What information is needed for completion of a Medicare Set-Aside Allocation?
• First Notice of Injury/Loss • Last 2-3 years of medical payouts • Last 2-3 years of medical records • Any medical documents stating Maximum Medical Improvement • Rated Age* (can be obtained from KRS MSA or your annuity broker) • Completed Referral Form • Life Care Plan/Medical Cost Projection (if available) • Pharmacy Summary listing each medication and price (if available) • Legal documents and or Court orders supporting any denied or controvered body part (if applicable) • Estimated settlement amount • Claimant’s Medicare or Social Security Disability status (if available) * KRS MSA will obtain rated ages for you at no additional charge if needed How long will it take for completion of a Medicare Set-Aside Allocation report? Once the information needed for completion is received, you will receive the Medicare Set-Aside report in 14 days or less. Rush reports are also available upon request at no additional fee. What items are needed if CMS approval is requested? In addition to the
