TN 24 (09-02)

RS 00615.754 Determining the Amount of Each Benefit When Total Benefits Exceed the Maximum

POLICY

1. General

If the total monthly original benefits exceed the family maximum, the amount of each auxiliary or survivor benefit must be adjusted downward proportionately.

NOTE: Total family benefits actually payable may be less by a few dimes than the FMAX due to rounding. Benefits are first adjusted for the maximum and then reduced for age.

2. Exceptions to Table Maximum Limits

  • Child entitled to child's benefits on more than one SSN. See RS 00615.770.

  • One or more beneficiaries subject to deductions. See RS 00615.766.

  • Divorced spouse or surviving divorced spouse entitled. See RS 00615.682.

  • Savings clause maximums. See RS 00615.801.

  • Effective 1/91 when both a deemed spouse and a legal spouse are present on the record, the legal spouse is paid outside the family maximum. See RS 00615.684.

3. Administrative Finality and the Maximum

When administrative finality protects the rates of one or more beneficiaries and a new person is entitled the rates for the new beneficiary are computed using the correct PIA and family maximum. See GN 04030.070B.1.c. Compute the rates for the new person as if the other beneficiaries are receiving the correct rates. This may result in the family maximum being exceeded. To document these cases the MBR PIA History field should show the correct PIA and maximum. The special message field should be used to document which rates are protected by administrative finality and to show the PIA and maximum used to arrive at those rates. In addition the Administrative Finality indicator must be coded to prevent automated changes in the rates per instructions in MSOM T2PE 007.026.

The two examples that follow illustrate how to process a case when only the numberholder is protected by administrative finality and when the numberholder and another person are protected.

EXAMPLE: The numberholder is receiving a PIA/benefit of $1,000.00 with a maximum of $1,750.00. A new auxiliary files a claim and we determine the correct PIA is really $750.00 with a maximum of $1,312.50. We determine that the rate to the NH is protected by administrative finality and cannot be changed. To determine the rate for the new child we subtract the correct PIA from the correct maximum ($1312.50 - $750.00) and are left with $562.50. The child is entitled to one half the PIA or $375.50 so we have enough to pay the child the full correct rate. The rates payable will then be $1,000.00 to the NH and $375.50 to the new child. The total payable to the family will then be $1,375.50 even though the correct maximum is only $1,312.50.

EXAMPLE: The numberholder is receiving a PIA/benefit of $1,000.00 with a maximum of $1,750.00. There is also a child receiving $500.00. A new auxiliary files a claim and we determine the correct PIA is really $750.00 with a maximum of $1,312.50. We determine that the rates to the NH and the first child are protected by administrative finality and must be based on the protected PIA and maximum. The NH will continue to get $1,000.00. Although GN 04020.020C. allows us to adjust the rate for the first child because of the new child that adjustment must be made using the original PIA and maximum because administrative finality protects the NH and the child. The rate to the first child based on the original PIA and maximum would be: $1,750 minus $1,000 is $750 divided by 2 or $375.00. To determine the rate for the new child we subtract the correct PIA from the correct maximum ($1312.50 - $750.00) and are left with $562.50. We divide that by the number of children (2) and get $281.20 as the correct rate for the new child. The rates payable will then be $1,000.00 to the NH, $375.00 to the first child and $281.20 to the new child. The total payable to the family will then be $1,656.20 even though the correct maximum is only $1,312.50.


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