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