HI 01001: Supplementary Medical Insurance
TO: | Railroad Retirement Board |
Health Insurance Operations | |
844 Rush Street | |
Chicago, Illinois 60611 | |
FROM: | SSA PSC NE MAT AW FL MM QN ODO DIO |
SUBJECT: | SMI Premium Arrearages Based on Equitable Relief |
Take the following actions on this case:
RRB claim number
SSA claim number
Name
Check the appropriate box:
□ 1. Waiver request - Development made by district office
□ 2. Beneficiary in: □ current pay □ suspense □ uninsured status
Comments: