This document is locked as it has been sent for signing. The purpose of the form is to provide to the enrollee a standardized format to request termination of Part B and/or premium Part A coverage, explain why (s)he wishes to terminate such coverage and to . Update it below and resend. Because the termination of (Part A) hospital or (Part B) medical insurance is not strictly regulated, enrollees can do it whenever they think it is necessary. You can also fax the CMS-40B and CMS-L564 to 1-833-914-2016; or return forms by mail to your local Social Security office . 7500 Security Boulevard, Baltimore, MD 21244, Request for Termination of Premium Hospital and Supplementary Medical Insurance, An official website of the United States government. ","hasArticle":false,"_links":{"self":"https://dummies-api.dummies.com/v2/authors/9067"}}],"_links":{"self":"https://dummies-api.dummies.com/v2/books/282390"}},"collections":[],"articleAds":{"footerAd":"
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