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This version of the form is not currently in use and is provided for reference only. Download this version of
Form CMS-4040
for the current year.
Form CMS-4040 Request for Enrollment in Supplementary Medical Insurance
What Is Form CMS-4040?
This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on August 1, 2020 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form CMS-4040?
A: Form CMS-4040 is a request form for enrolling in Supplementary Medical Insurance.
Q: Who can use Form CMS-4040?
A: Any individual who wants to enroll in Supplementary Medical Insurance can use Form CMS-4040.
Q: What is Supplementary Medical Insurance?
A: Supplementary Medical Insurance is a health insurance program that helps cover healthcare costs that are not covered by Original Medicare.
Q: Is there a deadline for submitting Form CMS-4040?
A: There is no specific deadline for submitting Form CMS-4040. However, it is recommended to submit the form as soon as possible to ensure timely enrollment in Supplementary Medical Insurance.
Q: Do I need to pay a fee to submit Form CMS-4040?
A: No, there is no fee to submit Form CMS-4040.
Q: What documents do I need to submit with Form CMS-4040?
A: The specific documents required may vary depending on individual circumstances. Generally, you will need to provide proof of age, citizenship or immigration status, and any other relevant documentation for enrollment.
Form Details:
- Released on August 1, 2020;
- The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form CMS-4040 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.
Download Form CMS-4040 Request for Enrollment in Supplementary Medical Insurance
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