TN 2 (02-91)

HI 00901.025 Certification of Part A/Part B Coverage for West German Government

A. BACKGROUND

Because of a decision of a West German Federal court, German social security retirement benefits are supplemented for beneficiaries who are voluntarily enrolled in certain kinds of public or private health insurance programs. Thus, Medicare beneficiaries who are also receiving West German social security retirement benefits may request a certification from SSA as to their Part A/Part B entitlement on a German form.

B. PROCEDURE: FO

Do not complete the West German document.

1. Beneficiary on Microfiche

Prepare a letter patterned after the model letter in D.

  • Accept the beneficiary's statement that (s)he has neither withdrawn nor terminated his/her coverage. If there is any doubt, request an HI/MBR Status Query (HMQ) to confirm coverage. (See SM 00706.005.)

  • Use the information on the microfiche or the reply from the MBR to determine the monthly premium.

2. Claim Pending in FO

Inform the beneficiary that SSA cannot complete the document.

If the claim is being...Then...
forwarded to the Processing Center (PC) tell the beneficiary that the PC will send a statement of Part A/Part B entitlement when his/her claim has been adjudicated.
  

When forwarding the claim to the PC, include a Report of Contact (RC) explaining the situation and have the PC issue the appropriate letter.

3. Claim For- warded to PC — Beneficiary not on Microfiche

Ask the beneficiary for evidence of his/her entitlement. (Request HI/MBR Status Query if necessary. See SM 00706.005.)

Follow 1. and 2. above after entitlement has been confirmed.

C. PROCEDURE: PC

When a request for certification is received, take the following action.

If the request..Then...

is on the West German application form

advise the beneficiary that SSA is furnishing the letter of certification and, if (s)he has any further questions, to contact the FO.

  • Return the form to the beneficiary.

  • Send a letter patterned after the model in D. (substituting the title of Director, PC).

comes from the FO with an RC in file send a letter patterned after the model in D. (substituting the title of Director, PC).

D. PROCEDURE: MODEL LETTER

1. Beneficiary's First Request

(Enter the beneficiary's name and address.)

Dear

In reply to your request regarding your Medicare entitlement, our records indicate that you were born on (date), and you have been entitled to hospital insurance benefits since (date), and to supplementary medical benefits since (date). Benefits payable under this insurance are those authorized under Title XVIII of the Social Security Act.

The monthly premium payment for the supplementary medical insurance benefits was (amount) per month effective (date). (This was raised to (amount) per month effective (date)). [For beneficiaries first entitled after a change in premium rate, omit this sentence.]

[If the beneficiary is enrolled in Premium-Part A,add a paragraph stating the monthly premium.]

Payments are made under both the hospital insurance and supplementary medical insurance without regard to the financial status of the individual. These payments, except in certain limited instances, are made only for health care expenses incurred within the United States.

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