Under section 9319 of PL. 99-272, Medicare became the secondary payer for the disabled active individual who was covered under their own or any family member's LGHP. An “active individual” was an employee, an employer, a self-employed individual (such as the employer), an individual associated with the employer in a business relationship or a member of the family of any of these persons.

Often, the disabled person was the family member of the employee, employer, or individual associated with the employer in a business relationship. This meant that a disabled person who was covered under the LGHP of a spouse, parent, or any other family member was considered to be an active individual even though the disabled individual was not actually the worker.

For enrollments and reenrollments that occurred between 1/87 and 8/9/93, the SEP for a disabled beneficiary began:

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  the first month the claimaint e was no longer covered under an LGHP as an active individual (or the LGHP no longer met the definition in HI 00805.266A.3, and

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  one of the requirements in HI 00805.270 was met.

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  Effective for premiums due for 1/87 and later, the calculation of the premium surcharge for late enrollment excluded:

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  those months beginning 1/87 (or the end of the IEP, if later) during which the individual could demonstrate they were enrolled as an active individual in an LGHP, and

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  all months of SMI enrollment.

The SEP provisions were expanded for enrollments occurring in or after 7/90, so that disabled individuals covered under their own or a spouse's GHP based on current employment are also eligible for the SEP, although Medicare is the primary payer. Thus, the SEP requirements for the disabled became the same as those for the aged.

Effective for premiums due for 7/90 and later, the calculation of the premium surcharge for late enrollment excludes:

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  all months beginning 1/87 (or the end of the IEP, if later) during which the individual can demonstrate they were enrolled in a GHP based on their own or a spouse's current employment, and

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  all months of SMI enrollment.

Beginning 8/10/93, Medicare is the secondary payer for the disabled individual who has LGHP coverage on the basis of their own or a family member's current employment status. An individual has “current employment status” with an employer if the individual is working as an employee, is the employer (including self-employed persons), or is associated with the employer in a business relationship.

Effective for enrollments and reenrollments that occurred 8/10/93 through 2/95, the SEP began:

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  as soon as a disabled beneficiary was no long covered under an LGHP by reason of their own current employment status or the current employment status of a family member, or when the LGHP was no longer considered a “large” plan as defined in HI 00805.266 A.3., and

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  one of the requirements in HI 00805.270 was met.

These amendments did not change the requirements for an SEP for the disabled beneficiary covered under a GHP (a plan of any size below 100 employees) based on their own current employment status or the current employment status of a spouse (see HI 00805.275).

These requirements also applied to the disabled individual enrolling in Premium-HI for the Working Disabled under section 6012 of P.L. 101-239.