TN 10 (11-00)

HI 00820.025 Termination of Disability HI (D-HI)

A. POLICY

Entitlement to D-HI terminates under the following circumstances:

1. Attainment of Age 65

D-HI ends with the month before the month in which the individual attains age 65. Immediately upon attainment of age 65 and without interruption, HI is effective under the regular insured provision.

2. Death

D-HI entitlement ends with the date of death.

3. Loss of DI Benefits - No Trial Work Period (TWP)

If an individual's disability benefit entitlement ends and the individual is not eligible for a TWP, D-HI entitlement ends with the:

  • Month in which title II benefit entitlement ends or, if later,

  • Month after the month in which the benefit termination notice is sent to the individual.

This “month after the month” rule is intended to prevent retroactive terminations of D-HI and applies to cases in which:

  • A retroactive disability benefit termination results in an individual having fewer than 25 months of disability benefit entitlement.

  • A revised disability onset date with a later onset date makes the person ineligible for D-HI until a future date. (In this case, the notice of revised onset is treated as a notice of disability benefit termination and D-HI terminates with the month following the month of the notice). D-HI continues without interruption if the individual is eligible for D-HI at the time the notice is sent.

The “month after the month” rule does not apply to cases in which the individual's continuation on the disability benefit rolls was the result of fraud or similar fault (e.g., the individual failed to inform SSA that he/she was working). In this case, D-HI may be terminated retroactively.

4. SGA Termination Following TWP

Where title II disability benefits end because of substantial gainful activity (SGA) following a TWP, D-HI ends as follows:

  • If disability cessation (the first month of SGA following the end of the TWP) occurs prior to the 14th month of the extended period of eligibility (EPE) and the individual engaged in SGA in the 16th month of the EPE, D-HI ends with the last day of the 57th month* following the end of the 36 month disability re-entitlement period or, if later,  the end of the month following the disability benefit termination notice. *Prior to 10/00, replace “57th month” with “3rd month”.

  • If disability cessation occurs prior to the 14th month of the EPE, but the individual does not engage in SGA in the 16th month of the EPE, D-HI ends with the last day of the 77th month* following the first month of SGA which occurs thereafter or, if later, with the end of the month following the disability benefit termination notice. *Prior to 10/00, replace “77th month” with “24th month”.

  • If disability cessation occurs after the 13th month of the EPE, D-HI ends with the last day of the 80th month* following the disability cessation month or, if later, with the end of the month following the disability benefit termination notice. *Prior to 10/00, replace “80th month” with “27th month”.

Prior to 1/88, an individual was eligible only for a 15-month re-entitlement period. In such cases, D-HI ended with the last day of the 23rd month following the disability benefit cessation (DBC).

Beginning 7/1/90, individuals whose D-HI ends solely because of SGA are eligible to enroll in premium-HI for the Working Disabled.

5. Non-SGA Terminating Event After TWP

If medical improvement or some other non-SGA terminating event occurs prior to the dates in HI 00820.025A.4., D-HI ends as provided for in HI 00820.025A.3. If the individual's title II benefits have already terminated because of SGA, D-HI ends with the last day of the month following the month he/she is notified of the occurrence of the terminating event.

6. D-HI Reinstatement Pending Appeal

If an individual's D-HI is continued pending appeal of a medical cessation and the cessation is upheld on appeal, D-HI terminates with the end of the month following the month the notice affirming the medical cessation is sent. This includes cases in which title II entitlement is terminated retroactively to a month prior to the person's 25th month of entitlement and those in which the disability onset date is changed to a later date (provided fraud or similar fault is not involved).

B. EXAMPLES

Example 1: Medical Improvement

A determination is made that the disability insurance benefit (DIB) entitlement of Mr. Kant, a D-HI beneficiary, must be terminated effective 4/30/00 because his impairment is no longer disabling. If notice of termination is sent in 2/00 or 3/00, D-HI terminates at the same time as his DIB. If notice of DIB termination is first sent