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.

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  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.

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

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

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    Create a Paperless barcode coversheet and assign the new document the type of:

    HI/SMI INTVOL-Int’l Volunteer SEP Enrollment

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  Fax the materials directly into Paperless.

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  The PC identifies the FO request to reinstate Medicare Part B SEP for International Volunteers coverage via Paperless by the TOELs:

  • –

    HISMI,/ INTVOL

Note:Only use HI/SMI INTVOL-Int'l Volunteer SEP Enrollment for International Volunteers Special enrollment requests.

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  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.

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

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  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.

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  Forward the SSA-A101 and the evidence discussed in HI 00805.355 to the PSC for processing according to the procedure in HI 00805.360B.2.

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  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.

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

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  Forward the enrollment request and the evidence discussed in HI 00805.355 to the PSC according to the procedure in HI 00805.360B.2.

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

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

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

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.”

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  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.”

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