A claimant who meets the non-medical requirements and completes a request for Expedited Reinstatement (EXR) may receive up to 6 months of provisional cash benefits and Medicare while we make a determination on their request. Medicare coverage during the provisional benefit period is the same Medicare coverage the claimant had at the time of their termination.

A claimant is not eligible for provisional benefits when any of the following applies:

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  they do not meet one of the eligibility requirements for EXR listed in DI 13050.001B.1;

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  an event has occurred that would preclude entitlement (a childhood disability benefits (CDB) recipient has married); or

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  the Disability Determination Services (DDS) determines the claimant does not meet the disability requirements for EXR.

A claimant can decline provisional cash benefits, but still elect to receive Medicare coverage during the provisional benefit period.

NOTE: Provisional benefits are not payable to auxiliary claimants, other than a previously entitled disabled widow(er) benefit (DWB) or CDB who is eligible and requests EXR. Provisional benefits are not payable to a claimant requesting EXR of CDB benefits on the record of a living number holder who is not currently entitled.

We do not pay provisional benefits on an EXR request if the claimant previously requested EXR for the same period of eligibility and received provisional benefits based on that request, regardless of how many months they received provisional payments on the previous request. However, we can pay provisional payments on a subsequent EXR request if the claimant:

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  was approved for EXR on a previous request;

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  completed the initial reinstatement period (IRP);

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  completed a trial work period (TWP);

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  completed an extended period of eligibility (EPE);

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  had their benefits later terminated due to substantial gainful activity (SGA), and

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  filed a new request for EXR within 60 months of that termination, or we can find good cause for late filing.

Example 1:

An individual requests EXR on March 4, 2016, and we approve the request on May 4, 2016. They receive 3 months of provisional benefits before they are re-entitled to disability benefits. They complete their IRP, TWP and EPE. After completing the EPE, benefits terminate due to SGA in January 2023. On April 12, 2023, the individual files for EXR again because they are no longer performing SGA. As they completed the IRP, TWP, and EPE on the new entitlement period, had their benefits terminated for SGA, and then filed a new EXR request within 60 months of that termination, they are eligible to request a subsequent EXR and receive provisional benefits.

Example 2:

An individual requests EXR on March 4, 2021, and we medically deny the request on May 4, 2021. They received 3 months of provisional benefits. The individual refiles for EXR on May 2023. Because we paid at least one month of provisional benefits on the prior request, we cannot pay provisional benefits on the subsequent request.

Compute the provisional benefit following these steps:

1. a. 

   Base the provisional benefit payment amount upon the payable benefit amount at the time the previous entitlement terminated, increased by intervening cost of living adjustments (COLA) and re-computations. This is regardless of any other changes (such as overpayments, offsets);

2. b. 

   Base the provisional payment amount upon the prior reduced benefit payable, if the prior payable benefit was reduced due to offset or other reductions;

3. c. 

   Apply current tax levies or garnishments to provisional payments in accordance with GN 02410.110 and GN 02410.210;

4. d. 

   Apply any Medicare premium arrearages to provisional benefits;

5. e. 

   If an overpayment exists on the record, do not recover this against provisional benefits without the claimant’s written consent; and

6. f. 

   If we award the EXR request, adjust for offsets, such as Workers Compensation/Public Disability Benefits, Government Pension Offset, Windfall Elimination Provision, overpayments, and other payment issues with the first month of reinstated benefits.

When a claimant requests reinstatement on one record and is currently receiving a Title II benefit on another record, the provisional benefit is payable only if the provisional benefit amount is greater than the current benefit payable on the other record. If the current benefit amount is higher than the provisional benefit amount, no provisional benefits are payable. If a claimant requests EXR for more than one benefit, pay provisional benefits on the record that yields the highest benefit payable amount. If provisional benefits end for a dually entitled beneficiary, payment will resume on the other record as long as they are still eligible for benefits on that record.

NOTE: A claimant must file separate EXR requests for multiple entitlement situations. Evaluate each request against the EXR requirements and process accordingly.

For DWB and CDB claimants, the payment of provisional benefits may cause the total benefits payable on the record to exceed the family maximum (FMAX). In such cases, pay the provisional benefit amount outside the FMAX and do not adjust the benefit amount for any auxiliary already entitled on the same record during the provisional benefit period.

Provisional benefits are payable beginning with the month the claimant submits a signed and completed EXR request per DI 13050.045B.2., assuming benefits have not already been paid for that month. If the claimant performed SGA in the month of filing, provisional benefits are payable in the month after the month of filing. We can only pay provisional benefits during the consecutive 6-month period beginning with the month of the EXR request, or the following month if there is SGA in the month of filing.

NOTE: Do not use the protective filing date for determining when provisional payments begin. Use the protective filing date to determine the retroactive scope of the EXR.

Example 1: A claimant contacts SSA about filing for EXR on April 24, 2023 but does not return the signed request forms until June 03, 2023. They did not perform SGA in June. Provisional benefits will begin June 2023, the month they completed and submitted their EXR request.

Example 2: A claimant completes and returns a signed request for EXR on June 25, 2023. They performed SGA in the month of June, but stopped performing SGA by the date of their request. Provisional benefits will begin July 2023, the month after they stopped engaging in SGA.

Provisional benefits cannot start until the previous benefits terminate and the master beneficiary record (MBR) Ledger Account File (LAF) Code is T6, T8, U or X7. If we made a determination to terminate the previous benefit but the MBR does not reflect it, the field office (FO) will contact the program center (PC) to expedite the termination in order to begin provisional benefits. Use the exclusion case procedures described under DI 13050.025I.3. in this section to expedite the previous benefit termination. We cannot pay provisional benefits for any month in which the claimant has already received the same type of benefit payment on the same entitlement.

Regular payment provisions apply. Consider windfall offset. Title II provisional benefits are income for SSI computation purposes. The claimant must file a separate request for reinstatement under Title XVI.

Provisional benefits terminate when a claimant attains FRA. Provisional benefits do not automatically revert to an retirement benefits at FRA. If the claimant wishes to receive aged benefits, they must file an application, or already be entitled to a benefit that will automatically convert to an aged benefit at full retirement age (regular widow's benefit or retirement).

The appeal of a prior claim denial, or termination, has no effect on the claimant’s eligibility for EXR. The claimant can receive provisional benefits and reinstatement through EXR, if the claimant meets EXR eligibility requirements in the month of the EXR request.

Input the request for provisional benefits on the Provisional Payment (PEPP) screen of the Title II POS. Instructions are in MS 06303.040. Follow these steps to access the PEPP screen:

1. a. 

   Select option “2”, Title II/PE, on the SSA MAIN menu and press “Enter”.

2. b. 

   On the POS Menu (PEMU) screen, select “1” to establish and complete the required fields, then press “Enter”.

3. c. 

   On the Post Entitlement Selection List (PESL) screen select “item 1” (Addr/Dir Dep/Tel) and “item 7” (Provisional Payments) for the appropriate BIC and, press “Enter”.

4. d. 

   On the Post Entitlement Address (PEAD) screen, enter any changes to the claimant’s address, direct deposit, or telephone number propagated to the PEAD screen from the MBR. If no changes are necessary , press “Enter” to advance to the PEPP screen.

5. e. 

   On the PEPP screen, enter the provisional payment start month in MMYY format. Add any necessary remarks, and press “Enter”. The provisional benefit start month is the month we receive the EXR request package. However, if the claimant engaged in SGA in the month of the request, the provisional payment start month is the following month. If the provisional benefit start month is later than the current operating month (COM), hold the POS input after the next COM changes.

NOTE: If the claimant engaged in SGA in both the month of the EXR request and the following month, deny the request for EXR. For denials, see DI 13050.065

Some cases require manual processing in the PC to start provisional benefits. The following situations will generate an exception alert in the PC:

• •

  concurrent Title II/Title XVI cases and a prior month accrual (PMA) check is payable;

• •

  DWB and CDB cases in which there are other entitled auxiliaries on the same record; and

• •

  cases where the individual requesting EXR is already entitled to another Title II benefit.

If the direct input excepts, do not re-input through POS. Check PCACS for an Action Control Record (ACR) with TOELs DIPROV PAYMENT. It may take up to three business days for the ACR to appear in PCACS. If the ACR does not appear in PCACS after three business days, contact the PC of jurisdiction.

If the ACR appears in PCACS, tickle the case for 15 business days to allow for PC processing. If the MBR does not update after 15 business days, contact the PC of jurisdiction and tickle the case for 15 days for follow up.

To contact the PC of jurisdiction:

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  Use PCACS to identify which PC/Module has jurisdiction.

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  Access the Detailed Office/Organization Resource System (DOORS) using the search SSN function to send an email to the appropriate PC module with the subject line "Provisional Benefit Request." Add a special message to the MBR indicating the date the request was sent.

If the MBR does not update after the second 15-day tickle or if a dire need/adverse public relation situation exists, FOs will use the Manager-to-Manager process to contact the PC per GN 01070.228.

Do not make a POS input for exclusion cases as they require manual action by the PC. Some examples of exclusion cases are:

• •

  the provisional benefit is not payable in the first month of the provisional period (payment is suspended) or

• •

  the EXR request date is more than 60 months after the previous termination (good cause found for late filing)

Do not use CPS to start provisional benefits, as any monies withheld from CPS payments for supplemental medical insurance (SMI) premiums are not credited until the provisional benefit action is processed and may result in an incorrect termination of SMI due to non-payment of premiums. Requests for initiation of provisional benefits are high priority actions.

To contact the PC of jurisdiction:

• •

  Use PCACS to identify which PC/Module has jurisdiction.

• •

  Access the Detailed Office/Organization Resource System (DOORS) using the search SSN function to send an email to the appropriate PC module with the subject line "Provisional Benefit Request." Add a special message to the MBR indicating the date the request was sent.

Tickle for 15 days to follow up. If the MBR does not update after the 15-day follow up tickle expires or if a dire need/adverse public relation situation exists, use the Manager-to-Manager process to contact the PCs per GN 01070.228.

The performance of SGA during the provisional benefit period terminates provisional benefits. The FO technician must:

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  Develop work activity during the provisional benefit period.

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  Document the work on Forms SSA-820-BK (Work Activity Report Self-Employment) or SSA-821-BK (Work Activity Report - Employee) and record the determination on Form SSA-823 (Report of SGA Determination – For SSA Use Only) and store the completed forms in the electronic file in not in EDCS.

• •

  Notify the DDS examiner of the finding by telephone.

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  Terminate provisional benefits through POS input, see MS 06303.024. The last month provisional benefits are payable is the first month of SGA. Provisional benefits do not resume after termination due to SGA, even if SGA later ends.

• •

  If applicable, access the Detailed Office/Organization Resource (DOORS) using the search SSN function to send an email to the appropriate PC module with the subject line "EXR Provisional Benefit Termination Request" to request termination of Medicare. Add a special message to the MBR indicating the date the Medicare termination request was sent.

If the claimant performs SGA in the month of the EXR request and the following month, recall the folder from the DDS and process an FO jurisdiction technical denial as outlined in DI 13050.065D. For EXR requests filed prior to April 17, 2017, if the claimant performed SGA in the month of filing, recall the folder and deny the request.

Terminate provisional benefits (if currently being paid) when the DDS makes a medical determination to deny EXR. The last month provisional benefits are payable is the month the FO mails the EXR denial notice. To stop provisional benefits input the medical decision using POS, refer to DI 13050.065B.3. To determine how a medical determination may affect Medicare coverage, see DI 13050.070.

When a claimant reaches FRA during the provisional benefit period, provisional benefits automatically terminate. If the claimant wishes to receive aged benefits, they must file an application, or already be entitled to a benefit that will automatically convert to an aged benefit at full retirement age (regular widow's benefit or retirement).

Provisional benefits and Medicare based solely on the provisional benefit period automatically terminate after six months of payments.

If the claimant dies during a month that comes after the EXR request but before a medical decision by the DDS, stop the provisional benefits. The month before the month of death is the last month that provisional benefits are payable. The DDS should make a medical decision based on the evidence provided. If we approve the EXR request based on the medical evidence, pay any retroactive benefits as an underpayment per GN 02301.030.