NOTE: Although Medicare is withdrawn on either the EXR or initial claim, Medicare or Medicaid
will be available on the other action when it is processed. When an individual previously
had Medicare and entitlement ended within 5 years, the individual does not serve another
qualifying period for Medicare.
If the individual chooses EXR:
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•
Process the EXR allowance per DI
13050.060 for title II and DI 13050.061 for Title XVI.
Take these additional steps for Title II:
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•
If current entitlement exists on the initial claim, do not stop current initial claim
benefits. This will avoid interruption of benefits and Medicare coverage. OCO/PC will
take necessary termination, recovery and entitlement actions when it processes the
EXR award.
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•
Alert OCO/PC to the withdrawal via a remark on the EFBCRN screen of the EF-101 to
remind it of action needed in relation to the initial claim withdrawal, if appropriate.
If the individual chooses an initial claim:
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•
Add a statement to the withdrawal request that the individual understands that the
withdrawal will end provisional benefits (and provisional Medicare/Medicaid if applicable),
and that the individual understands that they will have Medicare/Medicaid on the initial
claim and a new Initial Enrollment Period (IEP) will also apply.
a. Title II initial claim award
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•
Do not stop provisional benefits, if still being paid. This will avoid interruption
of benefits and Medicare coverage. OCO/PC will take necessary termination, recovery
and entitlement actions when it processes the award.
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•
Adjudicate the initial claim.
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•
Annotate a remark on the EFBCRN screen of the EF-101, stating “EXR filed mm/dd/yy
withdrawn mm/dd/yy”, if appropriate. Also annotate remarks about the need to offset
appropriate provisional or reinstated payments made against initial claim benefits
due.
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•
Forward the claim to the PC of jurisdiction.
b. Title XVI initial claim awards
If necessary, terminate provisional payments in accordance with SM
01701.080. Process the initial claim provisional payments and reinstated payments that have
been made.