TN 25 (09-93)

HI 00801.032 Establishing Entitlement

A. Process — Initial entitlement cases

HI entitlement for a monthly beneficiary is established using the same SSN and BIC used for payment of the monthly benefit. HI entitlement for an individual eligible for but not currently entitled to monthly benefits is established under the claimant’s own SSN (even if the claimant’s HI entitlement is based on another person’s earnings). The BIC of “T” is used to identify individuals who file for HI only.

Once the HI entitlement date is established on the Master Beneficiary Record (MBR), it is subsequently passed along to CMS"s health insurance system for entry onto the Health Insurance Master Record and for preparation of a health insurance card. The SSA award certificate will advise the individual of his/ her HI entitlement date and explain that the award certificate may be used as proof of Medicare entitlement until receipt of a health insurance card.

B. Process — Prior entitlement cases

RSDI beneficiaries whose entitlement continues into the month they attain age 65 are automatically entitled to HI. Each month, the MBR is screened to identify entitled beneficiaries who will attain age 65 within 4 months. Entitlement data for each individual are forwarded for entry onto the Health Insurance Master Record and for preparation of an SMI automatic enrollment package. The only notice of HI entitlement in these cases is mailed with the health insurance card.

The date of birth (DB) shown on the MBR for some beneficiaries merely represents an allegation and has not actually been established. By means of a quarterly screening of the MBR, these beneficiaries are identified and alert messages are sent to the PSC 12 months before attainment of age 65. If a beneficiary’s DB has not been established at the time a record is created on the Health Insurance Master Record, the record is treated as inactive and an HI card will not be issued until the DB has been established.

C. Process — QRRBS

When RRB establishes that an individual is a QRRB, RRB automatically assumes jurisdiction of the Health Insurance Record and transmits the appropriate data to SSA for entry on the HI master record under the RR prefix claim number. If the QRRB is also entitled to RSI benefits, appropriate data is transmitted to SSA for entry on the MBR which stops SMI premium deductions by SSA and transfers data from the HI master record under the SSA claim number to the active RR HI master record.

While SSA selects individuals for automatic enrollment in SMI at age 64 and 9 months, RRB selects at age 64 and 7 months to preclude an automatic enrollment package being sent to the individual by SSA.

D. Reference

See HI 01001.130, “JURIS Processing.”


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600801032
HI 00801.032 - Establishing Entitlement - 04/16/2015
Batch run: 04/16/2015
Rev:04/16/2015