TN 22 (11-01)

A. PROCEDURE--FIRST DELINQUENT NOTICE (SECOND NOTICE)

An initial delinquent notice marked "Second Notice" will be sent approximately 60 days after the initial billing notice for quarterly billed enrollees whose premiums have not been paid by that time. If the enrollee has already made a partial payment when the second notice is sent, he/she should send the balance promptly. If the enrollee has not paid any of his/her quarterly premiums before the above notice is sent, the notice will remind him/her that the entire balance is still due.

If an enrollee is billed monthly, a second notice is sent 30 days from the initial billing notice.

B. PROCEDURE--SECOND DELINQUENT NOTICE (DELINQUENT NOTICE)

Each quarterly billed enrollee who has either paid no premiums by the last month of his/her grace period, or who has made a partial payment, will be sent a premium bill marked "Delinquent Notice" early in the last month of his/her grace period. This is 90 days after the initial bill. This notice will inform the enrollee of the date his/her Medicare coverage will terminate if the overdue premiums are not paid by the billing due date. The notice will also explain the limitations on re-enrollment after a termination, and that if he/she re-enrolls later the premiums may be higher.

The delinquent notice will include the past-due amount (amount of initial bill) and premiums due for the next 3 months. If the past-due amount (the amount over 90 days old) is not paid or a partial payment of the past-due amount is made which leaves a balance of more than $10.00, the Medicare coverage will end by the billing due date.

If an enrollee is billed monthly, the second delinquent notice is mailed 60 days from the initial bill and will only inform the enrollee that the premiums are still in arrears and are due. The delinquent notice will not reflect a termination date at this time.

C. PROCEDURE--THIRD DELINQUENT NOTICE (DELINQUENT NOTICE) (MONTHLY BILLED BENEFICIARIES ONLY

This delinquent notice is sent 90 days from the initial billing notice for those enrollees who have not paid premiums or who made a partial payment of their premiums. This delinquent notice will include the past-due amount (amount owed from prior billing notice) plus premiums for the next month. If the past-due amount is not paid or if a partial payment of the past-due amount leaves a balance of more than $10.00, the Medicare coverage will terminate by the billing due date.

NOTE: All notices explain the limitations on enrollment after a termination, and the potential consequence of a higher premium in the event of a late re-enrollment.