TN 9 (06-92)

HI 00820.035 Termination of SMI Entitlement

A. POLICY - GENERAL

Once an eligible individual has enrolled in SMI, coverage continues until it is terminated by one of the events listed in B. below. When two or more terminating events occur, requiring different termination dates, SMI ends with the earliest date.

NOTE: Termination of HI for an individual age 65 or over is not a SMI terminating event.

B. POLICY - TERMINATING EVENTS

1. Death

SMI coverage, unlike monthly benefit entitlement, continues into the month of death, up to and including the date of death. This permits payment for covered medical expenses incurred during the last illness.

2. Termination of HI (Under Age 65)

For all HI enrollees under age 65, SMI ends when HI entitlement ends.

EXCEPTION: In cases where the R-HI termination is untimely, R-SMI ends the month after the month the R-HI termination action is taken. Process in accordance with SM 00850.610C.2.

3. Premiums Not Paid

The effective date of termination for nonpayment of premiums is the last day of the grace period for payment of overdue premiums, as explained in HI 01001.095, and HI 01001.290.

EXCEPTION: If a disability beneficiary's SMI coverage is terminated for nonpayment of premiums while a CDI is pending, but DI benefits are later resumed, the SMI termination is reversed. All overdue premiums are deducted from the first monthly benefit check.

4. Voluntary Termination, No State Buy-In

Termination requests filed on or after 7/1/87, will terminate SMI with the end of the calendar month following the calendar month in which the termination request is filed.

NOTE: Prior to 7/1/87, termination occurred at the end of the calendar quarter after the calendar quarter in which the request for termination was filed.

5. Voluntary Termination, State Buy-In

A person on State buy-in cannot terminate SMI until after buy-in ends. (When State buy-in ends, the individual is deemed to have enrolled in SMI during the initial enrollment period (IEP) for SMI.)

Effective 4/1/81, any individual who files a request for SMI termination during the last month of buy-in coverage or during the 6 succeeding months, has SMI terminated at the end of the month in which the request is filed. A termination request filed after this period is handled under 4. above.

C. REFERENCES


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600820035
HI 00820.035 - Termination of SMI Entitlement - 10/13/2015
Batch run: 10/13/2015
Rev:10/13/2015