Get Cms L564

The Cms L564 form, officially known as the request for employment information, is essential for verifying health coverage under an employer’s group health plan. This guide provides clear and detailed steps to help users efficiently complete this form online.

Follow the steps to fill out the Cms L564 accurately.

1. Click the ‘Get Form’ button to retrieve the Cms L564 form and open it in the editor.
2. Provide the contact information of the requesting organization, including the name and telephone number of the person in charge.
3. Fill in the employer's name and address, ensuring all details are accurate and up-to-date.
4. Input the date when the request is being made.
5. Enter the employee's name and their Social Security number carefully to avoid errors.
6. In the claimant’s section, fill in the claimant’s name and their claim number.
7. Respond to the question about whether the claimant is or was covered under an Employer Group Health Plan by selecting 'Yes' or 'No.' If 'Yes,' provide the date the coverage began.
8. Indicate whether the coverage has ended. If 'Yes,' please provide the end date.
9. Specify the employment period for the employee by filling in the start date and selecting whether the employee is still employed.
10. Complete the form by having an official from the company sign and date it.
11. Lastly, save any changes made to the form. You can choose to download, print, or share the completed Cms L564 as needed.

Complete your Cms L564 form online today to ensure timely processing of your request.