HI 01001.160 “P” Option is Currently Present on the MBR

The proper handling of cases in which it is necessary to change an existing “P” option to a “Y” depends on whether the individual is insured or uninsured.

A. Insured and Special Age 72 Claims

When SSA is assuming HI/SMI jurisdiction via the MADCAP program, and an SOC of “P” is on the MBR, MADCAP will deduct 1 month's premium from the next CMA check. The Health Insurance and Inquiries Examiner must enter an “SU” amount equal to the month following the month indicated in item 14 of the RR-80 through the current operating month. A form SSA-666 must also be prepared to transfer the “SU” amount from the FOASI trust fund to the FSMI collection account. It is also necessary to prepare an SSA-1592 with a RIC 3 equal to the premiums paid from the DOES through COM. This is required because the SOBER system will develop a CPDA for that period. When the action to transfer the jurisdiction is passed to the SOBER system, a SOBER alert is produced in the heading “RRB CONVERSION ALERT”.

If a MADCAP action is taken in the next COM and no action has been taken to record the premiums paid, a “make-whole” SOBER alert is produced. This alert can be cleared, assuming the correct amount of premiums has been deducted, by preparing a form SSA-1592 with a RIC 3. If the CPDA is not correct, adjust the CPDA by means of an SSA-1592.

Example:

A Form RR-80 is received for a D beneficiary. Item 14 reflects that RRB collected premiums through 5/76. Item 11 shows the first date of entitlement to SMI is 6/74. The MBR shows an SOC of “P.” The COM is 10/76. When the HI/SMI coding is entered on the SSA-2795U2, MADCAP will deduct 1 month's premium (for 11/76). As premiums are due for 6/76 through 10/76, the Health Insurance and Inquiries Examiner must enter an “SU” amount of $35.50. A form SSA-666 must be prepared to transfer $35.50 from the FOASI trust fund to the FSMI collection account. Also, a Form SSA-1592 with a RIC 3 must be prepared for premiums paid for 6/74 through 10/76 ($203.10).

In some instances, the Claims Authorizer will indicate the necessity of preparing an award or amended award for a previously terminated beneficiary on SSA rolls. It is important to remember that the HIC code of “F” must be coded on the SSA-2795U2 whenever an option code of “P” is being changed to any other SOC.

Regardless of whether the processing of the form RR-80 requires a transfer of jurisdiction or an award with a previous SOC of “P” on the MBR, a special BCM alert “RRB CONVERSION ALERT” will be generated. The CPDA of record must be cleared by preparing a Form SSA-1592 with a RIC 3.

B. Uninsured Claims

The jurisdictional change for uninsured individuals must be accomplished through the MISCOR CIP R program. In addition prepare a Form SSA-1592 with a RIC 3 to credit the individual with premiums collected by RRB.

C. Requests From BSS to Remove a “P” Option

There will be rare instances when a request to remove a “P” option will be received from BDP. This will occur because RRB has screened the MBR and established the “P” option and later discovers that the individual is not eligible (e.g., does not have enough service months under RRB). In these instances, BSS will furnish all necessary information to the Claims Authorizer in the program service center who will determine the individual's election and forward the case to the Exceptions and Health Insurance Specialist for handling as indicated above.


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HI 01001.160 - "P" Option is Currently Present on the MBR - 09/25/2012
Batch run: 09/25/2012
Rev:09/25/2012