TN 24 (03-07)

HI 00805.360 Processing SEP Enrollments for International Volunteers

A. Procedure – General

All SMI and Premium-HI enrollment requests will be processed by the PSC via MACADE. The SEP enrollment package will contain the SMI/Premium-HI enrollment request and evidence of volunteer service, tax-exempt status of the sponsoring organization, and health insurance coverage outside the U.S.

B. Procedure – FO

1. Individual is a QRRB

RRB annuitants who inquire about SMI and/or Premium-HI enrollment should be referred to the appropriate RRB office. The RRB will process the enrollment.

2. Individual Entitled to HI

  • If the individual already has HI, use form CMS-40B (Application for Enrollment in Medicare) for SMI enrollment. A signed and dated statement such as “I want to enroll in Medicare Part B”, is also acceptable.

  • Annotate “SEP for INT’L VOLUNTEERS” at the top of the enrollment request.

  • Forward the enrollment request and the evidence discussed in HI 00805.355 to the PSC and prepare an MDW.

3. Individual Filing for Monthly Benefits and/or HI

  • If the individual files for monthly benefits and/or HI and SMI after the end of the IEP, process the monthly benefit and/or HI claim via the Modernized Claims System (MCS). SMI is processed as a refusal.

  • Follow the procedure in HI 00805.360.B.2. for the SMI enrollment request.

4. Individual Filing Initial Claim for SMI and/or Premium-HI

  • If the individual is filing an initial claim for SMI or SMI and Premium-HI simultaneously, prepare a SSA-A101 (Determination of Award) in accordance with existing procedures.

  • Forward the SSA-A101 and the evidence discussed in HI 00805.355 to the PSC for processing.

5. Individual filing for Premium-HI (Previously Enrolled)

  • If the individual is filing for Premium-HI, use form CMS-18F5 (Application for Hospital Insurance). A signed and dated statement such as “I want to enroll in Medicare Part A,” is also acceptable.

  • Annotate “SEP for INT’L VOLUNTEERS” at the top of the enrollment request.

  • Forward the enrollment request and the evidence discussed in HI 00805.355 to the PSC.

C. Procedure - PSC

SEP enrollments received in the PSCs should be input via MACADE. (Refer to SM 00850.550).

D. Procedure - 800 Number Agents

1. Individual Currently Entitled to HI (Insured)

  • Annotate “SEP for INT’L” Volunteers at the top of form CMS-40B.

  • Complete the SSA-795s with the information described in HI 00805.355D. or the SSA-795 that is available on eForms.

  • Send the caller the CMS-40B, the SSA 795s and a courtesy return envelope addressed to the PSC.

2. Individual Not Entitled to HI (Insured)

If the individual is filing for HI and SMI or an initial claim for SMI only, make a claims referral in accordance with TC 10010.000. Show claim type as “RIB” and in the remarks portion show “SEP for INT’L Volunteers.”

3. Individual Not Entitled to Premium-HI (Not Insured)

  • If the individual is filing for Premium-HI and SMI, or Premium-HI only, make a claims referral in accordance with TC 10010.000. Show claim type as “HI/SMI” and in the remarks portion show “SEP for INT’L Volunteers.”

  • If the individual was previously enrolled in SMI and is filing for SMI only, follow the instructions in HI 00805.360D.1.

E. Reference

See SM 00850.550 for MACADE processing instructions.


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