Jackie Johnson, employed at University Hospital since 11/89, has been covered under
the Hospital's LGHP since Jackie began working. Jackie 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. Jackie 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 to contact SSA about enrolling in SMI under the D-SEP provisions.
The letter stated that Jackie has been covered under the LGHP since 11/89 and a copy
of the MAC certification is also provided.
Jackie's D-SEP is 1/00 through 7/00. Jackie enroll 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 surcharge calculation. Should Jackie have requested an retroactive effective date
of 1/99, Jackie would not have incurred a premium surcharge.