TN 22 (11-01)

HI 01001.045 Benefits Are Suspended

A. Procedure - When a Beneficiary will be Billed

When the beneficiary's benefit payments are suspended for a period of time, which will not permit collection of all premiums due from benefits for the current year, the beneficiary will be billed and expected to pay the premiums by direct remittance. For billing instructions if SMI entitlement is initially awarded after the year in which coverage begins.) When an individual goes from suspense status to deferred status (i.e., a definite date is set for resumption of benefits), premium billing continues until benefit payments actually begin. When benefit payments are resumed following a period of deferred status, any premiums owed are deducted from the first benefit(s) payable (e.g., where the enrollee has not remitted all premiums timely in response to direct billing).

Beneficiaries in suspense for an extended period are billed for 3 months' premiums at a time on a regular quarterly cycle beginning with the first, second, or third months of the calendar quarter, as explained below.

The billing notices are mailed in the month preceding the quarter. However, the enrollee may pay premiums for more than one quarter at a time. When a beneficiary pays his/her premiums in advance, the direct billing system will not send a bill until the premium liability exceeds $10.00.

If a beneficiary sends a payment that is less than what was billed, such payments will be accepted. If the payment received is less than the amount billed and the notice received was a delinquent notice, a termination will still occur if the remaining premium liability is more than $10.00.

When the beneficiary's payments are deferred, i.e., a definite date is set for resumption of benefits, premium billing will occur if the deferred date is not in the current year. If the deferred date is in the current year, any premiums owed will be deducted from the first benefit check(s) payable when the benefit payments are resumed.

B. Procedure - Beneficiaries in a Quarterly Billing Cycle

Uninsured beneficiaries and beneficiaries who are in suspense status are billed in three quarterly billing cycles for their SMI premiums. The cycles are divided equally to better manage the direct billing process. These quarterly billing cycles are identified as A, B, and C. The chart below indicates the months in which the billing notices are mailed for each cycle. Bills mailed in the months displayed will include premiums for the subsequent 3-month period:

Cycle

A

B

C

 

January

February

March

 

April

May

June

 

July

August

September

 

October

November

December

NOTE: Records are selected for billing on the 27th of the month preceding the month that the bill is being mailed.

Example: A bill mailed in July will include premiums for August, September and October. The next bill for this cycle will be mailed in October for the subsequent 3 months.

A monthly beneficiary entering into billable status upon suspension of benefit payment is placed in the first billing cycle feasible following the actual suspension of payments. He/she will remain in this billing cycle as long as he/she is in billable status. However, if the beneficiary finds that his/her billing cycle is financially inconvenient, and he/she makes a specific request, the cycle may be changed to monthly billing. (See HI 01001.075.) It is not necessary to routinely volunteer information about changing billing cycles since monthly billing is a more expensive process.

Example: Mr. Fothemiller, a monthly benefit beneficiary, has his benefit check suspended in 7/00 and owes premiums for months beginning in August. He is placed in billing cycle B and in August is billed for 4 months of premiums (August through November). After the initial bill, he will be routinely