HI 00801.000 Hospital Insurance Entitlement

Subchapter Table of Contents
Section Latest
Transmittal
HI 00801.001IntroductionTN 25 09-93
HI 00801.002Waiver of HI Entitlement by Monthly BeneficiaryTN 25 09-93
REGULAR INSURED PROVISION
HI 00801.006Requirements for Entitlement - Regular Insured ProvisionTN 25 09-93
HI 00801.008HI Entitlement for Aged Spouse of Age 62 WorkerTN 25 09-93
HI 00801.011Qualified Railroad Retirement Beneficiary (QRRB) Defined—AgedTN 31 06-04
HI 00801.012Deemed QRRBTN 31 06-04
HI 00801.017Proof of AgeTN 25 09-93
HI 00801.022Application Requirement and Effective Date for Hospital Insurance for Insured BeneficiariesTN 25 09-93
HI 00801.027Taking the ClaimTN 25 09-93
HI 00801.029Special Development ConsiderationsTN 31 06-04
HI 00801.032Establishing EntitlementTN 25 09-93
HI 00801.034Withdrawal ConsiderationsTN 25 09-93
DEEMED INSURED PROVISION
HI 00801.047Requirements for Entitlement - Deemed Insured ProvisionTN 25 09-93
HI 00801.052Application Requirement and Effective Date for Hospital Insurance for Deemed Insured BeneficiariesTN 25 09-93
HI 00801.056Eligibility Under Regular Insured ProvisionTN 25 09-93
HI 00801.058Proof of AgeTN 25 09-93
HI 00801.061Residence and Citizenship/Alien Status RequirementsTN 25 09-93
HI 00801.066QC Requirement 
HI 00801.071FEHBA eligibility preclusion 
HI 00801.076Coverage Under FEHBA 
HI 00801.081Establishing FEHBA Eligibility 
HI 00801.086Preclusion Because of Crimes Against U.S 
HI 00801.091Filing the Claim 
HI 00801.096Completion of Items on SSA-18F5 
HI 00801.106RR Involvement 
HI 00801.111Determining RR Status 
HI 00801.116HI Leads from RRB 
HI 00801.121FORM RR-80 (Report of Health Insurance Information — SSA Jurisdiction) 
Premium-HI
HI 00801.126HI for the Uninsured 
HI 00801.131Eligibility for Premium-HI 
HI 00801.133Enrollment and Coverage PeriodsTN 26 11-93
HI 00801.134HI Premium Reduction for Aged Individuals With At Least 30 Quarters of CoverageTN 29 08-99
HI 00801.135HI Premium Reduction to Zero for Certain Public RetireesTN 29 08-99
HI 00801.137Initial InterviewTN 29 08-99
HI 00801.138Application for Premium HITN 29 08-99
HI 00801.139QMB ProvisionsTN 29 08-99
HI 00801.140State Buy-In and Group Payer Provisions for QMBsTN 26 11-93
HI 00801.142Transfer Enrollment Period for Individuals Enrolled in Medicare Managed Care PlansTN 31 06-04
HI 00801.143Evidence of Enrollment in A Medicare Managed Care PlanTN 31 06-04
HI 00801.144Taking the ClaimTN 31 06-04
HI 00801.145Withdrawal of Application for EnrollmentTN 31 06-04
DISABILITY PROVISION
HI 00801.146Entitlement to HI for the DisabledTN 31 06-04
HI 00801.151D-HI for QRRB AnnuitantsTN 31 06-04
HI 00801.152Counting Months in Reentitlement CasesTN 31 06-04
HI 00801.153D-HI Qualifying Period for Individuals Awarded DIB Under Section 332 of P.L. 98-21TN 25 09-93
HI 00801.154SSI/SSP Credit for Disabled Widow(er)sTN 25 09-93
HI 00801.155Deemed Entitlement to DWB for MedicareTN 25 09-93
HI 00801.161Medicare Continuation During Appeal of Title II Disability CessationTN 25 09-93
HI 00801.163Disability Cessation Affirmed or Reversed After Benefit ContinuationTN 25 09-93
HI 00801.164Medicare Entitlement During the Provisional Benefit Period – Expedited Reinstatement of Disability BenefitsTN 30 08-01
HI 00801.165Medicare Terminations When The Provisional Benefit Period EndsTN 30 08-01
HI 00801.166Favorable Medical DecisionsTN 30 08-01
HI 00801.167Examples Of How Disability Determinations Affect Medicare Coverage During The Provisional Benefit PeriodTN 30 08-01
PREMIUM-HI FOR THE WORKING DISABLED
HI 00801.170Premium-HI for the Working DisabledTN 26 11-93
HI 00801.172Taking Premium-HI Claims for the Working DisabledTN 31 06-04
HI 00801.174Withdrawal of EnrollmentTN 26 11-93
CHRONIC RENAL DISEASE
HI 00801.186HI Based on End Stage Renal DiseaseTN 26 11-93
HI 00801.191Requirements for Entitlement to R-HITN 31 06-04
HI 00801.196Application RequirementTN 31 06-04
HI 00801.197Withdrawal of ApplicationTN 31 06-04
HI 00801.201R-HI Insured StatusTN 28 07-95
HI 00801.206Course of DialysisTN 28 07-95
HI 00801.211Kidney Transplant - DefinitionTN 28 07-95
HI 00801.215Date of Entitlement - General PolicyTN 28 07-95
HI 00801.216Date of Entitlement - DialysisTN 31 06-04
HI 00801.221Date of Entitlement - TransplantTN 31 06-04
HI 00801.226Date of Entitlement Based on Self-Dialysis TrainingTN 31 06-04
HI 00801.233Medical Evidence of ESRD - Form CMS-2728-U3TN 31 06-04
HI 00801.235Development of ClaimsTN 31 06-04
HI 00801.246R-HI and R-SMI Benefits - PolicyTN 31 06-04
HI 00801.247Medicare as Secondary Payer of ESRD BenefitsTN 31 06-04
HI 00801.248Effect of Immunosuppressive Drug Coverage on Filing for R-HI and R-SMITN 32 02-05
HI 00801.251SMI EnrollmentTN 31 06-04
HI 00801.256SMI PremiumsTN 23 07-91
HI 00801.257State Buy-In ConsiderationsTN 28 07-95
HI 00801.258Relationship Between R-HI, D-HI, and Age 65 HITN 31 06-04
HI 00801.261HI FreezeTN 31 06-04
HI 00801.300District Office Final Authorization (DOFA) of ESRD Medicare Awards and DisallowancesTN 31 06-04
HI 00801.302Medical Review of ESRD ClaimsTN 31 06-04
HI 00801.308Form SSA-892-U2 (End-Stage Renal Disease (ESRD) Medicare Determination)TN 31 06-04
HI 00801.309SSA-892-U2 (End-Stage Renal Disease (ESRD) Medicare Determination) — ExhibitTN 28 07-95
HI 00801.325Notice to RRB: ESRD Medicare Award — LAF Code on MBR is “E”-ExhibitTN 28 07-95
MEDICARE QUALIFIED GOVERNMENT EMPLOYMENT
HI 00801.400Medicare Qualified Government Employment (MQGE)TN 31 06-04
HI 00801.405HI Entitlement for Auxiliaries and Survivors Based on MQGETN 27 05-94
HI 00801.410Insured Status Based on MQGETN 27 05-94
HI 00801.415Evidence of MQGE — Earned GEQCsTN 27 05-94
HI 00801.420Deemed GEQCs for Federal Employees — Employee Status During 1/83TN 27 05-94
HI 00801.425Deemed GEQCs for Federal Employees — Pre-1983 EarningsTN 27 05-94
HI 00801.430Using CS DATA Element to Determine Fully Insured StatusTN 27 05-94
HI 00801.435Taking the ClaimTN 27 05-94
HI 00801.440Special Rules Applicable to MQGE ClaimsTN 27 05-94
TEMPORARY NOTICE OF ELIGIBILITY
HI 00801.500Temporary Notice of EligibilityTN 27 05-94
HI 00801.510Issuing the NoticeTN 33 02-06
HI 00801.515Request for Notice After Claim ForwardedTN 27 05-94
HI 00801.520Subsequent Handling After Issuance of NoticeTN 27 05-94
HI 00801.901RR-80;Report of Health Insurance Information, SSA Jurisdiction 
HI 00801.902CMS 2728-U3, End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration - ExhibitTN 28 07-95
HI 00801.904Temporary Notice of HI-SMI Eligibility — Sample 
HI 00801.905CMS-565, Medicare Qualification Statement for Federal Employees — Locally Reproducible - ExhibitTN 28 07-95

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HI 00801.000 - Hospital Insurance Entitlement - Table of Contents - 08/10/1999
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