In some cases, an individual who is otherwise eligible for enrollment on the basis
of the deemed IEP provision may decline SMI enrollment (e.g., because he /she prefers
other insurance, etc.). If that individual seeks to enroll for coverage at a later
date, the deemed IEP protection no longer applies.
Similarly, if an individual was enrolled in SMI on the basis of a deemed IEP but that
person allows coverage to lapse (either through non-payment of premiums or based on
a request for termination), the premium protection afforded by the deemed IEP provision
is not applicable should the person reenroll for coverage at a later date.
In determining the amount of the individual's SMI premium surcharge for late enrollment,
months of non-coverage will be counted beginning with the month following the end
of the person's actual IEP, keeping in mind that some months of non-coverage may not be countable because of
the working aged provision (see HI 00805.295).
EXCEPTION: If an individual would be eligible for an SEP and/or premium surcharge rollback because
of coverage under an employer group health plan (EGHP), the deemed IEP protection
continues for that person. All determinations for SEP and/or premium rollback purposes
will be based on the deemed date of birth and deemed IEP.