• 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 Pay-
ment-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.
MEDICARE
(Includes 1967 Changes]
HOW TO
CLAIM BENEFITS
under
Medical
Insurance
Health fffly) Insurance
SOCIAL     SICURITV     ACT
NAME  OF  BENEFICIARY
JOHN Q PUBLIC
CLAIM  NUMBER SEX
000-00-0000-A MALE
IS  ENTITLED  TO EFFECTIVE   DATE
HOSPITAL INSURANCE 7-1-66
MEDICAL INSURANCE
tyl»ffi$Ui-~
7-1-66
um
WMmB:
wmy
myym
lift
U.S.  DEPARTMENT OF
HEALTH,  EDUCATION, AND WELFARE (!(}(jTi)f
SOCIAL SECURITY ADMINISTRATION   ^
SSI-37a MARCH   1968
* U.   S.   GOVERNMENT  PRINTING OFFICE : 1968  O - 295-055