Definitions The following definitions relate to topics addressed in this Chapter. Cancellation of Election - An action initiated by the beneficiary to cancel an election before the effective date of the election. There are instances when what appears to be a complete election can turn out to be not legally valid. These instances are outlined in sections 4.6 and 5.5 .
Some States have additional requirements before an enrollment is considered complete.
For example, some States require phone verification prior to enrollment. A model individual enrollment form is provided in Exhibit 1. Beneficiaries are not required to use a specific form to disenroll, but they must submit signed requests for disenrollment in writing. There are several types of election periods, all of which are defined under section 3 . For individuals enrolling in their Initial Coverage Election Period, an SSA application for Medicare Part A and B showing the effective date for both Parts A and B may be considered acceptable evidence of Part A and Part B coverage.