TN 31 (06-04)

HI 00801.029 Special Development Considerations

A. Procedure – Deemed insured HI eligibility

  1. Develop to establish entitlement to deemed insured HI (see HI 00801.047) if the claimant:

    • is eligible for deemed insured HI for months prior to the first month of HI eligibility under the regular insured provision; and

    • incurred Part A expenses which could be reimbursed in any of those earlier months.

  2. If there were no reimbursable expenses in the earlier months:

    • Restrict the individual's application to the first month of eligibility under the regular insured provision; and

    • Document the file to show that no Part A expenses were incurred in the earlier months.

B. Procedure – Premium-HI

If an individual is ineligible for HI under the regular and deemed insured provisions and in an enrollment period, give the individual the opportunity to enroll for Premium-HI as explained in HI 00801.126.

C. Procedure – RRB involvement

If an individual filing for HI only (or the person on whose record he/she is filing) has:

  • 120 months of RR service; or

  • after 12/31/95, has at least 60 months but less than 120 months of RR service,

forward the application and related development to RRB, Bureau of Retirement Claims, Health Insurance Operations, 844 North Rush Street, Chicago, Illinois 60611 for a determination whether the individual is eligible for an RRB annuity. When making such a referral:

  • Annotate the transmitting cover sheet as “QRRB Filing for Medicare Only.”

  • Send the claimant a letter patterned after the following:

“This refers to your claim for hospital insurance under Medicare. If an individual is eligible for benefits under the Railroad Retirement Act, the Railroad Retirement Board is responsible for processing that person's hospital insurance claim. This is true even if the Railroad employee had enough Railroad employment and work under Social Security to be insured under both programs. Since       (enter “you” or, if the claimant is filing on another person's account, the insured worker's name) had enough Railroad earnings to be insured under the Railroad Retirement Act, we are forwarding your claim to the Railroad Retirement Board so that they may determine whether you are eligible for a Railroad Retirement annuity. If you are, that agency will process your claim for hospital insurance entitlement. If you are not, your claim will be returned to us for a determination based on social security earnings alone. The Railroad Retirement Board will advise you of the action they take on your claim.”

If the individual is not eligible for an RRB annuity and RRB returns the claim to the SSA FO, make a determination of HI eligibility based on title II benefit eligibility, and award or deny the claim as appropriate.


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