HI 01001.155 “P” Option is Not Currently on the MBR

There will be instances when the HOC/SOC of “P” was not recorded on the MBR even though RRB has jurisdiction.

A. Insured Claims

The beneficiary may have had previous entitlement to social security benefits with RRB jurisdiction of HI/SMI, but the HOC/SOC of “P” was never recorded and an amended award is being processed. Also, the action may be an initial award for SSA where RRB has had jurisdiction; or an adjustment action to transfer jurisdiction is being taken, but the “P” option was never recorded on the MBR.

For beneficiaries in current payment status, there are certain procedures to be followed which will depend on the information recorded on the MBR. When the above types of cases are processed through MADCAP, all premiums due will be deducted by MADCAP, usually from the date of entitlement to SMI through COM + 1. Therefore, it will be necessary to offset the amount MADCAP deducts by the amount that has already been paid. This adjustment can be accomplished by entering an “AA” amount equal to the amount of premiums already paid. An SSA-666 must be prepared to adjust the trust funds by charging the “AA” amount from the FSMI collection account and depositing to the FOASI trust fund.

Example:

A Form RR-80 is received for a D beneficiary. Item 14 reflects that the RRB collected premiums through 5/76. Item 11 shows the first date of entitlement to SMI is 6/74. The MBR shows a refusal of SMI. The COM is 10/76. By examining the folder, it is determined that D refused SMI based on RRB involvement. Therefore, when the HI/SMI coding is entered on the SSA-2795U2, MADCAP will deduct all premiums due from 6/74 through COM +1 (11/76) To offset this deduction, enter an “AA” amount equal to premiums paid for 6/ 74 through 5/76 ($160.40) and prepare an SSA-666.

B. Uninsured Claims

Process uninsured claims through the MISCOR CIP R facility to establish the appropriate HI/SMI data. If the current MBR SOC is “T,” “W,” or “Y,” determine if any premiums were collected from the individual for the same period in which RRB was collecting. This may be determined by examining the premium history of the BCM printout. The individual must be given credit for all premiums collected by RRB as well as the excess premiums, if any. If the current MBR SOC is “R,” the individual has not paid any excess premiums.


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http://policy.ssa.gov/poms.nsf/lnx/0601001155
HI 01001.155 - "P" Option is Not Currently on the MBR - 03/15/1999
Batch run: 01/27/2009
Rev:03/15/1999