TN 2 (09-09)

DI 23540.005 Developing and Evaluating Medicare for Qualified Government Employment (MQGE) Cases

A. Policy

For the disability requirement of the law, treat MQGE disability claims like Title II disability claims, subject to the same disability evaluation criteria and reviews (e.g., medical re-exam, periodic review, etc.).

NOTE: If the Disabled Insurance Beneficiary (DIB), Disabled Widow(er) Beneficiary (DWB), or Childhood Disability Beneficiary (CDB) dies while the claim is pending in the disability determination services (DDS), and there is no evidence that the claimant was ever entitled to a previous disability benefit, return the case to the Field Office (FO).

B. Evidence from the Office of Personnel Management (OPM)

Some claimants who file an application for Medicare based on the worker's Federal employment may have also filed an application with OPM (formerly the Civil Service Commission) for a civil service annuity based on disability. When the claimant has filed with OPM, the FO alerts the DDS of this by an entry in the remarks section of the SSA-3367.

The FO includes the civil service annuity claim number. Existing civil service records may benefit the DDS with relevant information, such as physician’s letters, medical examination certificates containing clinical and laboratory findings, and reports from the employing agency describing the claimant’s duties and his or her ability to perform those duties.

DDSs should send the request with a signed SSA-827 to:

Office of Personnel Management
Retirement Operations Center
Post Office Box 45
Boyers, PA 16017

Include the following claimant information:

  • name,

  • date of birth,

  • current address, and

  • civil service annuity claim number (or last government employer, location, dates of employment, and date of retirement).

If a response is not received within 45 calendar days from the date of the initial request, send a follow-up request.

See Also:

DI 81020.100 – Electronic Assistance Requests (AR)

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DI 23540.005 - Developing and Evaluating Medicare for Qualified Government Employment (MQGE) Cases - 09/11/2009
Batch run: 04/14/2014