PAY032 DUAL ENTITLEMENT (CHECKS COMBINED) — AUXILIARY/SURVIVOR AWARD AFTER PRIMARY (A42)

(Requested)

Caption: What We Will Pay

 (1)  benefit is  (2)  as a  (3)  . This is in addition to the benefit of  (4)  on  (5)  own earnings record.

PAY067 PMA PAYMENT REDUCED BY AMOUNT OF CRITICAL PAYMENT (B55)

(System Generated)

Caption: What We Will Pay

We will subtract  (1)  from your next check. This is the amount we paid you before we finished work on  (2)  claim.

PAY068 CMA ONLY PAYMENT DUE - CRITICAL PAYMENT DEDUCTION MADE (B58)

(System Generated)

Caption: What We Will Pay

When we figured how much to pay you through  (1)  , we subtracted the money which we already paid you while we finished work on  (2)  claim.

PAY072 EXPLANATION THAT FIRST CHECK INCLUDES AN INSTALLMENT AMOUNT (B50)

(Requested)

Caption: What We Will Pay

This check includes  (1)  regular monthly payment of  (2)  for  (3)  .

PAY073 PAYMENT OF PAST-DUE BENEFITS WILL BE PAID IN INSTALLMENTS (B51)

(Requested)

Caption: What We Will Pay

 (1)  still due back payments of  (2)  for past months.  (3)  will receive this money over a period of months. We will send  (4)   (5)  more each month with  (6)  regular payment until all of the extra money is paid.

PAY161 CMA or MBP = $0.00 After Adjustments (G07)

(System Generated)

Caption: None

No payment is due at this time because of adjustments made to  (1)  benefits.

PAY176 IRMAA – CHANGE RESULTS IN PREMIUM REFUND (HB2)

(Requested/Generated)

Caption: What We Will Pay and Why

Based on the information we have,  (1)   (2)  due a Medicare Part B premium refund.

PAY180 CHECK PARAGRAPH USED WHEN ARF AND/OR DRC NOT PROPERLY APPLIED (B20)

(System Generated)

Caption: What We Will Pay

 (1)  next check for  (2)  includes additional benefits through  (3)  .

After that,  (4)  will receive a new regular monthly payment of  (5)  .

PAY181 PAYMENT RESUMED AFTER SOME WITHHOLDING (M15)

(Requested)

Caption: Your Benefits

Since we withheld  (1)  , we can pay  (2)  beginning  (3) 

PAY182 PAYMENT STOPPED (M16)

(Requested)

Caption: Your Benefits

We are stopping  (1)  benefits beginning  (2)  .

PAY183 ADDITIONAL WITHHOLDING REQUIRED (M18)

(Requested)

Caption: Your Benefits

Since we withheld  (1)  , we must withhold  (2)  more.

PAY184 INCORRECT EARNINGS OVERPAYMENT CAUSED BY REDUCTION IN BENEFIT AMOUNT (M26)

(Requested)

Caption: Your Benefits

We reviewed our records, and found that a mistake was made when  (1)  benefit amount was increased. In  (2)   (3)  earned  (4)  instead of  (5)  , which was the amount we used when we figured  (6)  payment. We have now corrected our records, and found that we paid  (7)   (8)  too much in benefits.

PAY212 INITIAL PARTIAL AWARD/PARTIAL MONTH BENEFITS PAID (B78)

(Requested)

Caption: Your Benefits

We used  (1)   (2)   (3)   (4)   (5)  to decide how much to pay  (6)  . We are still working on  (7)  claim. When we make a final decision about the  (8)  , we will figure the amount of  (9)  payments. We will send you another letter to let you know if there will be any change in  (10)  payments.

PAYB15 SINGLE PAYMENT FOLLOWED BY SUSPENSION/TERMINATION (B29)

(Requested)

Caption: What We Will Pay

 (1)  will receive  (2)  around  (3)  . This is the money, after all deductions,  (4)  due for  (5)  .