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Verification of Alternative Coverage Please fill out this form if you are waiving your right to part

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The document is a verification form for employees in Massachusetts who are waiving coverage under the Tufts Health Plan. It requires employees to provide their personal information, reasons for waiving coverage, and details about any alternative health insurance they may have. The form also outlines the conditions under which employees can later enroll in the Tufts Health Plan if their circumstances change.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What does waiving coverage mean?

If your employer is unable to complete Section B of the CMS-L564, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence: Income tax returns that show health insurance premiums paid. W-2s reflecting pre-tax medical contributions.

Can I opt out of employer health insurance for Medicare?

Yes, you can drop or un-enroll from Medicare if you are covered by a qualifying medical insurance plan provided by an employer.

Can an employee waive health insurance?

It is a formal agreement or declaration that modifies the terms of the insurance policy, removing or altering specific provisions or conditions that would otherwise apply. The waiver may be temporary or permanent, and it must be agreed upon by both parties to be legally binding.

What is the Medicare small employer exception?

If an employer, having fewer than 20 full and/or part-time employees, sponsors or contributes to a single-employer Group Health Plan (GHP), the Medicare Secondary Payer (MSP) rules applicable to individuals entitled to Medicare on the basis of age do not apply to such individuals.

What if my employer wont fill out CMS L564?

Employees who choose to decline one or more lines of coverage offered by a company for themselves or their dependents must sign a waiver and provide a reason for declining. The waiver that the employee will be required to sign can include the following: Name. Social Security number.

Is CMS-L564 required?

The CMS-L564 Medicare form and Medicare form CMS 40-B are necessary for individuals enrolling in Medicare Part B after their initial enrollment period.

Can my employer force me to enroll in Medicare?

Companies with 20 or more employees are required to continue offering health insurance to current workers and their spouses who are 65 or older. If youre insured under a plan from a company of that size, you have the option to enroll in Medicare and decline your group plan, but the employer cant force this decision.

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