TN 25 (09-93)

HI 00801.022 Application Requirement and Effective Date for Hospital Insurance for Insured Beneficiaries

A. Policy - RSI beneficiaries

Applications for retirement age monthly benefits are also applications for HI. Thus, a separate HI application is not required if an individual:

  • becomes entitled to monthly RSI benefits at age 65 or later (HI is effective with the first month of RSI benefit entitlement), or

  • was entitled to a reduced RSI benefit prior to age 65 (HI is effective with the month the individual attains age 65).

HI may begin earlier than the first month of RSI benefit entitlement if the individual was eligible for HI during any of the 6 months prior to the month of filing but RSI benefit entitlement is restricted to a later month. In such cases, HI begins with the first month during the 6 months prior to the month of filing in which the individual is age 65 and eligible for monthly RSI benefits.

B. Policy - QRRBS

There is no separate HI application requirement for RR annuitants or pensioners or for individuals who have been or would be considered under the SS guaranty provision in computing the RR annuitant's benefits.

NOTE: An RR worker (or the spouse of an RR worker) who could be entitled to an annuity if RR employment ended must file an application with RRB to be certified as a QRRB.

C. Policy - HI only applicants

1. General

Beginning 1/1/81, an individual age 65 or over who is eligible for the following monthly benefits may file an application for HI only:

NOTE: An aged spouse (or other aged auxiliary) may file for HI only whether or not the NH has filed for RIB.

2. Retroactive life

An application for HI may be retroactive for as much as 6 months prior to the month of filing but no earlier than the month all other requirements for HI entitlement are met. This 6-month rule is waived if the individual was entitled to Premium-HI at the time the application for HI under the regular insured provision was filed. In this case, premium-free HI entitlement begins with the first month in which the individual was entitled to Premium-HI and would have been eligible for RSI benefits had he/she filed a timely application.

D. Policy - Statement filed with hospital protects filing date

See GN 00204.010 for full instructions on the circumstances under which a statement filed with a hospital by, or on behalf of, an inpatient will protect the filing date for HI. A statement meeting the conditions of GN 00204.006 and GN 00204.010A.4. protects the filing date for HI, not only under the regular insured provision, but under all HI entitlement provisions (i.e., deemed insured, ESRD, Premium-HI, and even for the disabled who can establish HI as of the first month of entitlement to a second period of disability benefits because they met the 24-month waiting period requirement during an earlier period of disability entitlement). To protect entitlement to Premium-HI, however, the individual must have completed the statement during an enrollment period and already be entitled to SMI, or have filed a request for SMI during a prescribed enrollment period.

NOTE: A protective statement for HI may not be construed as an intent to enroll in SMI. However, as in all insured cases (including deemed insured) where automatic enrollment is applicable, an individual who is entitled to HI is automatically enrolled in SMI as of the initial enrollment period (IEP), current general enrollment period (GEP), or following GEP (whichever is applicable), unless he or she specifically refuses the SMI enrollment. Thus, when the statement filed with a hospital is used to protect the HI filing date, the individual (if subject to automatic enrollment) is also enrolled in SMI based on that same statement.