TN 75 (02-23)

HI 00805.230 Delayed Deletion from State Buy-In Rolls Prejudices Termination Rights

A. Background

People who wish to terminate individual SMI coverage after buy-in ends face financial disadvantages if delayed deletion occurs.

B. Policy

1. General

Under current procedures, an individual"s SMI coverage under buy-in can be terminated retroactively for as many as 2 months before the State"s notice to CMS that claimant *is no longer entitled.

After receipt of the notice from the State, a notice will be sent (usually a HCFA-L1636) to the individual. It advises that the claimant is responsible for paying the SMI premiums beginning with the month following the last month of buy-in coverage.

Because of administrative delays, a beneficiary can already be in the third month after buy-in termination and owe 3 months SMI premiums before the claimant is even notified that the buy-in coverage has been terminated.

2. Equitable relief

Equitable relief can be granted to allow an individual"s SMI coverage to end effective with the termination of buy-in coverage, thus allowing the individual to avoid entirely any premium liability. To do this, all of the following conditions must be met:

  • the individual submits a written request to have the individual SMI coverage end effective with the end of buy-in coverage;

  • such request is filed within 30 days of the date of the HCFA-L1636 or other notice informing the beneficiary of the buy-in termination; and

  • the individual certifies that the claimant has incurred no medical services covered under SMI after the last month of buy-in coverage.

REMINDER: An individual granted retroactive SMI termination should be cautioned that if the claimant receives reimbursement for services received after buy-in ended, the amount of that reimbursement represents an overpayment and can be collected later upon reenrollment.

If the claimant is a monthly social security or Railroad Retirement beneficiary, it is collected from monthly benefits.

3. Equitable relief not applicable

If an individual says that the claimant had medical expenses covered under SMI after buy-in ended, equitable relief does not apply.

SMI entitlement must be terminated at the end of the month in which the termination request is filed (if the request is filed within 6 months of buy-in termination, see HI 00820.035 B.5.).

C. Procedure - SMI cancellation

1. Use of Form HCFA-L1636

Ask the beneficiary to submit Form HCFA-L1636, if the claimant wishes to cancel SMI.

NOTE: This form is normally the source of the date of the buy- in deletion notice for purposes of determining the 30-day period in which relief under this section is applicable.

2. HCFA-L1636 is not available

If Form HCFA-L1636 has been destroyed or is otherwise unavailable, assume that the date of the letter is 7 days after the annotation to the TTDS (Third Party Termination Date - State) to the MBR.

NOTE: If a PSC contact is needed because the MBR does not have the transaction date, the date of the letter would be 7 days after the run date shown on the form SSA-1596-C1 (Record of Changes in Premium Deduction or Billing Status).

D. Procedure - Withdrawal of SMI termination

If a beneficiary cancels SMI under this section and later decides the claimant acted hastily, reinstate SMI if the request to do so is received on or before the 60th day after the date of Form

HCFA- L1636.

To Link to this section - Use this URL:
HI 00805.230 - Delayed Deletion from State Buy-In Rolls Prejudices Termination Rights - 02/06/2023
Batch run: 02/06/2023