TN 54 (10-22)

HI 00805.235 Special Considerations for Premium-HI

A. Policy

Where appropriate, equitable relief as described in HI 00805.170 - HI 00805.230 is also provided in situations involving Premium-HI.

Because the HI premiums are so much greater than SMI premiums, equitable relief for Premium-HI is available when Government error results in premium liability for at least 2 months of retroactive coverage.

Thus, relief under HI 00805.195 is given if the individual's HI entitlement is not processed until 2 or more months after coverage and premium billing would have begun if the enrollment request had been processed promptly. Coverage is awarded with the month in which the first premium billing is sent, with a notice of the individual's right to an earlier starting date if the claimant wishes to pay the premiums.

Similarly, the notice specified in HI 00805.220 C. (with appropriate changes) is issued whenever, because of interruption of premium billing, the enrollee owes premiums for 2 or more months of past HI coverage.

B. Example

Mrs. Rose filed for Premium-HI (and SMI) in 3/92, which was the month before the claimant attained age 65. Due to government delays, the claim was not adjudicated until 6/92.

Since the first premium bill to be sent to Mrs. Rose would cover April and May (2 retroactive months), the claimant is instead offered equitable relief. That is, the claimant is awarded Premium-HI effective with 6/92, with the option to elect 4/92, if the claimant pays the $384 retroactive bill for those 2 months. (The claimant SMI award is processed with the 4/92 date of entitlement because the premium liability is less than 6 months for SMI.)

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HI 00805.235 - Special Considerations for Premium-HI - 10/24/2022
Batch run: 10/24/2022