TN 27 (05-99)

RS 00605.238 Extended DIB Eligibility

A. Policy

The statute permits a NH who has completed a trial work period to have an extended period of eligibility (EPE) for disability benefits. The period of the EPE is 36 months after the last month of the trial work period (prior to 1 /1/88, the EPE was 15 months). See
DI 13010.210 for the rules governing when the EPE is effective.

Benefits are not payable for any SGA month during the EPE except the disability cessation month and the following 2 months. The NH is considered to be entitled to DIB for all months of the EPE, including nonpayment months. However, the period of disability for freeze purposes ends with the last month that DIB benefits are payable.

In any month where the NH is not performing SGA, the benefit is computed as though benefits had not ended. This includes any recomputation due to earnings in the EPE. (See RS 00605.210A.3.) For PIA computation on expedited reinstatement cases (EXR) see DI 13050.060. When we establish a DIB Guarantee PIA after a prior period of DIB with EPE involvement, we use the DIB PIA in the last month of entitlement before termination, whether that PIA was paid or not. When determining whether a new waiting period is required, the 60 month period starts with the month after the last month of the prior period of DIB entitlement.

B. Procedure

Consider the EPE where a subsequent freeze PIA is computed.

1. Benchmark Year

For the benchmark year, determine the 12 month period in RS 00605.005B. using the last month of the EPE; i.e., the month before the DIB termination month.

During the EPE, consider the NH to be entitled to DIB for purposes of determing the benchmark year.

2. Elapsed and Base Years

For elapsed years and base years, determine the end of the period of disability using the last month DIB was payable. This month may be up to 33 months prior to the DIB termination month where the NH continued in SGA after the trial work period.

Exclude from elapsed years the years wholly or partially in the period of disability.

Exclude from base years the years wholly within the period of disability.

3. Example

Selma, DB 4/26/28, was disabled 5/17/85 through 10/31/88. Her EPE ended 10/91 and the first month of nonentitlement is 11/91. She files for RIB with a Month of Entitlement (MOET) of 5/92. In a disability exclusion comp, the benchmark year is 1985, the elapsed years are 51-84 and 89 (she is 62 in 1990), and base years are 1951-1991 excluding 1986-1987.

C. Policy - EPE and Entitlement to Other Benefits

1. RIB

Where the NH is entitled to RIB during the EPE, months of concurrent entitlement are excluded from the RIB reduction factor at FRA. (See RS 00615.482B.1)

2. Auxiliary or Survivor Benefits

If the other benefit is an auxiliary or survivor benefit, this benefit is computed as if the DIB is payable in each month.

3. Combined Family Maximum

The combined family maximum is not affected by the EPE. Further, establishing an EPE does not require a reevaluation of the SSN upon which benefits will be paid. (See
RS 00615.772)

4. Auxiliary's or Survivors Own Benefit Goes Into EPE

a. Mother's/Father's/Young Spouse's benefit

If a mother/father/young spouse is receiving benefits because he/she has a disabled adult child in care and that child's benefits are suspended due to an EPE (based on the child's disability), the mother/father/young spouse may continue to receive benefits if the in care requirements are met. (See RS 00202.035, RS 01310.035, and RS 01310.040)

b. All auxiliaries or survivors on the record

If benefits to an auxiliary or survivor on a record is suspended due to an EPE, the maximum is not redistributed to any other persons on that record. (See GN 02603.040B)


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