TN 49 (11-22)
HI 01001.255 Beneficiary Dropped From Group Payment Plan
When a Formal Group Payer gives notice that a beneficiary is (or was) no longer eligible
for group payment as of a particular date for a reason other than death, the Centers
for Medicare & Medicaid Services (CMS) asks the beneficiary to pay their premiums
by direct remittance. Similarly, CMS in some cases will notify the group that premiums
are no longer to be paid for specified individuals. Because of the prohibition against
disclosure of information, explanation will not be given by CMS for the reason it
is “deleting” the beneficiary from the group payment arrangement, when the premiums must be deducted
from Social Security (SS) benefits which became payable because the beneficiary is
no longer working or because age 72 was attained. When the beneficiary is dropped
from a group payment arrangement, premiums will be deducted, where appropriate, from
the beneficiary's benefits, or the beneficiary will be sent individual bills.
When CMS is notified that a beneficiary has been dropped, the beneficiary will be
billed directly for their premiums. The time and manner of billing, and the due date
and grace period, will be determined in accordance with the rules for beneficiaries
or nonbeneficiaries, whichever are applicable.