TN 29 (08-99)

HI 00801.138 Application for Premium HI


The form CMS-18-F5 (Application for Hospital Insurance, OS 15060.085) is the preferred application for Premium-HI. However, as with SMI, any signed statement requesting enrollment that is filed with SSA/CMS during an enrollment period constitutes an effective enrollment. If an individual filing for Premium-HI does not have SMI, he/she must also complete the SMI enrollment portion of the application or submit a written request for SMI enrollment at the same time.

To Link to this section - Use this URL:
HI 00801.138 - Application for Premium HI - 02/18/2010
Batch run: 02/18/2010