at www.socialsecurity.gov on the Internet. If you would like a Social Security representative to take the application for you, call us toll free at 1-800-772-1213 to schedule an appointment.

 

What Will Happen

 

You should get in touch with us right away because the date you file an application can make a difference in when the extra help for Medicare prescription drug plan costs begins. If you file the application by ______(6)_________, we will use ____(7)__________, the date _________(7)_________ contacted us, as the filing date.

If you file an application, we will review the claim and make a decision. If you do not agree with what we decide, you will be able to appeal the decision.

 

If You Have Any Questions

 

If you have any questions, you may call, write, or visit any Social Security office. If you call or visit, please have this letter with you. The address and telephone number of the office that serves your area is:

 

                                             ________________(8)______________

Also, if you plan to visit, you may call ahead to make an appointment. Our toll-free number is 1-800-772-1213. If you are deaf or hard of hearing, you may call our TTY number toll-free at 1-800-325-0778.

 

This will help us serve you more quickly when you arrive at the office.

 

 

 

                                                                                Manager

 

SSA-L824 (12/2004)

 

First Paragraph

 

  1. 1) 

    Choice 1: Date of interview

    Choice 2: Null

  2. 2) 

    Choice 1: you

    Choice 2: inquirer’s name

  3. 3) 

    Choice 1: your

    Choice 2: claimant’s name

  4. 4) 

    Choice 1: you are

    Choice 2: (claimant’s name) is

What to Do Next

 

  1. 5) 

    Choice 1: 60 days after the date of the notice (mm/dd/yyyy-must be a workday)

    Choice 2: Null

  2. 6) 

    Choice 1: date of interview

    Choice 2: Null

  3. 7) 

    Choice 1: you

    Choice 2: name of inquirer

 

If You Have Any Questions

 

  1. 8) 

    Choice 1: FO address

    Choice 2: Null

 


HI 03094 TN 2 - Medicare Part D Exhibits Of Notices - 8/10/2020