1199 SEIU Medicare Form – Fill Out and Use This PDF

1199 SEIU Medicare Form: Eligibility, Requirements, and PDF Details

The 1199SEIU National Benefit Fund gives eligible retirees a way to recover part of their Medicare Part B premiums through the Statement of Claim for Medicare Part B Premium Reimbursement. Based at West 42nd Street in New York, the fund processes claims on a quarterly, semi-annual, or annual basis. Qualifying retirees and their spouses can receive up to 50% of the basic Medicare Part B premium cost.

Who Is Eligible for the 1199SEIU Medicare Reimbursement Benefit

Eligibility is defined by years of service and age at retirement, as outlined in the Summary Plan Description. You must be enrolled in Medicare Part B to qualify for this benefit. Retirees must meet the fund's minimum service requirements and have retired at the age specified in the plan. Spouses of eligible retirees are also covered and may claim 50% reimbursement on their own Medicare Part B premiums. For related benefit documentation, see the 1199SEIU benefit form available on FormsPal.

Documents Required to File a 1199SEIU Medicare Claim

Every claim requires Form SSA-1099 for each person included and for each claim year. First-time filers must attach a copy of the Medicare Part B ID card to their submission. Spouses filing for the first time also need to include their Medicare Part B ID card. Attaching all required documents to your Medicare reimbursement claim helps prevent delays in processing and ensures your payment arrives without complications.

Filing Deadlines and the Claim Period

Claims may cover the current benefit year and up to two prior years. Reimbursement is limited to past coverage through the month the claim is received by the fund. Future coverage cannot be claimed in advance. Retirees should file each year to ensure they receive the full reimbursement they are entitled to. Before submitting, also review whether you need to complete a standard Medicare Part B form as part of your enrollment or renewal process.

How to Submit Your Claim to the 1199SEIU National Benefit Fund

Complete the 1199SEIU Medicare form by providing all identifying information, checking the applicable claim period boxes (quarterly, semi-annual, or annual), and including the required SSA-1099 form. Mail or deliver the completed form along with all supporting documents to the 1199SEIU National Benefit Fund at West 42nd Street, New York. Retirees who need help with similar claims for other benefit types can also find the 1199SEIU optical reimbursement claim on FormsPal. After receiving your submission, the fund will process your claim and issue reimbursement for the covered months.

Claiming Reimbursement for a Spouse or Surviving Dependent

Spouses of 1199SEIU retirees who are enrolled in Medicare Part B may file their own claim for the 50% reimbursement benefit. Surviving spouses of deceased eligible retirees may also qualify to continue receiving the benefit, depending on the rules outlined in the Summary Plan Description. Each eligible person must file their own claim form along with their own SSA-1099 and Medicare Part B ID card. Retirees and dependents looking for supplemental Medicare coverage may also want to review the Medicare supplement form options available through FormsPal.