TN 2 (09-09)
DI 23540.010 Completing Form SSA-831 for Medicare Qualified Government Employment (MQGE) Cases
Complete the SSA-831 according to “Completion of Form SSA-831-C3/U3 -- Title II, Title XVI and Concurrent Claims” DI 26510.000 for any Title II claim with the following exceptions:
A. Item 11 - remarks
This item should show the applicable remarks made by the Field Office (FO) if the claim is in the Modernized Claims System (MCS). Item 11 of all MQGE claims should show “MQGE,” as well as “insured status under transitional provisions of P.L. 97-248,” and “MQGE claim for Medicare entitlement only” if identified by the FO.
B. Item 15 – claimant disabled
1. Disabled Insurance Beneficiary (DIB)
Enter the actual onset date when the claimant is determined to be under a disability on or after January 1, 1983. Enter "01/01/83" when the claimant is determined to be under a disability prior to January 1, 1983.
2. Childhood Disability Beneficiary (CDB)
Same as for non-MQGE CDB, i.e., onset need be no earlier than attainment of age 18 years old, and can be no later than attainment of age 22 years old.
3. Disabled Widow(er) Beneficiary (DWB)
Enter the actual onset date when the claimant is determined to be under a disability on or after January 1, 1983.
C. Item 29 – ltr/par no.
If a system-generated notice cannot be used, the DDS examiner designates “DDS D/L” and the appropriate notice or rider in item 29 of the SSA-831. (For a list of MQGE case notices and riders, see DI 23540.015.)
DI 26535.005 – Types of Notices
DI 26535.026 – Denial Notices for Initial Disabled Widow(er) Medicare Coverage Only, Medicare Qualified Government Employee (MQGE), CDB and Medicare Only DWB Claims
D. Item 34 — Remarks
For Medicare only and concurrent DIB/MQGE claims, enter “MQGE Case”.
For situations where a claimant is found to meet the medical definition of disability after expiration of the DIB DLI, but before expiration of the MQGE DLI, process as an adverse allowance and enter “Change of Onset”.
See also DI 26510.095, Completing Item 34 (Remarks) on the SSA-831