In simultaneous accretion/deletion cases when the reported deletion month does not
represent a current period, i.e., when the effective deletion month is 3 or more months
before the month in which CMS received the prescribed notice of accretion and deletion,
the enrollee is awarded a closed period of buy-in coverage and has buy-in coverage
only for the months reported by the State. The State is liable for premium payments
only for those months. If the enrollee had individual coverage and paid premiums for
any of the months in the closed period, premiums for those months are refunded to
The enrollee's current SMI coverage is not affected, i.e., if he has SMI coverage,
it will continue. Conversely, if the individual did not have SMI coverage prior to
the State's action, he is not awarded individual SMI coverage following the period
of buy-in coverage.
However, the records are annotated to reflect the prior buy-in coverage. Also, if
he enrolls for SMI at a later date, only months after the buy-in coverage period will
be counted in determining the statutory premium increase for late enrollments.
The individual will be sent a special buy-in letter from CMS Central Office notifying
him of the inclusive dates of limited buy-in coverage.