TN 27 (05-94)

HI 00801.440 Special Rules Applicable to MQGE Claims

A. Policy — Aged claims

Individuals age 65 or over who are found to be ineligible for HI based on GEQCs should be informed about Premium-HI and SMI enrollment and given an opportunity to enroll if in a prescribed enrollment period.

B. Policy — Disability claims

1. General

A disabled person may not be entitled to HI based on GEQCs any earlier than someone with the same onset date who is insured for title II disability benefits. This means the individual is essentially “deemed” entitled to title II disability benefits and is, therefore, subject to the same reviews (e.g., medical reexam) and has the same reporting responsibilities.

2. Waiting period

A disabled worker or widow(er) insured for HI only by using GEQCs must serve the equivalent of the 5-month disability cash benefit waiting period and the 24-month D-HI waiting period. In the case of a childhood disability beneficiary, since there is no cash benefit waiting period for such individuals under title II, the individual is only required to serve the 24-month D-HI qualifying period.

Previous months of title II disability benefit entitlement or GEQC deemed disability benefit entitlement may be counted in determining when HI begins as described in HI 00801.152. Also, see HI 00801.154 for circumstances under which months of SSI/SSP eligibility for disabled widow(ers) may be counted as months in the D-HI qualifying period.

NOTE: Even though a disabled person's HI based on GEQCs may not begin until the above waiting period requirements are met, individuals should be encouraged to file as soon as possible after becoming disabled because of the 12-month limit on retroactivity of an application based on disability.

3. Onset date

The earliest possible disability onset date under the MQGE provisions is 1/1 /83 based on Federal employment and 4/1/86 based on State and local employment. This does not mean that the disability must actually have begun on or after those dates. However, if a worker or widow(er) were disabled prior to that date, the onset date shown on the award would be the effective date of the provision even though the individual need only be insured through the date of actual onset. The first possible month in the 5-month waiting period is the first possible month of coverage (i.e., 1/83 in the case of Federal employment, and 4/86 in the case of State and local government employment). Thus, unless an individual had previously been entitled to title II disability benefits within the limits specified in 2. above, HI entitlement based on GEQC's may not begin any earlier than 6/85 (Federal) or 9/88 (State or local).

In the case of a DAC, since there is no cash benefit waiting period, the 24-month Medicare qualifying period can begin immediately and Medicare can begin as early as 1/85 (Federal) or 4/88 (State or local).

C. Policy — ESRD cases

For ESRD claims in which a person is eligible for R-HI only through use of GEQCs, entitlement is established on the worker's SSN using the BICs in SM 00550.010.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600801440
HI 00801.440 - Special Rules Applicable to MQGE Claims - 04/23/2015
Batch run: 04/23/2015
Rev:04/23/2015