Under current law, unless CHAMPUS beneficiaries are:
dependents of service personnel on active duty, or
entitled to Medicare based on disability (but not ESRD) and enrolled in SMI,
eligibility for HI under Medicare terminates their CHAMPUS rights.
Any individual entitled to HI (other than Premium-HI) who writes to SSA or CMS that
he/she does not want SMI because of CHAMPUS coverage, should be contacted before the
SMI refusal or termination is processed. He/she should be advised that, according
to information from DoD, upon becoming eligible for HI at age 65 or over he/she may
lose CHAMPUS rights. If eligible for HI prior to age 65 due to disability (but not
ESRD), CHAMPUS continues only if SMI is elected.
The reply should also inform the individual that, since he/she does not wish to be
left without health care protection, we are taking no further action on the request
unless he/she notifies us in writing within 60 days of the date of our letter that
he/she still does not want SMI.
In the event that the explanation is given personally or by phone and the individual
confirms his/her desire to refuse or terminate SMI, the file will be documented and
the refusal (or termination) will be processed.