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Medicare beneficiary form available online
The Railroad Medicare Beneficiary Authorization Form is now available in Acrobat's Portable Document Format (PDF).

(To view and print PDF documents, you must first download and install the free Acrobat Reader program from www.getadobe.com/reader.)

In this age of technology, privacy is important. To protect your privacy, Palmetto GBA Railroad Medicare will always ask certain questions before discussing your personal information.

Palmetto GBA is a national Part B Medicare carrier contracted by the Railroad Retirement Board to administer Medicare Part B health insurance for railroad workers and their families. When calling, you will be asked to give your:

•Full name
•Date of birth
•Health insurance claim number
•Telephone number

While Palmetto understands it may seem inconvenient, federal law provides that Medicare cannot release specific information about your benefits to anyone but you unless you give your verbal or written permission.

If your spouse or anyone else calls for you, Palmetto will not be able to give any details about your Medicare unless it has your permission. Also, the same applies if you try to obtain details about your spouse. Therefore, it is important that both you and your spouse have an authorization form on file with Palmetto.

Verbal permission has to be given over the phone at the time of each call. Since written permission is more detailed and is used for future reference, it must include the following:

•The name of the person or group to whom information may be given.
•The specific types of information (data or records) that may be released.
•Your signature and date you signed your name.
•Length of authorization (ongoing or one-time only).

If Palmetto does not have your verbal or written consent, the only information it will release is:

•Claim has/has not been received.
•Claim has/has not been processed.
•A Medicare summary notice (MSN) can be expected by a certain date.

If you know that your spouse or someone else will be calling for you on a regular basis, you might consider sending in written permission for them.

Click here to download and print the Railroad Medicare Beneficiary Authorization Form that you may fill out and return to Palmetto so that your records can be updated and your privacy protected.

October 20, 2009
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