A disabled beneficiary may allege he/she was misinformed about whether the GHP or
LGHP was the primary payer of benefits. If there is proof, or the likelihood, that
the information alleged was given by an employee or agent of the Federal Government
(e.g. SSA or a Medicare carrier), the employer, or by the GHP/LGHP, equitable relief
may be granted to correct the results of the incorrect information. Premium surcharges
may be waived or reduced, and an SEP may be granted in cases of errors from the above-mentioned
The individual may enroll or reenroll in SMI under the equitable relief provisions
if he/she submits a letter or other information from the employer that states:
the GHP or LGHP has been primary payer of benefits for some period of time in or after
the GHP/LGHP should not have been primary payer; and
the GHP/LGHP stopped (or will stop) making primary payments as of a specified date.
b. Enrollment Requirements
The individual must enroll within 7 months of the date of notice from the employer
advising that the GHP/LGHP is no longer primary payer or, if later, within 7 months
of the last month for which the GHP/LGHP is primary payer.
The SMI entitlement date for a beneficiary who complies with these conditions is:
the first day of the month of enrollment in SMI, or
the first month the GHP/LGHP is no longer primary payer. (Note: the beneficiary must
agree to pay all premiums due, if applicable.)
When calculating the premium surcharge, exclude all months beginning 1/87, during
which the GHP/LGHP was the primary payer of benefits.