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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICESForm Approved OMB No. 09380787REQUEST FOR EMPLOYMENT INFORMATION WHAT IS THE PURPOSE OF THIS FORM?WHAT DO I DO WITH

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Social Security Claim Request for Employment Information & Making a Template

If you’re a boss, business owner, or employer, one of your employees may end up applying for Medicare or Medicaid services. When they do, the Social Security Claim Request for Employment Information form into a template for later use.

How to turn the Social Security Claim Request form into a template:

In the “My Forms” page, select the Social Security Claim Request for Employment Information form.
Type in the information & add the signatures that you always want the template to contain (information that always stays the same), like your company’s name, address, phone number, your supervisor title, and signature.
Click the red “DONE” button to save. You’ll be automatically taken back to the “My Forms” page.
Now, select the document you just edited, and click the “Template” button. If you can’t find the button right away, click “More” and a list with drop down with more clickable functions (see the image below for an example).5. Your claim form has now been instantly converted into a template. You’ll know which one it is because it’ll be labeled with a “T.”

From now on, every time you open this template document, it will include the permanent information you saved, but you will be able to enter all the unique employee/claimant information for each individual work situation. CMS-L564 form template (or any of your other templates) changes, you can make edits anytime. To learn more about making your PDFfiller account really work for your business, click here.

When you’re finished answering the form’s employment questions, you have a few options. Save a stamp and eFax the form directly to the Social Security Department, email it, or simply print it out and tuck it into the return envelope they’ve already supplied for you.

We hope this tutorial makes life and work easier for you and your employees. If you have any comments or questions, we’d love to hear from you.

Thanks for stopping by!

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Hello and welcome to the Medicare and Federal Employees Health Benefits Program webcast. My name is Lottie Thompson and Iím a Legal Administrative Specialist with OPMís Insurance Operations office. Today we are going to start by focusing on Medicare. What is Medicare? What is Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D. How much does Medicare cost? When can you enroll in Medicare? When you have a health plan in the FEHB Program, how does the plan work with Medicare? What should you consider when you are thinking about enrolling in Medicare? What are some resources that can help you make your decision? Letís take a closer look at Medicare. Medicare is health insurance for 3 groups of people: * Those who are 65 and older * Those who are under 65 with certain disabilities, and * Those who are any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) You enroll in Medicare through the Social Security Administration. Once you enroll, the Centers for Medicare and Medicaid Services will administer your Medicare benefits. You can think of the Social Security Administration as the door to Medicare. Once youíve entered the door, the Centers for Medicare and Medicaid Services will provide your Medicare benefits. As you can see from this slide, Medicare has 4 parts ñ Part A, Part B, Part C, and Part D. Part A is hospital insurance. It helps cover benefits such as inpatient hospital stays, skilled nursing facilities, hospice, and home health care. Most people can get Part A for free because you or your spouse paid Medicare taxes while working. Part B is medical insurance. Part B helps cover doctorsí and other health care providersí services, outpatient care, durable medical equipment, and home health care. It also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse. Part B has a monthly premium. Weíll take a closer look at the premiums later in the presentation. Part A and Part B together are known as the Original Medicare. You can go to any doctor that accepts Medicare and get your Medicare benefits. Thereís another option for people who want to get their Medicare benefits. This other option is called Part C and is also known as Medicare Advantage. Medicare Advantage plans are health plan options run by Medicare-approved private insurance companies. Medicare Advantage Plans are a way to get the benefits and services covered under Part A and Part B. Most Medicare Advantage Plans cover Medicare prescription drug coverage. Some Medicare Advantage Plans may include extra benefits for an extra cost. Medicare Part D is prescription drug coverage. It may help lower your prescription drug costs and help protect against higher costs. Part D plans are run by Medicare-approved private insurance companies. Their costs vary. You can find more information about what is covered under each part in the Medicare and You Handbook on...

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