AUDIENCE: BA, BATA, CRTA, RECOVR, IES
If the individual expressly requests relief from repayment or states that he does
not have the means to repay the incorrectly refunded amount, a determination on his
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 monthlybenefit 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 appropriate documents used in the development (including SSA-632-F4)
a current DO-BCM Query Response; and
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.