Basic (09-82)

GN 01704.205 Entitlement to Supplementary Medical Insurance (SMI) Benefits After Entitlement to Totalization Benefits

Individuals who are not entitled to premium-free HI will not be automatically enrolled in SMI even if they reside in the United States. (GN 01701.145 A.) The claims authorizer prepares an SSA 101-U3 to document the claims folder if a beneficiary establishes entitlement to SMI and the TSC is A1 or A2.

If a retired NH becomes fully insured without the inclusion of foreign coverage, i.e., the TSC changes from A1 or A2 to E1, E2, or E3, the NH and any auxiliaries entitled to benefits on his earnings record will become eligible for SMI based on entitlement to HI. The usual rules regarding SMI entitlement apply if the NH becomes insured before the beneficiary attains age 65. When this occurs, the beneficiary will be eligible for SMI upon attainment of age 65, and if a U.S. resident, the beneficiary will be subject to automatic enrollment. However, if a NH becomes insured based only on U.S. coverage in a beneficiary's month of attainment of age 65 or later, the beneficiary must file a request for SMI enrollment. An SSA-185, HCFA-4040 (formerly 40A), or equivalent information must be secured in order to determine the beneficiary's first month of eligibility to SMI, and thus the date of entitlement to SMI and premium amount.