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Form CMS-1763 Request for Termination of Premium Part a, Part B, or Part B Immunosuppressive Drug Coverage
What Is Form CMS-1763?
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 January 1, 2022 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-1763?
A: Form CMS-1763 is a request form for terminating premium Part A, Part B, or Part B Immunosuppressive Drug Coverage.
Q: What is premium Part A coverage?
A: Premium Part A coverage refers to Medicare Part A, which covers hospital insurance.
Q: What is premium Part B coverage?
A: Premium Part B coverage refers to Medicare Part B, which covers medical insurance.
Q: What is Part B Immunosuppressive Drug Coverage?
A: Part B Immunosuppressive Drug Coverage refers to Medicare coverage for drugs used to prevent organ rejection in transplant patients.
Q: Why would someone need to fill out this form?
A: Someone would need to fill out this form if they wish to terminate their premium Part A, Part B, or Part B Immunosuppressive Drug Coverage.
Form Details:
- Released on January 1, 2022;
- 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-1763 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-1763 Request for Termination of Premium Part a, Part B, or Part B Immunosuppressive Drug Coverage
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