T20 &T28 |
No DIB overpayment or underpayment No HI/SMI involvement. |
SSA-L1021 |
NL 00701.460 |
|
Same as SSA-L1021 except auxiliaries in W/E's household. |
SSA-L1026 |
NL 00701.485 |
|
No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. |
SSA-L1022 |
NL 00701.465 |
|
Same as SSA-L1022 except auxiliaries in W/E's household. |
SSA-L1027 |
NL 00701.490 |
|
No DIB overpayment or underpayment HI/SMI involved. SMI premium to be refunded. |
SSA-L1023 |
NL 00701.470 |
|
Same as SSA-L1023 except auxiliaries in W/E's household. |
SSA-L1028 |
NL 00701.495 |
|
DIB underpayment and HI/SMI involvement with a SMI premium arrearage. |
SSA-L1024 |
NL 00701.475 |
|
No DIB overpayment or underpayment HI/SMI involvement with no premium coverage or
arrearage.
|
SSA-L1025 |
NL 00701.480 |
|
Same as SSA-L1025 except auxiliaries in W/E's household. |
SSA-L1030 |
NL 00701.505 |
|
DIB cessation—DIB U/P SMI Premium Arrearage Auxiliaries in NH's Household. |
SSA-L1029 |
NL 00701.500 |
T21 |
No DIB overpayment or underpayment No HI/SMI involvement. |
SSA-L1016 |
NL 00701.435 |
|
No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. |
SSA-L1017 |
NL 00701.440 |
|
No DIB overpayment or underpayment HI/SMI involved. SMI premium to be refunded. |
SSA-L1018 |
NL 00701.445 |
|
DIB underpayment and HI/SMI involved with a SMI premium arrearage. |
SSA-L1019 |
NL 00701.450 |
|
No DIB overpayment or underpayment HI/SMI involvement with no premium coverage or
arrearage.
|
SSA-L1020 |
NL 00701.455 |
T22 |
Same as SSA-L1031 except auxiliaries in W/E's household. |
SSA-L1036 |
NL 00701.535 |
|
No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. |
SSA-L1032 |
NL 00701.515 |
|
Same as SSA-L1032 except auxiliaries in W/E's household. |
SSA-L1037 |
NL 00701.540 |
|
No DIB overpayment or underpayment HI/SMI involved. SMI premiums to be refunded. |
SSA-L1033 |
NL 00701.520 |
|
Same as SSA-L1033 except auxiliaries in W/E's household. |
SSA-L1038 |
NL 00701.545 |
|
DIB underpayment and HI/SMI involvement with a SMI premium arrearage. |
SSA-L1034 |
NL 00701.525 |
|
Same as SSA-L1034 except auxiliaries in W/E's household. |
SSA-L1039 |
NL 00701.550 |
|
No DIB overpayment or underpayment HI/SMI involved with no premium coverage or arrearage. |
SSA-L1035 |
NL 00701.530 |
|
Same as SSA-L1035 except auxiliaries in W/E's household. |
SSA-L1040 |
NL 00701.555 |