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Un ashi medicare 2026
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- Click ‘Get Form’ to open the un ashi medicare document in the editor.
- In SECTION 1, clearly print your full name, index number, mailing address, retiree number, personal email address, and telephone number. Ensure all information is accurate for processing.
- Move to SECTION 2 to claim Part B premiums. Enter your name, relationship to the ASHI participant, Medicare ID, coverage period (from and to), and the monthly premium paid. Remember to attach proof of payment like Form CMS-500.
- If applicable, complete SECTION 3 with your bank information for EFT payment. Provide your bank name, account number, and routing or ABA #. This section is only necessary if your Medicare premium exceeds your ASHI contribution.
- Finally, sign and date the form at the bottom to confirm your commitment to continue paying Medicare premiums.
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