TN 1 (07-04)
DI 45001.341 Notice — R-HI/R-SMI Award Based on Transplant or Dialysis, Entitlement Dates are the
Same or Later Than D-HI/D-SMI Coverage (Conversion Notice)
TO REQUEST THIS NOTICE:
Enter on SSA-5002: “Send
If the footnote applies (claimant already entitled
to D-HI only), include the special instruction
(with fill-ins) to the typist on the SSA-5002.
This refers to your claim for entitlement to Medicare benefits on the basis of a kidney
condition. The law provides Medicare coverage for people with this condition if it
has been determined that a course of dialysis or a kidney transplant is the required
treatment. Your claim has been allowed. However, since you are already entitled to
Medicare based on your entitlement to monthly disability benefits, there will be no
change in the effective date of your entitlement to hospital insurance and supplementary
Your Medicare entitlement will continue as long as you are entitled to disability
benefits. If your disability benefits end, your coverage may continue based on kidney
disease if at that time 12 months have not elapsed since the date dialysis ended,
or 36 months have not elapsed since the date of the last transplant. Therefore, please
notify any Social Security office of any significant change in your condition or treatment.
If you have any questions about your claim, you should contact any Social Security
office. Most questions can be handled by telephone or mail. If you visit an office,
however, please take this notice with you.
1 If the claimant is already
entitled to D-HI only, change the last sentence in first paragraph
Since you are already entitled to Medicare based on your entitlement to monthly disability
benefits, there will be no change in the effective date of your hospital insurance.
However, you now have medical insurance beginning (date) . Your monthly medical insurance premium is