TN 75 (02-23)

HI 00805.200 SMI Awarded on Later of 2 Timely Enrollment Requests

A. Introduction

After a person has been awarded SMI on the basis of an enrollment request, SSA discovers an earlier timely enrollment request, still unprocessed. If SSA were, on its own motion, to revise the existing SMI award to change the effective date of SMI coverage, the individual could be required to pay for many months of undesired retroactive coverage.

B. Procedures for handling enrollment request

1. General

Handle cases involving an unprocessed earlier request from a person currently enrolled as follows:

  • The enrollee's premium rate is reduced, if necessary, to be consistent with the enrollment period in which they filed earlier.

  • Any excess premium payments are refunded or credited against future premium liability.

  • The enrollee is notified that the prior premium rate had been erroneously computed, and that this error has now been corrected.

No other award action will ordinarily be taken.

2. Timely protest in file

Where the file reflects a current or timely protest (one filed within 6 months of notice) against the existing SMI award, send a notice to the enrollee advising that SMI coverage can begin as of (a specified date - when coverage would have begun if the original enrollment request had been properly and promptly processed) if, within 30 days,

  • the enrollee elects the earlier coverage, and

  • pays the retroactive premiums which have accrued since the earlier coverage date or authorizes the deduction of such amount from monthly benefits, as in HI 00805.195 B. (Installment payments are acceptable.)

    EXAMPLE: Mr. Blue, who attained age 65 in 4/87 was awarded SMI effective 7/89 (based on enrollment during the 1989 GEP) with a premium increase of 10 percent. In 10/90, SSA finds a request for SMI which Mr. Blue had filed in 4/87. Mr. Blue's premium rate is reduced to the standard (unincreased) amount effective 7/89 and the previously collected premium increase is refunded or credited against future premium liability.

    Mr. Blue is notified that the premium rate has been adjusted to correct a prior error. If SSA records show Mr Blue protested timely about the effective date of SMI, Mr Blue is also advised of the right to obtain earlier coverage, as specified in HI 00805.195 B.

To Link to this section - Use this URL:
HI 00805.200 - SMI Awarded on Later of 2 Timely Enrollment Requests - 02/06/2023
Batch run: 02/06/2023