Medicare Part B Premium Increase for 2010:
For Members with Medicare Parts A and B

As a Medicare member, you may be affected by the Part B standard premium increase in 2010.  Please refer to your annual benefits statement from the Social Security Administration (SSA) or quarterly billing statement from the Centers for Medicare and Medicaid Services (CMS) to locate your 2010 Medicare Part B premium amount.  If your monthly Part B standard premium is $110.50, please submit the form along with a copy of your statement, and we will adjust your monthly Part B reimbursement amount to reflect the increase.

If you have any questions, please contact Medical and Dental Benefits at (800) 787-2489, EXT. 84560, or (213) 978-4560.

2010 MEDICARE PART B PREMIUM INCREASE FORM