Request for Employment Information (CMS-R-297 2025

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The document is a Request for Employment Information form from the Centers for Medicare & Medicaid Services, required for individuals applying for Medicare during a Special Enrollment Period. It outlines the process for obtaining proof of group health plan coverage through current employment, detailing how to complete the form and where to submit it. The form must be filled out by both the applicant and their employer, providing necessary information about health coverage and employment dates.

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Versions	Form popularity	Fillable & printable
2023	4.9 Satisfied (26 Votes)
2020	4.8 Satisfied (234 Votes)
2016	4.3 Satisfied (100 Votes)
2010	4.3 Satisfied (143 Votes)
2000	4 Satisfied (26 Votes)

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What is a document used by an employer that asks for information related to employment?

I-9, Employment Eligibility Verification. Use Form I-9 to verify the identity and employment authorization of individuals hired for employment in the United States. All U.S. employers must properly complete Form I-9 for every individual they hire for employment in the United States.

What is the Medicare request for employment verification?

Medicare plan , your plan will send you an Evidence of Coverage (EOC) each year, usually in the fall. The EOC gives you details about what the plan covers, how much you pay, and more.

When must an employer respond to a verification of employment request and what information must or can be given?

Employers arent obligated to respond to calls to verify an individuals employment for a third party unless the requests are made by federal entities.

What is documentation verifying your GHP coverage through your or your spouses current employment?

Form CMS-L564 (Request for Employment Information) The Form CMS-L564 has two sections. The applicant completes Section A and the employer, the GHP or LGHP completes Section B of the form. The information provided in Section B is the evidence of GHP or LGHP coverage. To view the Form CMS-L564, see HI 00805.340.

What does GHP stand for?

The CMS-L564 Medicare form, also known as the Request for Employment Information, verifies an individuals group health plan coverage under an employer. This form is typically required for those who delayed enrolling in Medicare Part B because they or their spouse were covered by employer-sponsored insurance.

form l564

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What is CMS r 297?

The form CMS-L564, also referred to as CMS-R-297, is used, in conjunction with form CMS40B, Application for Supplementary Medical Insurance, during an individuals special enrollment period (SEP). Completed by an employer, the CMS-L564 provides proof of an applicants employer group health coverage.

What does GHP coverage mean?

A Group Health Plan (GHP) is health insurance offered by an employer, union or association to its members while they are still working. GHP coverage is based on current employment.

Request for Employment Information (CMS-R-297 2025

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What is a document used by an employer that asks for information related to employment?

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When must an employer respond to a verification of employment request and what information must or can be given?

What is documentation verifying your GHP coverage through your or your spouses current employment?

What does GHP stand for?

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