TN 19 (03-93)

HI 00805.215 SMI Terminated Erroneously

A. Introduction

When SMI is terminated erroneously, an individual is in approximately the same position as the person whose enrollment was not processed timely. That is, the individual does not know whether he/she still has SMI. Thus, he/she may enroll in other health insurance to ensure some protection against medical expenses, or may defer necessary treatment because of uncertainty about being insured against the costs of such treatment, etc.

When the error is finally corrected, it would be unfair to reinstate SMI entitlement retroactively, which would require the individual to pay premiums for past SMI coverage that he/she was unable to use at that time.

B. Policy

If 6 months or more premiums are owed, the individual whose SMI was terminated erroneously will be offered the same options offered to the individual whose enrollment was not processed timely (see HI 00805.195).

C. Procedure

1. Notice of reinstatement

When reinstating the erroneously terminated SMI, send the beneficiary a notice (similar to the notice in HI 00805.195) to the effect that:

  • entitlement was erroneously terminated;

  • the month of the erroneous termination;

  • entitlement is being reinstated with the current month;

  • he/she has the right to choose coverage effective with the month of erroneous termination if notice of this choice is received within 60 days of the date of this notice. (Do not mention this option if the file already contains a request from the beneficiary for fully retroactive, or only current, coverage.);

  • if full retroactivity of coverage is desired, premiums must be paid for the period from the erroneous termination month to the month of reentitlement. This can be done either by withholding from benefit checks, or by direct remittance, if the beneficiary does not receive a check;

  • the right to request from the FO an alternate method of payment if the beneficiary would have difficulty in paying the arrearage in a lump sum.

2. Retroactive reinstatement

If the individual pays in full, or agrees to installments after receiving the information in HI 00805.180, or agrees to benefit deductions for the accrued premiums, reinstate coverage as of the month of the erroneous termination.

3. SMI is no longer wanted

If the enrollee protests the current reinstatement of SMI within 2 months after the month of notice, reverse the reinstatement of SMI (i.e., permit the original termination to stand) and refund any premiums collected.

D. Example

Mr. Clay's SMI coverage was terminated effective with 10/31/91 due to a medical cessation of DIB. In 12/92 his DIB was fully reinstated on appeal with no break in entitlement.

Mr. Clay will be notified that:

  • his SMI was erroneously terminated but is being reinstated effective with 12/92;

  • if he wishes SMI reinstated retroactively he must submit a signed request for SMI as of 11/91 and authorize deduction of retroactive premiums amounting to $409.60 ($29.90 a month for 11/91-12/91 and $31.80 a month for 1/92-11/92) from his monthly benefit check; and

  • he may request alternative methods for paying the arrearage.

E. Reference

Enrollee's right to file claims after expiration of the usual time limit, HI 00805.195 C.5.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805215
HI 00805.215 - SMI Terminated Erroneously - 06/08/2015
Batch run: 06/08/2015
Rev:06/08/2015