Jackie Johnson, employed at University Hospital since 11/89, has been covered under
the Hospital's LGHP since she began working. She has not actually worked since 6/96.
Jackie was entitled to disability benefits effective 1/95 and was automatically enrolled
in SMI beginning 1/97. She requested termination of the coverage effective 9/97.
In 1/00, the employer informed Jackie that they are no longer primary payer of benefits
beginning 1/99 and advised her to contact SSA about enrolling in SMI under the D-SEP
provisions. The letter stated that she has been covered under the LGHP since 11/89
and a copy of the carrier certification is also provided.
Jackie's D-SEP is 1/00 through 7/00. She enrolls in SMI in February and requests an
effective date of 3/00. A 10 percent premium surcharge applies since the months the
employer is not primary payer of benefits (1/99 – 2/00) can not be excluded from the