TN 65 (12-22)

HI 00805.155 Enrollment Request Filed After Age 65 But Before Deemed Date of Attainment

A. Policy

A person may file for SMI (or be subject to automatic enrollment) after the person's actual IEP ended and before the beginning of the deemed IEP (based on the documentary evidence on which the person relied).

B. Procedure

1. Deemed IEP begins after GEP

If enrollment occurs during a GEP and the deemed IEP begins after the end of the GEP, coverage begins February of the current year.

EXAMPLE: In 2/10/2023, Tim Brown files for reduced RIB, with an alleged date of birth of 2/04/1960; however, the Numident record shows a date of birth of 2/4/1956. Since there is a discrepancy between Tim's claim allegation and the Numident, we request evidence to correct the date of birth on the Numident record (GN 00203.030). Tim Brown provides the required evidence which confirms the Numident DOB of 2/4/1956 is correct. An unreduced RIB is awarded 8/2022, and HI is awarded effective 8/2022.

Since Tim Brown filed an application establishing HI entitlement during a GEP and while eligible to enroll (being age 65 and entitled to HI), Tim is deemed to have requested SMI enrollment. Unless Tim refuses such deemed enrollment timely, Tim has coverage beginning February 2023, as Tim is deemed to have filed the first day of the then current GEP. If Tim Brown had filed an application in 7/23 (i.e., not during a GEP), Tim would be deemed enrolled during the 2024 GEP, because this would permit coverage to begin earlier than enrollment in Tim's deemed IEP (11/24-5/25).

2. Deemed IEP begins during GEP

If the deemed IEP begins during a GEP, but after the enrollment request was filed, deem the person to have enrolled during the deemed IEP. The effective date of coverage follows the IEP rules.

EXAMPLE: Sandy Adams files a SMI enrollment request on 2/15/92. Sandy submits an original birth certificate showing that Sandy was born 6/24/25. Sandy explains that Sandy did not enroll for SMI when first eligible because Sandy only recently discovered the birth certificate. Sandy previously believed Sandy was born on 6/24/27 in reliance upon an insurance policy issued in 1945 showing the 6/24/27 DB.

Because Sandy Adams relied on documentary evidence showing Sandy was younger than Sandy's true age, a deemed IEP of 3/92-9/92 is established for Sandy. This deemed IEP begins after Sandy's filing date, but during a GEP. Sandy is effectively enrolled during Sandy's deemed IEP and is awarded coverage beginning 6/92.

3. Enrollment after GEP

If the enrollment request is filed outside a GEP, deem the person enrolled during the next GEP or in the deemed IEP. If the person enrolls in the deemed IEP, coverage starts based on the IEP rules. If the person enrolls outside the GEP and deemed IEP, the person is deemed to have filed the first day of the next GEP.

NOTE: This is not considered a late enrollment and there are no months which count toward a premium increase.

4. Report of contact is required

If an individual files for SMI in a GEP or deemed IEP after a prior enrollment request was denied because the individual was older than alleged and outside an enrollment period, prepare an RC as described in HI 00805.150 E.

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HI 00805.155 - Enrollment Request Filed After Age 65 But Before Deemed Date of Attainment - 12/02/2022
Batch run: 12/02/2022