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FORM 4UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549Check this box if no
longer subject to
Section 16. Form 4 or
Form 5 obligations
may continue. See
Instruction 1(b).OMB
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What is on December 7 form?
The December 7 form refers to the annual election period for Medicare plans, specifically the notice for beneficiaries to select or change their Medicare Advantage or Part D prescription drug plans.
Who is required to file on December 7 form?
Individuals who are eligible for Medicare, including those who are new to Medicare, have changed plans, or wish to compare and select different Medicare Advantage or Part D plans, are required to file the December 7 form.
How to fill out on December 7 form?
To fill out the December 7 form, beneficiaries must provide their personal information, including their Medicare number, select their desired plan, and submit the form by the deadline to ensure enrollment.
What is the purpose of on December 7 form?
The purpose of the December 7 form is to allow Medicare beneficiaries to inform their insurance providers about changes in their coverage, ensuring they have the appropriate health and prescription drug coverage for the following year.
What information must be reported on on December 7 form?
Beneficiaries must report their Medicare number, personal contact information, the selected plan details, and any changes in their coverage preferences on the December 7 form.
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