[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-304353-105":53,"doc-detail-304353-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","medicare-reimbursement-form-letter-2020-submission-instructions-and-required-documents","Medicare Reimbursement Form Letter 2020 - Submission Instructions and Required Documents","","Medicare Part B premium reimbursement instructions for Mamaroneck Union Free School District retirees and eligible spouses. Provides eligibility criteria for age 65+, specifies required documentation including SSA Medicare Part B premium verification notice, SSA 1099 tax form, a notarized certificate of eligibility, and a retiree payment form only when banking information changed. Sets submission deadline of February 26, 2021, explains reimbursement processing and payment timing, and lists email and mailing submission methods, including contact details for Darwin Quinde.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/medicare-reimbursement-form-letter-2020-submission-instructions-and-required-documents/304353/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/medicare-reimbursement-form-letter-2020-submission-instructions-and-required-documents/304353.png","ImageObject",442,249,{"name":88,"@type":89},"Jasmine","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Who is eligible to submit for Medicare Part B premium reimbursement?","Question",{"text":108,"@type":109},"Retirees and their spouses are eligible if the spouse is not covered by another agency and either you or your spouse is 65 years of age or older and receive Medicare Part B benefits.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What documents are required for the 2020 Medicare Part B premium reimbursement?",{"text":113,"@type":109},"Required items include the 2020 Social Security Administration benefit notice for Medicare Part B premiums, the SSA 1099 tax form, a notarized certificate of eligibility, and a retiree payment form for both you and your spouse when banking information has changed since last year’s payment.",{"name":115,"@type":106,"acceptedAnswer":116},"When must documents be submitted and when will reimbursement be issued?",{"text":117,"@type":109},"Documents must be received on or before February 26, 2021 for 2020 reimbursements. If approved, payment will be issued on or before April 30, 2021 covering the 2020 calendar year.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},304353,1790223257,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":73},2336478487870,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Dear Mamaroneck Retiree,  \nThe Mamaroneck Union Free School District (the District) provides Medicare Part B premium reimbursement to retirees and their spouses provided the spouse is not covered by another agency.  \nIf either you or your spouse is 65 years of age or older and receive Medicare Part B benefits, please submit the following documents to the Mamaroneck School District Business Office on or before February 26, 2021, so that your Medicare Part B reimbursement may be processed.  \n1) 2020 Social Security Administration Benefit notice of Medicare Part B Premium – also known as 2020 Social Security Benefit Verification Letter-for you & your spouse, if both eligible  \nThis form is mailed directly to you from the Social Security Administration usually in November 2019  \n2) SSA 1099 Tax Form – also known as 2020 Social Security Benefit Statement – for you & your spouse, if both eligible  \nThis is your tax form used to prepare your IRS income taxes each year and is mailed directly to you in January 2021  \nIf you don't collect Social Security and pay for Medicare Part B on your own, please provide proof of your payments (premium statements and/or cancelled checks)  \n3) Notarized Certificate of Eligibility Form signed by you and your spouse, if both eligible.  \n4) Retiree Payment Form for both you and your spouse. The district has transitioned to electronic payments.  \nPLEASE SUBMIT THE RETIREE PAYMENT FORM ONLY IF YOUR BANKING INFORMATION HAS CHANGED SINCE LAST YEAR’S PAYMENT.  \nA copy of your SSA Benefit Statement can be obtained online at www.ssa.gov or by calling 1-800-772-1213, attached is a sample for your reference.  \n• Link to receive a copy of your SSA Benefit Verification Letter:  \n[https://www.ssa.gov/myaccount/proof-of-benefits.html](https://www.ssa.gov/myaccount/proof-of-benefits.html)  \n• Link to receive a copy/replacement SSA 1099 Tax Form:  \n[https://www.ssa.gov/myaccount/replacement-SSA-1099.html](https://www.ssa.gov/myaccount/replacement-SSA-1099.html)  \nUpon receipt and review of the above documents, if appropriate, the District will issue a payment to you and your spouse for the standard Medicare Part B Premium. Payments will be issued on or before April 30, 2021 and will cover the 2020 calendar year. Reimbursements for 2020 will only be paid for documentation received by February 26, 2021.  \nPlease e-mail the required documents [to](to Dquinde@mamkschools.org)[ ](to Dquinde@mamkschools.org)[Dquinde@mamkschools.org](to Dquinde@mamkschools.org)  \nor send by mail on or before February 26, 2021, to:  \nBusiness Office-Medicare Department  \nMamaroneck UFSD  \n1000 West Boston Post Road  \nMamaroneck, NY 10543  \nThank-you, Darwin Quinde, Senior Bookkeeper, 914-220-3049","cbCaiekNG0rkV7KS","https://ap.wps.com/l/cbCaiekNG0rkV7KS","pdf",865520,"English","# Required Documents\n## Deadlines and Payment Processing\n# Submission Methods","[{\"question\":\"Who is eligible to submit for Medicare Part B premium reimbursement?\",\"answer\":\"Retirees and their spouses are eligible if the spouse is not covered by another agency and either you or your spouse is 65 years of age or older and receive Medicare Part B benefits.\"},{\"question\":\"What documents are required for the 2020 Medicare Part B premium reimbursement?\",\"answer\":\"Required items include the 2020 Social Security Administration benefit notice for Medicare Part B premiums, the SSA 1099 tax form, a notarized certificate of eligibility, and a retiree payment form for both you and your spouse when banking information has changed since last year’s payment.\"},{\"question\":\"When must documents be submitted and when will reimbursement be issued?\",\"answer\":\"Documents must be received on or before February 26, 2021 for 2020 reimbursements. If approved, payment will be issued on or before April 30, 2021 covering the 2020 calendar year.\"}]","Medicare Reimbursement Form Letter 2020 - Submission Instructions and Required Documents | PDF",1789812134]