HI 00830.030 Incorrect SMI Termination

When an SMI termination is discovered to be in error, the termination must be reversed and billing or deduction of premiums initiated. If less than 6 months retroactive premiums are owed, the claimant will be notified of this reversal and told the amount of premiums for the retroactive period that he or she will now be billed for or have deducted from his or her benefit payment.

If 6 months or more premiums are due:

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  Record the SMI start date as equal to the COM.

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  Record an Equitable Relief code of G (Granted). See SM 00510.300.

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  Inform the claimant of his right to have SMI reinstated beginning with the month of erroneous termination if he agrees to pay the retroactive premiums from the month of termination through the month before the month of reinstatement.

Also inform the claimant of his right to request waiver or make other arrangements for the payment of the retroactive premiums. Use a paragraph similar to the following:

We stopped your Medical insurance coverage under Medicare in _____ by mistake. We are sorry if our error caused you any inconvenience. We have corrected the mistake, and are starting your coverage again beginning ____.

It might be to your advantage to start your medical coverage at an earlier date. We can start the coverage beginning ____. However, you would have to pay the premiums for this insurance. The total amount of premiums from ____ through_____ is ______.

If you want coverage to start at the earlier date, please let us know within 60 days. You will need to tell us whether you want to pay us directly for the premiums or have us take the money for the premiums out of your checks.

If you would like to have coverage beginning _____, but it would be a hardship for you to pay the premiums at one time, please let us know.