CMS Pub. 100-04, ch. 21, § 10.3.10

The envelopes in which MSNs are mailed will be consistent in format, rather than

varying depending on which MAC is responsible for printing and mailing the MSN.

The envelopes will feature the DHHS seal, not the individual MAC logo or the CMS

logo. Content will be printed using Minion for the address and Myriad in all caps for any

additional information. Both the DHHS seal and the content will be printed in CMS blue,

or Pantone 300 U.

The MSN may be mailed in one of three sizes of envelopes: standard #10 (4.125” x 9.5˝),

half size (6” x 9˝), or full size (9” x 12”).

All MACs are encouraged to print on customized envelopes with adjusted window

position to show the recipient address of the MSN when inserted in the envelope.

Therefore, coversheets or address labels will no longer be needed for any of the envelope

sizes. (The only exception is in the case of Pay MSNs, where the check will be part of a

cover sheet containing the beneficiary’s mailing address; see the section above for check

cover-sheet instructions, and see below for specifications for the front of Pay MSN

envelopes.)

See Exhibit 2.14 for examples of the three different sizes of non-pay envelopes and the

Pay MSN envelope.

A. Front of Non-Pay MSN Envelopes

POSITION OF CONTENT

The front of the envelope contains information of a fixed size. It does not vary in overall

width or length.

The Department of Health & Human Services seal, an imported image, is located (0.375˝,

0.25˝). It measures 57 points in width and 57.5 points in height.

The text element starts (1.25˝, 0.3˝), indented 6 points from the seal. It measures 210

points in width and 75 points in height.

POSITION OF ADDRESS WINDOW

For all sizes of the envelope, the window measures 4.5 inches in width and 1.5 inches in

height with rounded corners.

On standard #10 and half-size envelopes, the window is located at (0.75˝, 2.06˝) from left

top corner. To meet USPS requirements, the window on the standard #10 envelope

should be placed 0.625” from the bottom.

[The below figure has been revised.]

On full-size envelopes, the window is located at (0.5˝, 2˝) from left top corner.

[The below figure is new.]

See Exhibit 2.14 for layout reference.

FORMATTING

[GL 7] Department of Health & Human Services seal

[TB 1.1] return address

[GR 4.1] space after

[TB 2.2] notification line (in all capital letters)

DYNAMIC RULES

n/a

CONTENT

The return mailing address listed should be the preferred mailing address of the MAC

generating the MSN. Complete content is as follows:

[GL 7]

Centers for Medicare & Medicaid Services

c/o {A/B MAC (A), (B), (HHH), or DME MAC Name}

{MAC Street Address}

{MAC City}, {ST} {ZIP+4}

OFFICIAL MEDICARE INFORMATION

B. Front of Pay MSN Envelopes

POSITION OF CONTENT

The front of the envelope contains information of a fixed size. It does not vary in overall

width or length.

The Department of Health & Human Services seal, an imported image, is located (0.375˝,

0.25˝). It measures 57 points in width and 57.5 points in height.

The address text element starts (1.25˝, 0.3˝), indented 6 points from the seal. It measures

210 points in width and 75 points in height.

The return-service text element starts (5˝, 0.5˝). It measures 191 points in width and 26

points in height.

See Exhibit 2.14 for layout reference.

[Figure 10.3.10B has been replaced with figure 10.3.10B1.]

[The below figure is new.]

POSITION OF ADDRESS WINDOW

Reference specifications on Section 10.3.10.A for window position.

FORMATTING

[GL 7] Department of Health & Human Services seal

[TB 1.1] return address

[GR 4.1] space after

[TB 2.2] notification line (in all capital letters)

[TB 2.2] important document line (in all capital letters)

NOTE: For alternate layout of the important document line, it can be below the

notification line.

DYNAMIC RULES

n/a

CONTENT

The return mailing address listed should be the preferred mailing address of the MAC

generating the MSN. Complete content is as follows:

[GL 7]

Centers for Medicare & Medicaid Services

c/o {A/B MAC (A), (B), (HHH), or DME MAC Name}

{MAC Street Address}

{MAC City}, {ST} {ZIP+4}

OFFICIAL MEDICARE INFORMATION

IMPORTANT DOCUMENT ENCLOSED

C. Back of All Envelopes

POSITION

The back of the envelope contains information of a fixed size. It does not vary in overall

width or length.

On standard #10 envelopes, the content area begins 0.375 inches from the top margin and

is centered to the width of the envelope. It is 459 points in width and 48 points in height.

The vertical position may be adjusted slightly depending on the shape and height of the

envelope flap.

On half- and full-size envelopes, the content area begins 0.5 inches from the top margin

and is centered to the width of the envelope. It is 433 points in width and 48 points in

height. The vertical position may be adjusted slightly depending on the shape and height

of the envelope flap.

See Exhibit 2.14 for layout reference.

FORMATTING

[TB 2.1] instructions, center aligned

[GR 4.1] space after

[TB 2.2] notification line, all caps, center aligned

DYNAMIC RULES

n/a

CONTENT

For help regarding your notice, call us at 1-800-MEDICARE (1-800-633-4227).

If you change your address, contact the Social Security Administration at 1-800-772-

1213.

TO BE OPENED BY ADDRESSEE ONLY

D. Envelope Liner

All Pay envelopes must have a security liner inside the envelope to ensure the inserted

check cannot be seen through. Shown below is a suggested pattern using the DHHS seal.

The artwork will be provided as GL 8 in vector and flash image formats. The MACs may

also use a standard pattern if the recommended custom pattern will be costly to

implement.

E. Coversheet

All MACs are encouraged to print on customized envelopes without coversheets.

However, if there is a need to have coversheets, the address block should follow the same

specifications to those on the MSN. See 10.3.3.C “Recipient Address” subsection for

specifications.