TN 10 (11-00)
HI 00820.025 Termination of Disability HI (D-HI)
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.
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).
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 in 11/00, Mr. Kant's D-HI ends 12/31/00.
Example 2: Revised Onset Date
Mr. Johnson was awarded DIB beginning 6/97 based on a disability onset date of 12/12/96. He was awarded D-HI effective 6/99, his 25th month of DIB entitlement. In 12/99, however, he is notified that his disability onset date has been revised to 12/9/98. Mr. Johnson's D-HI ends 1/31/00, the end of the month following the month he was notified of the correct onset date. He will be re-entitled to D- HI effective 6/01, his 25th month of DIB entitlement based on the 12/98 onset date.
Example 3: SGA Termination After TWP
Mr. Smith has been entitled to D-HI since 5/97. Although he continues to be severely impaired, he completed a TWP in a sheltered workshop on 9/30/98. If he continues working at SGA levels, his DIB entitlement will end on 10/1/01. His D-HI entitlement, however, will continue through 6/30/06. He will then be eligible to enroll in Premium-HI for the Working Disabled. On the other hand, if his impairment ends prior to 10/1/01, D-HI ends with the end of the month following the month the DIB termination notice is mailed to him and he will not be eligible to enroll in Premium-HI for the Working Disabled.
Example 4: D-HI Reinstated During Appeal
Mr. Klein met the 24-month D-HI qualifying period requirement in 9/90. In
5/99, it is determined that he is no longer disabled and he is notified that he is no longer entitled to DIB or Medicare. The D-HI termination is effective 6/30/99, the end of the month following the month the title II benefit termination notice is mailed to him. Within 10 days of receiving the notice, Mr. Klein files an appeal and requests reinstatement of his benefits. His DIB and Medicare continue pending resolution of the appeal. In 12/99, Mr. Klein is informed that the initial cessation was proper. Although DIB is terminated retroactively, Medicare continues through 1/31/00, the end of the month following the month the hearing notice was mailed to him.
Title II EPE provisions, DI 13010.210 ff.
Age 115 Termination, SM 03020.380