Effective Dates: 05/12/2008 - Present Previous | Next

Basic (07-81)

NL 00722.017 Form CMS-L325 Notice of Termination of Medical Insurance Benefits

A. Sample Form

B. General

A two-part Form CMS-L325 (CMS-L325A) (Notice of Termination of Medical Insurance Benefits) will be generated for insured beneficiaries in current pay status who have requested termination of medical insurance coverage. The Form CMS-L325 will be sent to the beneficiary and Form CMS-L325A (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.

NOTE: INTPSC see Form CMS-L327 (CMS-L327A).

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900722017
NL 00722.017 - Form CMS-L325 Notice of Termination of Medical Insurance Benefits - 05/12/2008
Batch run: 05/12/2008
Rev:05/12/2008