POINTS TO REMEMBER
# Any covered medical expenses in October, November, or
December which are used to meet that year's $50 annual
deductible can also be used to meet the following year's deductible.
# In submitting bills to count toward your $50 annual deductible, you may wish to hold them until they total $50 or
more instead of sending each bill in as you receive it.
® You do not have to send bills in immediately, but to get payment you must submit them by the following dates:
For services you received in:
July, August. September 1966
October 1, 1966 - September 30, 1967
October 1, 1967 - September 30, 1968
Get bills in by:
April 1, 1968
December 31, 1968
December 31, 1969
• If you have more than one bill from your doctor or bills from
more than one doctor, all of them can be sent in with the
same Request for Medicare Payment.
• Do not send bills for services received before your medical
insurance protection started. This date is shown on your
health insurance card.
• Always be sure that all questions in Part I of the Request
for Medicare Payment (SSA-1490) have been answered
and that you have signed the form. If you are using the
Payment-To-You method and your doctor did not complete
Part II, be sure that all the bills you are attaching show your
name and health insurance claim number exactly as shown
on your health insurance card.
• You will receive a notice of all payments made by your
medical insurance.
For more information or assistance, get in touch with your
social security office. The people there will be glad to help you.
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Health •J&j Insurance
SOCIAL     UECURITV     ACT
NAME  OF  BENE. ICiAHV
JOHN Q PUBLIC
CLAIM  NUMBf R                                                    SC»
000-00 -0-00-A                       MALE
IS   1 ISTl-l CO   TO                                                   tFr.LTIV.     I-ATf
HOSPITAl   INSURANCE              7-1-66
MEDICAL INSURANCE                7-1-66
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
SOCIAL SECURITY ADMINISTRATION
SSI-37
JANUARY 1968