Get Medicare Part-d Irmaa Reimbursement Form - Dartmouth College - Dartmouth

This guide provides a comprehensive overview of how to complete the Medicare Part-D IRMAA Reimbursement Form for Dartmouth College. Follow these steps to ensure your form is filled out correctly and submitted for reimbursement.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling out Section 1, which requests retiree information. Clearly print your name (first, middle initial, last) and your Social Security number. If applicable, include the name and Social Security number of your eligible dependent.
3. Proceed to Section 2 to provide your mailing address. Clearly print the number, street, apartment (if any), city, state, and ZIP code. Include your residence address if it differs from your mailing address.
4. Move to Section 3 to confirm required documents. Check the boxes next to each included document to signify that you are submitting the necessary Social Security Administration statements for both the retiree and any eligible dependents.
5. Once you've completed all sections of the form, review your entries for accuracy and clarity.
6. After checking for completeness, proceed to save your changes, download the form, and prepare to print it.
7. Submit the completed form along with the required documentation to the designated address provided by Dartmouth College.

Complete your forms online to ensure efficient processing for your Medicare Part-D IRMAA reimbursement.