TN 25 (04-12)

HI 00805.350 Special Enrollment Period for International Volunteers

A. Policy for a special enrollment period for international volunteers

Section 5115 of the Deficit Reduction Act of 2005, provides a 6-month special enrollment period (SEP) beginning January 1, 2007, for SMI and Premium HI for an individual who is:

  • serving as a volunteer outside of the U.S. through a program that covers at least a 12-month period and is sponsored by a tax-exempt organization (For the definition of sponsoring organization, see HI 00805.350B in this section); and

  • has (or had) health insurance that provided coverage to the individual while he or she was outside of the U.S. for the duration of the volunteer service.

NOTE: The beneficiary need not serve as a volunteer for 12 months.

EXCEPTION: Individuals who are entitled to Premium-HI under the Premium-HI for the Working Disabled provision are not eligible to enroll during the SEP for International Volunteers.

B. Definition of sponsoring organization

A sponsoring organization may be a social, religious, educational, scientific, or charitable organization, as described in section 501(a) and (c)(3) of the Internal Revenue Code of 1986 section 501(a) and (c)(3). The sponsoring organization can be a:

  1. corporation(s),

  2. any community chest fund,

  3. foundation, organized and operated exclusively for:

    • religious,

    • charitable,

    • scientific,

    • testing for public safety,

    • literary,

    • educational purposes,

    • to foster national,

    • international amateur sports competition, or

    • organizations for the prevention of cruelty to children or animals.

C. General eligibility requirements for the SEP for international volunteers

An individual is eligible to enroll during the SEP if he or she meets the requirements discussed in HI 00805.350A, in this section, and one of the following requirements.

1. No previous SMI or premium-HI enrollment

If the individual did not enroll in the initial enrollment period (IEP), he or she had to meet the requirements in HI 00805.350A in this section, in the first month of eligibility for SMI or Premium-HI and all months thereafter.

The first month of eligibility for SMI and Premium-HI is the fourth month of the IEP, as explained in HI 00805.015.

2. Previous SMI or premium-HI entitlement

If the individual enrolled during the IEP and later terminated coverage, he or she had to meet the requirements in HI 00805.350A in this section the month of SMI or Premium-HI termination and all months thereafter.

If the individual previously enrolled during the general enrollment period (GEP), he or she must have enrolled in SMI or Premium-HI or meet the requirements in HI 00805.350A in this section, in the first month of eligibility.

D. Policy for the effective date of the SEP for international volunteers

The SEP for international volunteers was effective January 1, 2007. Premium-surcharge rollback only applies to months of international volunteer service as defined in HI 00805.350A (in this section) beginning January 1, 2007.

An individual who meets the requirements in HI 00805.350A and HI 00805.350C (in this section) effective July 1, 2006, or later is eligible to enroll in SMI and Premium-HI during the SEP. If the last month of volunteer service was July 2006, then January 2007 was the last month of the SEP. If the last month of volunteer service was August 2006, then February 2007 was the last month of the SEP, etc.

E. Policy for when enrollment for volunteers can occur

The SEP for volunteers is the 6-month period that begins the earlier of the first day of the month following the month for which the:

  • individual was no longer serving as a volunteer outside of the United States;

  • organization no longer has tax-exempt status; or

  • individual no longer has health insurance that provides coverage outside of the United States.

NOTE: Enrollment in SMI or premium-HI may not occur prior to the end of the IEP.

F. Policy for the effec