An updated COSE MEWA Small Employer Exception form has been posted to cosemewa.com. This form, with a revision date of June 2022 (6/22) replaces the April 2022 (4/22) version. You’ll find the updated form, along with instructions on how to complete it, under Self-Help Compliance Resources > Medicare or Additional Tools and Resources > Links and Forms.
Forms like this can change often. That’s why it’s important to always access the form directly from cosemewa.com instead of saving a copy to your desktop. This will ensure you are always using the most current form. Using an old version could cause delays in processing your request.
When to use the form
Complete and submit the form for employees who wish to:
- Be moved to Medicare Primary upon their 65th birthday
- Be moved to Medicare Primary at enrollment (for new groups)
- Be removed from Medicare Primary coverage
- Leave the group’s plan
Where to submit completed forms
To ensure timely processing, send completed forms to firstname.lastname@example.org.
You can find this form in your AGB Broker Suitcase! Contact your Cornerstone representative with any questions.