TN 3 (02-95)

GN 01703.270 Processing Cases Where Insured Status is Acquired Based on U.S. Coverage Only

A. Introduction

Some NHs engage in work covered by Social Security after entitlement to U.S. totalization benefits. These NHs may earn enough QCs to become fully insured without foreign coverage. If this occurs, CAs must consider adjusting the entitlement record.

B. Procedure - retirement cases

Use the following guidelines to determine the proper course of action when an NH acquires nontotalization insured status.

1. Highest MBA

Determine the highest MBA:

  1. Compute the PIA and benefit payable based on U.S. coverage only.

  2. Compare the result of this calculation with the current totalization benefit. Do not recompute the totalization benefit using earnings and quarters of coverage from the year insured status is met or subsequent years.

2. Nontotalization MBA highest

If the nontotalization MBA is highest:

  1. Prepare amended award to pay nontotalization benefits effective with the month that nontotalization insured status is met.

  2. Change TSC to T1.

  3. Obtain SMI election, if beneficiary is within four months of age 65.

  4. Notify beneficiary(ies) of new benefit amount and HI entitlement if age 65 or older.

  5. If all beneficiaries are U.S. residents, transfer RSDI folder, including all totalization related material, and MBR to PSC. Delete TF folder.

  6. Complete, sign, and reverse file a folder documentation notice (see exhibit below in GN 01703.270D) on the right side of the RSI or DIB folder. Reproduce these forms locally. Use the remarks portion of this form to provide explanations/instructions.

  7. If any beneficiary is a foreign resident, transfer the RSDI folder to the appropriate module.

3. Current Totalization MBA highest

If the current totalization MBA is highest:

  1. Change TSC to E2.

  2. Obtain SMI election, if beneficiary is within four months of age 65.

  3. Notify the beneficiary(ies) of automatic HI enrollment if age 65 or older.

  4. Send a notice only to the beneficiary who initiated the recomputation.

C. Procedure - disability cases

When a disabled beneficiary acquires nontotalization insured status:

Route folder to DRDD for resolution of cessation of DIB, trial work period, and related issues. (DRDD will return the file to the module with a decision on continuing DIB entitlement.)

Disability ceases - Terminate all entitled beneficiaries and retain the file in the module, if DIB entitlement ceases due to NH's work.

Disability continues - Follow steps 1 - 3 in B above.

Transfer the folder to the appropriate module if at least one beneficiary is a foreign resident. Transfer the folder to ODO, or if over age 59, to the PSC with a complete explanation of the reason for the referral, if all beneficiaries are U.S. residents.

D. Exhibit

 
SSN                

 

ATTENTION!

 

  1. NO UNRESOLVED TOTALIZATION ISSUES ARE PRESENT IN THIS CASE.

    (W/E IS EITHER FULLY INSURED OR DIB INSURED BASED ON U.S. COVERAGE OR HAS LESS THAN 6 U.S. QUARTERS OF COVER)

  2. DISREGARD TOTALIZATION APPLICATIONS IN FILE.

  3. VITAL STATISTICS MAY HAVE BEEN ESTABLISHED BASED IN CERTIFICATION FROM FOREIGN AGENCY (SEE POMS GN 01701.210).

  4. ALL MATERIAL RELEVANT TO THIS CLAIM HAS BEEN REMOVED FROM ANY RELATED TOTALIZATION FOLDER AND BEEN PLACED IN THIS FOLDER.

  5. ANY RELATED TOTALIZATION FOLDER WHICH DOES NOT CONTAIN A PENDING FOREIGN AGENCY ASSISTANCE REQUEST HAS BEEN DESTROYED.

     

 CLAIMS AUTHORIZER, MODULE
 OFFICE OF INTERNATIONAL OPERATIONS
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