The majority of T3 actions will be processed through the SALT program by the district offices. If current SMI entitlement exists, the program will place the recorded in LAFU status to initiate SMI premium billing, establish an HOC of “X” to indicate that HI is terminated because monthly benefits are terminated and generate a date of termination of HI (DOTH) equal to the date of suspension or termination (DOST). If current SMI entitlement does not exist, the HOC of “X” and DOTH equal to DOST will be established, but the LAF will remain in T3 status.

EXCEPTION:

If HI entitlement was originally based on the renal disease provisions (i.e., the HENC on the MBR is “K”), the system will change the LAF to U. However, as HI based on renal disease does not terminate when benefits terminate, the HOC of “X” and DOTH equal to DOST will not be established by the program. If it is later determined that HI entitlement under the renal disease provisions no longer exists (e.g., dialysis treatment ceases), a MADCAP conditional adjustment will be necessary to code the HOC/SOC of “S” and appropriate DOTH/DOTS.

All T3 actions processed through SALT will be alerted to the program service centers for additional action. The Form SSA-3926-C2 SALT output will contain two alert codes:

1. 1. 

   code 432, manual letter necessary, and

2. 2. 

   code 433, award determination necessary.

Instruct the typist to prepare a termination notice, Form SSA-L6901, rather than the usual SSA-L-597 letter. Taking into consideration the conditions involved in the case (i.e., whether SMI entitlement exists, if there is ongoing third party, if a verified BOAN has been established, etc.), instruct the typist to include the various paragraphs as shown in section C. below.

NOTE: The paragraphs indicated in C. below should be typed before any additional paragraphs; e.g., overpayment information.

If there is no evidence in the claims folder that an M or T claim was previously established, attach a Form SSA-567 to route the case to a Claims Authorizer for an award determination after the beneficiary notice has been released.

When current SMI entitlement exists, the LAP of U established on the terminated record may remain indefinitely. However, circumstances may dictate that additional activity will occur or that subsequent processing may be required. For example, if SMI becomes terminated for nonpayment of premiums, the system will change the LAF to X7.

There will also be instances when the terminated individual may have been previously entitled as a T or M on another SSN before becoming an auxiliary beneficiary. Or it is possible that a new award (usually a T or M) may be received simultaneously with the SALT termination output. In these cases, if SMI entitlement exists, it must be transferred immediately to the prior or new T or M claim (i.e., do not allow the terminated record to remain in LAF U status). Two separate manual actions through MADCAP are required:

1. 1. 

   change the LAF U on the terminated record to X5 by summarizing a TOCA and RFCA of “X” and “5” respectively and entering the cross-reference number and BIC in RID 5, and

2. 2. 

   reinstate or establish the prior or new claim through MADCAP. The two separate manual actions are required even when a new T or M claim is being processed at a later date.

To reinstate a prior T or M claim from X5 status, use the “Resum” facility with a zero rate. If a T claim is being reinstated, also enter the original DOEH and HOC of “E” in RID 6. Prepare an SSA-573 showing an SSA-31-C1 as the letter. For a T beneficiary, include the following paragraphs in the order shown; H09; if renal disease beneficiary include H22; H21; State buy-in or third party involved, H99; or if beneficiary will be billed, H60; and H23. For an M beneficiary include the following paragraphs in the order shown: H98; H21; if State buy-in or third party involved, H99; or if beneficiary will be billed, H60; MH07; and H23. All appropriate fill-ins must be given. Only the first paragraph of H21 will be used showing the current SMI premium rate and effective date. If the M or T has a foreign address include MH04 as the next to last paragraph.

Do not resume a prior M claim if current SMI entitlement does not exist on the terminated record. If a new M claim is received, it may be assumed that the individual wishes to be enrolled for SMI.

If a new T or M claim is being established, summarize a zero rate and full HI/SMI coding.

The TATTER program processes T8 terminations for aged auxiliary beneficiaries whose monthly benefits terminate due to the cessation of the wage earner's disability in the same manner as the SALT program processes T3 terminations. As with SALT, the SSA-3926-2C TATTER output will also contain one of two legends:

1. 1. 

   MANUAL LETTER NECESSARY, or

2. 2. 

   AWARD DETERMINATION NECESSARY.

Follow the instructions in A. above regarding the beneficiary notification and subsequent handling.

When terminating the benefits of an aged auxiliary who has health insurance entitlement, it must be determined what action will be taken to either maintain or terminate that entitlement. Unless the auxiliary has voluntarily withdrawn from Part B coverage (SOC-W) or has been terminated for nonpayment of premiums (SOC-T), the Part B coverage will continue after the date of termination to benefits. The benefit authorizer must determine on what claim number the Part B should continue. It must also be determined whether Part A coverage will continue or terminate. If there is no new or prior T claim, Part A coverage will terminate (unless there was dual-entitlement on another number). The Part A termination is recorded by entering a HOC of X. MADCAP will generate a DOTH equal to the DOST. If there is no known cross-reference number and BIC e.g., no new prior T or M claim, do not enter any number in the cross-reference fields in RID 5. As long as Part B coverage continues, and no cross-reference number and BIC is entered in the RID 5, MADCAP will place the auxiliary in LAF U so that Part B will continue. After the termination action is taken, route the case to a claims authorizer so that development for an uninsured claim can be taken. MADCAP will generate an 845 alert to emphasize the need for the claim development.

The MADCAP program will produce a code 845 alert which indicates that an award determination is necessary.

Upon completion of the MADCAP action, give the case to a Claims Authorizer to request the individual's earnings record and/or district office development and/or award processing.

When the termination action has placed the record in LAF U status and it is later determined that the HI and/or SMI entitlement must be transferred to another record, two separate manual actions through MADCAP are required:

1. 1. 

   change the LAF U on the terminated record to X5 by summarizing a zero rate with a TOCA and RFCA of “X” and “5” respectively and coding the cross-reference number and BIC in RID 5, and

2. 2. 

   reinstate the prior or establish the new claim through MADCAP.

To reinstate a prior T or M claim from X5 status, use the “Resum” facility with a zero rate. If a T claim is being reinstated, also enter the original DOEH and HOC of “E” in RID 6.