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.