HEATH INSURANCE PREMIUM SUBSIDY FROM PENSION FUND

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If you have had Aetna or Blue Cross since 1/1/17 and the Pension Fund was making the payments the answer to the questions are.

Medicare Status Yes

If Yes I qualified for Medicare coverage:

Check the proper box

Medicare if you were on Medicare January of 2017

Coverage Start Date would be. 1/1/2017

Insurance, Put in your carrier if Aetna, Blue Cross and the money is taken from your check put in paid from Pension.

If you have your own insurance you can have the bank generate a statement showing payments to your insurance company.

If you are just using Medicare for your insurance send in a copy of your end of the year Medicare statement to the Pension Fund.