HI 00801.116 HI Leads from RRB
RRB uses Form RR-80 (Report of Health Insurance Information—SSA Jurisdiction) to notify SSA that an individual is not eligible for HI as a QRRB or that an individual is no longer a QRRB. (See HI 00801.121) When an individual within 3 months of age 65 or older files an application with RRB but is ineligible for HI as a QRRB, RRB will notify SSA so that an application can be developed to establish HI entitlement with SSA. These cases may involve an RR worker or an RR worker’s spouse or survivor (within 3 months of age 65 or older) who has filed an application if: (1) the RR worker had less than 120 service months or (2) the RR worker has 120 service months but is not under a disability freeze and is not within 3 months of age 62; or (3) the spouse or survivor has not established the required relationship to the RR worker.
The Railroad Retirement Act of 1974 substantially altered the relationship between benefits paid under Title II of the Social Security Act and to Railroad annuitants. If a claimant becomes entitled to benefits under title II and is not entitled to RR benefits at that time, but has RR involvement and could become eligible to an RR annuity at a future date, SSA certifies payment to the RRB instead of to the Secretary of the Treasury. Payment of such benefits is made from the social security trust fund.
When an individual ceases to be a QRRB, RRB will notify SSA so that necessary development can be taken to establish his entitlement to HI with SSA. In addition, if the beneficiary is entitled to SMI, SSA must take a claims action to establish his premium collection record under an SS claim number (RRB is not responsible for collecting premiums from an individual who ceases to be a QRRB). These cases will usually involve:
an RR spouse whose annuity is terminated by the RR worker’s death and whose survivor benefits will be paid by SSA; or
an RR spouse whose annuity is terminated by divorce; or
an RR survivor whose annuity is terminated because of remarriage; or
the RR survivor who can no longer be considered under the special guaranty provision because the annuity of the principal annuitant has terminated.
B. RRB action
All RR-80 forms are forwarded to CMS, OAS Correspondence Services Branch, P.O. Box 11979, Baltimore, Md. 21207.
When an application is filed on the account of a RR worker who has less than 120 service months, RRB sends the RR-80 to CMS together with a copy of the RRB denial letter and a certification of the worker’s RR earnings.
When an individual ceases to be a QRRB, RRB prepares the RR-80 in triplicate. If RR earnings are being certified for use by SSA, a copy of the denial letter accompanies the RR-80. If RRB determines that the former QRRB is currently entitled to RSI benefits on another account, the SS claim number is shown at the top of the RR-80.
C. Central Office action
CMS’s, OAS Correspondence Services Branch receives all RR-80’s and related documents directly from RRB.
Upon receipt of an RR-80, CMS obtains an MBR printout to determine if the RR-80 should be forwarded to the DO or PSC for processing. The original and one copy of the RR-80 and all attachments (RR-90, RL-115, G-91, AA-2, etc.) are sent under cover of an HCFA-1746,
The RR-80 is sent to the DO if:
The MBR is NIF, orthe beneficiary does not appear in an MBR benefit line, or the beneficiary appears in an MBR benefit line in a terminated status (LAF code T or X).
The beneficiary remarried and RRB failed to furnish the proper SSA claim number.
RRB furnished an incorrect SSA claim number.
If the DO does not reply within 30 days a followup memorandum is sent for a status report.
At the time the RR-80 is forwarded to the DO, CMS freezes the RRB-HI Master Record until the case is resolved. Part B claims can still be processed under the RRB CN until the RRB CN is transferred over to the SSA CN.
The RR-80 is sent to the PSC if:
The beneficiary appears in an MBR benefit line.
The MBR LAF code does not reflect a termination.
If the PSC does not reply within 60 days a followup memorandum is sent.
When the PSC processing is complete, return one copy of the RR-80 to CMS, OAS Correspondence Services Branch. CMS takes the necessary action to verify that the Health Insurance Record has been corrected or established under the SSA claim number, to transfer any Health Insurance Utilization recorded under the RR claim number to the SSA claim number, and to establish the proper cross-reference.
D. DO action
When an RR-80 and any associated material is received in the DO, it is treated as any other claims lead. If the DO’s record show that the RR applicant or former QRRB is currently entitled to HI as a deemed insured individual, as a Premium-HI enrollee or under the regular insured provisions, forward the original copy or the RR-80 and related material to the processing center for association with the claims file. When the RR-80 pertains to a former QRRB, enter the appropriate claim number, name, etc. in section C of the second copy of the RR-80 and forward it to CMS, OAS Correspondence Services Branch, to insure that any Health Insurance Utilization recorded under the beneficiary’s RR claim number will be transferred to the RSDI claim number under which entitlement has been established with SSA. When the RR-80 pertains to an RR applicant who has not been found entitled to HI as a QRRB but is currently entitled to HI with SSA, only one copy will be received. In this case, complete the form and forward it to the processing center; no copy need be sent to CMS.
If the RR applicant or former QRRB has not established entitlement to HI with SSA, request the claimant’s SS E/R and if the claimant is the spouse of a RR worker age 62 or older, the worker’s E/R. Exert every reasonable effort to obtain an SSA-18F5 or appropriate application for monthly RSI benefits. This effort is particularly important where the individual had HI-SMI coverage as a QRRB. A delay in filing with SSA may result in an interruption of HI coverage.
Where there is a long delay in establishing a premium collection record by SSA, payment of all the accrued past due premiums may result in the claimant’s inability to pay current or future premiums or if the claimant is entitled to RSI benefits, the withholding of a large amount for the accrued SMI premiums may cause a hardship (See HI 00805.180). Note that if the claimant is enrolled for SMI but cannot be found entitled to HI or monthly RSI benefits, it will be necessary to process a SMI only award to establish a premium collection record for him under his social security number. (In such a case, an HCFA-4040 should be obtained from the claimant if he has not filed an SSA-18F5 or other RSI application.) If the RR-80 indicates the claimant is enrolled under a State buy-in agreement, show the proper “PW” code entries in item 7 of the award form.
When the DO obtains an application for monthly benefits, an SSA-18F5 or an HCFA-4040 from a former QRRB, section C of the second copy of the RR-80 should be completed and forwarded to CMS, OAS Correspondence Services Branch, when the claim is forwarded to the processing center. If the claimant is not entitled to HI indicate this and the reason in the “Remarks” section of the RR-80. In some cases, the RR claimant may contact the DO before the RR-80 is received. Ask such a claimant for her denial (or termination) notice from RRB so that a copy can be made for the claims file and have her complete an appropriate application. However, do not delay processing any claim awaiting receipt of the notice or an RR-80.
E. Processing Center action
When the processing center receives an RR-80, it will take the necessary adjudication action to establish HI and any SMI premium collection record under the appropriate SS claim number based upon the dates shown on the RR-80. Where the beneficiary has SMI coverage, any withholding or billing of SMI premiums will begin with the first month RRB did not collect the premium. If the premiums are being paid under a State buy-in agreement, central office will notify the State agency of the SS claim number under which continuing HI-SMI coverage is being established. If the DO prepared a HI-SMI award for a claimant and the reviewing office determines that neither HI nor SMI entitlement can be established, the reviewing office will indicate this in the “Remarks” section of the RR-80 and show the reason why such entitlement cannot be established. The RR-80 should be forwarded to CMS, OAS Correspondence Services Branch. Annotate the claims file to show that this action was taken.