TN 19 (03-93)

HI 00805.245 Development for SMI Enrollment of Civil Service Annuitants and Their Spouses

A. Policy - Interviewing

1. Annuitants

During the course of obtaining an application for SMI from an individual who is:

  • not entitled to monthly benefits under SS,

  • not entitled to an annuity or pension under RR, and

  • not eligible for coverage under a State buy-in agreement,

the DO should ask whether or not the applicant is a Civil Service annuitant or the spouse of an annuitant who has SMI.

If a person enrolling is an annuitant, this information and the civil service annuity number should be shown in the file. The claim should not be sent to the PSC until the correct annuity number is obtained. Otherwise, incorrect premium collection or delay in collection for several months will occur.

2. Spouse of annuitant

Where an annuitant is enrolled in SMI and subject to SMI premium deductions from the annuity, his or her spouse may also have SMI premiums withheld from the annuitant's monthly check if the annuitant consents in writing and the spouse is:

  • enrolled in SMI;

  • not entitled to a civil service annuity or any RSDI or RR benefits, and

  • not subject to State buy-in.

This arrangement is optional for the convenience of the annuitant and the spouse.

NOTE: OPM will not deduct for the spouse alone.

The annuitant must consent in writing to OPM's deduction of the spouse's SMI premiums from the annuitant's monthly check. The written authorization from the annuitant may be similar to the following:

I agree that the $         monthly premium to cover medical insurance for my wife (husband), (name), be deducted from my civil service annuity check.

3. CSC annuity number

The exact annuity number including the designation CSA (retired annuitant) or CSF (survivor annuitant) must be provided by the claimant.

Annuity numbers are assigned in numeric sequence as awarded.

NOTE: Both CSA and CSF numbers recently entered the seven-digit category although the majority of valid annuity numbers at the present time consists of six-digits. A few annuitants with five-digit numbers are still living and on the annuity rolls.

Annuity numbers of five or fewer digits should be questioned and validated. Two minor annuity designations, LSF and CZC, exist and may contain three and four-digit numbers, but these cases are rare.

Because of the critical timing of the SSA ADP system of SMI premium certification and the unique requirements of the OPM system, neither OPM premium deductions nor cessation of OPM premium deductions can begin until after the month for which it is effective. A delay of 4 months may be expected with full retroactive adjustment by the OPM.

4. RSI beneficiary, benefits suspended

Certification for SMI premium deductions from the civil service annuity applies to beneficiaries who are entitled to Medicare only. These are:

  • insured and age 65 or older (BIC-T)

  • ESRD (BIC-T)

  • deemed insured for Medicare only (BIC-T)

  • insured based on Medicare Qualified Government Employment (BIC-TA) and

  • uninsured age 65 or older (BIC- M).

The policy also applies to special age-72 claimants (BIC-J or K) who are entitled to SMI and are in total suspense because of Government pension offset, or whose monthly benefit payment is less than the SMI premium.  (See SM 00550.010 for information on BICs and type of payment).

RSDI beneficiaries are subject to SMI premium withholding from their monthly benefit. During periods of suspense, for work or other reasons, the beneficiary makes direct premium payments.

If a Civil Service annuitant, entitled to a social security benefit, but not receiving payment because of, e.g., government pension offset, wants the Part B premium deducted from the Civil Service annuity, he or she may wish to withdraw the monthly benefits portion of the application and be entitled to “HI only.” (This procedure is explained further in HI 00801.022 C. and HI 01001.190 B.)

B. Policy - Independent Federal systems

Certification for SMI premium deductions cannot be made from an annuity that is payable by an independent Federal retirement system other than OPM.

C. List of independent Federal systems

The following is a list of independent Federal civilian retirement