TN 19 (03-93)

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 his/ her 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, award coverage beginning the following July.

EXAMPLE: In 2/91, Mr. Brown files for reduced RIB, alleging he was born 2/28, and submitting corroborating evidence. Based on evidence of higher probative value, a 2/4/24 DB is established. An unreduced RIB and HI are awarded effective 8/90.

Since Mr. Brown filed an application establishing HI entitlement during a GEP and while eligible to enroll (being age 65 and entitled to HI), he is deemed to have requested SMI enrollment. Unless he refuses such deemed enrollment timely, he has coverage beginning 7/91. If Mr. Brown had filed his application in 7/91 (i.e., not during a GEP), he would be deemed enrolled during the 1992 GEP, because this would permit coverage to begin earlier than enrollment in his deemed IEP (11/92-5/93).

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 to permit coverage earlier than the following July.

NOTE: The individual does not have a choice of accepting the later coverage based on a GEP enrollment.

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

Because Mrs. Adams relied on documentary evidence showing she was younger than her true age, a deemed IEP of 3/92-9/92 is established for her. This deemed IEP begins after her filing date, but during a GEP. She is effectively enrolled during her 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, whichever results in earlier coverage.

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 - 03/17/1993
Batch run: 06/05/2015