TN 23 (04-01)

HI 00805.280 Premium Surcharge Rollback for Individuals With GHP/LGHP Coverage

A. Policy – What months are excluded from the premium surcharge calculation

The surcharge is determined by counting the number of months when an individual could have been, but was not, enrolled in SMI after the end of the IEP through the end of the enrollment period in which enrollment occurs. When calculating the number of months during which an individual could have been, but was not, enrolled in SMI, months of GHP or LGHP coverage are excluded, as described below.

1. Exclusion of GHP months for the aged

Effective for premiums due for 6/86 and later months, the calculation of the surcharge for late enrollment will exclude:

  • all months beginning with 1/83 (or the end of the IEP, if later) during which the individual can demonstrate he/she was enrolled in a GHP based on his/her or a spouse"s current employment status, even if the employer was not primary payer (i.e., did not have 20 or more employees), and

  • all months of SMI entitlement.

2. Exclusion of GHP months for the disabled

Effective for premiums due for 1/87 and later months, the calculation of the surcharge for late enrollment will exclude:

  • all months beginning with 1/87 (or the end of the IEP, if later) during which the individual can demonstrate he/she was enrolled in a GHP based on his/her or a spouse"s current employment status, and

  • all months of SMI entitlement.

The earliest month for which the premium rollback can be effective is 7/90.

3. Exclusion of LGHP months for the disabled

Effective for premiums due for 1/87 and later months, the calculation of the surcharge for late enrollment will exclude:

  • all months beginning 1/87 (or the end of the IEP, if later) through 7/93 during which the individual can demonstrate he/she was enrolled as an active individual in an LGHP (see HI 00805.752A.1 for an explanation of “active individual”), and

  • all months beginning 8/93 during which the individual can demonstrate that he/she was enrolled in an LGHP based on his/her own or a family member's current employment status, and

  • all months of SMI entitlement.

B. Policy - When premium surcharge rollback can be requested

There is no time limit for requesting premium surcharge rollback. An individual who is already entitled to SMI or who is filing a GEP request, and for whom the policy described above applies may request relief from the premium surcharge at any time. .

NOTE: The premium surcharge can be reduced or eliminated even if the individual cannot have an SEP for any reason.

C. Procedure -- Request for premium surcharge rollback is not part of SEP package

FO procedure

If the request for premium surcharge rollback is not part of an SEP enrollment package, annotate “Premium Surcharge Rollback” prominently at the top of the request form and forward it to the PSC. Make sure the annotated page is on top. Always include:

  • evidence of GHP or LGHP coverage (see HI 00805.295), and

  • Form SSA-5002 (Report of Contact) giving the months FO personnel have determined should be excluded from the surcharge computation.

D. References


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805280
HI 00805.280 - Premium Surcharge Rollback for Individuals With GHP/LGHP Coverage - 06/08/2015
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