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HI 01001: Supplementary Medical Insurance

Effective Dates: 01/31/2018 - Present
To: Railroad Retirement Board
  Health Benefits
  844 Rush Street
  Chicago, Illinois 60611
From: SSA PSC NE MAT SE GL MAM WN DBP DIO
RE: RR No. (RRB Annuity No.)
  SSA CAN (SSN/BIC)
  Name                     

Please resubmit accretion for above annuitant for RRB jurisdiction for SMI. All impediments to completed transfer have been removed.

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