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New York City Office of Labor Relations Health Benefits Program nyc.gov/olr Medicare Part B IRMAA Reimbursement Form The City of New York Health Benefits Program reimburses Medicare eligible retirees

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How to fill out health-retiree-medb-irmaa

01

Gather all necessary documents and forms required for filling out health-retiree-medb-irmaa.

02

Carefully read and understand the instructions provided on the form.

03

Fill out personal information accurately including name, address, social security number, and date of birth.

04

Provide information about your retirement health coverage and IRMAA eligibility.

05

Double-check all the information filled out to ensure accuracy.

06

Sign and date the form before submission.

07

Submit the completed form to the appropriate office or online portal as instructed.

Who needs health-retiree-medb-irmaa?

01

Individuals who are retirees and receiving health benefits post-retirement may need to fill out health-retiree-medb-irmaa form.

02

People who are subject to IRMAA (Income-Related Monthly Adjustment Amount) and need to report their retirement health coverage may also need to fill out this form.

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What is health-retiree-medb-irmaa?

health-retiree-medb-irmaa is a form used to report information about retiree health coverage and Medicare premiums.

Who is required to file health-retiree-medb-irmaa?

Retirees who receive health coverage and Medicare benefits are required to file health-retiree-medb-irmaa.

How to fill out health-retiree-medb-irmaa?

Health-retiree-medb-irmaa can be filled out online or by mail with accurate information about retiree health coverage and Medicare premiums.

What is the purpose of health-retiree-medb-irmaa?

The purpose of health-retiree-medb-irmaa is to ensure accurate reporting of retiree health coverage and Medicare premiums for tax purposes.

What information must be reported on health-retiree-medb-irmaa?

Information such as retiree health coverage provider, Medicare premiums paid, and any changes in coverage must be reported on health-retiree-medb-irmaa.

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