Take the following actions to process an SEP enrollment after documentation has been
a. Determine the proper process based on the beneficiary’s circumstances.
Follow one of the specified processes listed below based on the beneficiary’s circumstance:
1. Beneficiary is a qualified railroad retirement beneficiary
Refer Railroad Retirement Board (RRB) annuitants that inquire about SMI enrollment
to the nearest RRB field office. Identify the nearest RRB field office using the zip
code locater found at this link: RRB Field Office . Provide the beneficiary with the
nearest office and explain to the beneficiary that the RRB will process their SEP
2. Beneficiary filing for SMI only or HI and SMI (including premium-HI) and has no prior
GHP SEP – When a beneficiary is filing an initial application for SMI only or for
HI and SMI (including premium-HI) simultaneously, process the award via the Modernized
Claims System (MCS).
SMI only for Exceptional Conditions – When a beneficiary is filing an initial application
for SMI only, process the award via the Modernized Claims System (MCS).
SMI and premium – HI for Exceptional Conditions – process the award via the Modernized
Claims System (MCS).
International Volunteers – Process through MCS.
3. Beneficiary filing for monthly benefits or HI
If a beneficiary files for HI and SMI after the Initial Enrollment Period (IEP), process
the SMI award as part of the monthly benefit claim or the HI claim via MCS.
Example of processing the SEP enrollment request in an initial claim for monthly
Mr. Adell, who attained age 65 in February 2012, has coverage under a GHP based on
his own employment since 1998. In October 2014, he files an application for monthly
benefits and HI because he plans to retire at the end of that calendar year. Mr. Adell
elects SMI coverage effective January 2015. We process the SEP enrollment via MCS
as part of the monthly benefit claim.
4. Beneficiary entitled to HI
If the beneficiary is already entitled to HI, process the SMI SEP enrollment via the
Post-entitlement Online System (POS).
We generally use Form CMS-40B (Application for Enrollment in Medicare - Part B (Medical
Insurance)) for these enrollments.
Obtain a CMS-L-564 form, if needed.
For an SEP based on Exceptional Conditions, the preferred form is the CMS-10797, Application
for Medicare Part A and Part B – Special Enrollment Period (Exceptional Conditions).
A signed and dated statement such as, “I want to enroll for Part B of Medicare” is
Note the necessary evidence for the applicable SEP is still required, regardless of
the form used for enrollment.
5. Beneficiary entitled to SMI and filing for premium-HI
GHP SEP enrollment requests for beneficiaries already e entitled to SMI and are filing
for premium-HI must be input via POS. The Form CMS-18 (Application for Hospital Insurance)
is normally used in this situation, however, a simple signed and dated statement such
as, “I want to enroll for Part A of Medicare” is also acceptable.
Premium- HI for Exceptional Conditions – Process the enrollment -via POS.
6. Enrollments that the PC process
If the PC is processing the enrollment due to a processing limitation:
Annotate “SEP Enrollment” at the top of the enrollment request and coverage start
Fax the enrollment request, evidence, and any clarifying documentation to the PC of
jurisdiction via Paperless for the SMI (or premium-HI) award.
Monitor the request until the PC processes the SMI (or premium-HI) award and the MBR/HIQR
7. Online and fax enrollments for Medicare Part B under an SEP for the working aged (GHP
The following are service delivery channels for beneficiaries to utilize for enrollments
in Medicare Part B under the SEP provisions:
a. Apply online
Working beneficiaries age 65 or older who qualify for an SEP based on GHP may apply
online by visiting Medicare Part B. Under the online process for Medicare Part B SEP
enrollment, beneficiaries are required to provide an eSignature to submit the forms
The online application does not allow beneficiaries to save and revisit the application.
b. Apply by fax or mail
Working beneficiaries aged 65 or older who qualify for an SEP may apply by fax or
mail by downloading and completing the:
Application for Enrollment in Medicare Part B (Medical Insurance) (CMS-40B); and
Request for Employment Information (CMS-L564). Refer to HI 00805.295 Evidence of GHP or LGHP Coverage Based on Current Employment Status for secondary
proofs if the CMS-L564 cannot be provided.
The beneficiary can fax or mail these forms to their servicing FO. The address and
fax numbers can be obtained by accessing Social Security Office Locator from the SSA.gov
The online service does not apply to the Exceptional Conditions SEPs nor International