TN 3 (10-22)

GN 02330.085 Development of Relief


If the individual expressly requests relief from repayment or states that the individual does not have the means to repay the incorrectly refunded amount, a determination on the individual's request must be made. Whether or not the enrollee may be excused from repayment depends on whether repayment of this amount would be against equity and good conscience or deprive the individual of funds which are reasonably necessary for ordinary living expenses. This is the same test used in determining whether recovery of a benefit overpayment would defeat the purpose of title II. Therefore, the same rules and procedures pertaining to recovery of a monthly benefit overpayment (see GN 02250.150) apply even though the incorrect premium refund is not a benefit overpayment.

If an individual has received an incorrect premium refund and requests relief from repayment of the erroneously refunded amount, the DO is responsible for the development and the determination. The DO should identify for special handling and forward to the PSC:

  1. A. 

    the appropriate documents used in the development (including SSA-632-F4)

  2. B. 

    a current DO-BCM Query Response; and

  3. C. 

    a determination made on an RC as to whether the individual may be excused from repaying the incorrectly refunded amount.

Favorable decisions should be forwarded to the special Post Office box number for the PSC's shown in HI 01005.802 (Exhibit 3).

Unfavorable decisions should be forwarded in a separate envelope to the appropriate PSC. These cases will be reviewed in the PSC and if there is concurrence with the initial DO decision, a denial notification which includes the reconsideration paragraph will be sent to the enrollee. If the decision is questionable, the file may be returned to the DO for further consideration; however, if the DO reaffirms its prior decision, the decision will not be questioned further.

In order to avoid confusion and uncertainty as to the amount of premiums owed, the DO and reviewing office should develop and process these cases as soon as possible.

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GN 02330.085 - Development of Relief - 10/28/2022
Batch run: 10/28/2022