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Get 1199SEIU National Benefit Fund 3NBF18 2020-2024

FOR MEDICARE PART B PREMIUM REIMBURSEMENT Please print clearly in blue or black ink, or complete online. Filing claims for Medicare Part B premium reimbursement: Claims may be filed once every quarter, but no later than two years after the premium payment. To ensure proper reimbursement, please submit a copy of your Social Security Benefit Verification Letter for each person for each claim year. Eligible retirees may submit a claim for 50 percent of the standard Medicare Part B premium.

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