TN 1 (07-04)

DI 45001.342 Notice — R-HI/R-SMI Award Based on Transplant or Dialysis, Entitlement Dates are the Same or Later Than Age 65 HI/SMI Coverage (Conversion Notice)

TO REQUEST THIS NOTICE:

Enter on SSA-5002: “Send notice 1082.”

If the footnote applies (claimant already entitled to age 65 HI only), include the special instructions 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 attainment of age 65, there will be no change in the effective dates of your hospital insurance and supplementary medical insurance entitlement.

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 age 65 HI only, delete the phrase “and supplementary medical insurance” which changes the last sentence in the first paragraph to end after the phrase “hospital insurance.” Then add two new sentences as follows:

  • You now have medical insurance beginning (date). Your monthly medical insurance premium is   (amount)   .


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0445001342
DI 45001.342 - Notice -- R-HI/R-SMI Award Based on Transplant or Dialysis, Entitlement Dates are the Same or Later Than Age 65 HI/SMI Coverage (Conversion Notice) - 07/06/2004
Batch run: 01/27/2009
Rev:07/06/2004